Core decompression is based on the belief that the procedure relieves intraosseous pressure caused by venous congestion, allowing improved vascularity and possible slowing the progression of the disease. While initial promising results of core decompression have not been matched by more recent investigations, it has been noted that the results of core decompression are better than the results of nonoperative treatment. Current literature supports the use of core decompression for the treatment of Ficat stages I and IIA small central lesions in young, nonobese patients who are not taking steroids; its results are much less predictable in Ficat stages IIB and III.
A percutaneous technique has been described for core decompression using multiple small drillings with a 3.2-mm Steinmann pin. The technique is reported to have a lower rate of femoral head collapse than traditional core decompression, with low morbidity and few or no surgical complications.
With the patient supine on a hip fracture table, mark the position of the femoral head and prepare and drape the hip in standard fashion.
Insert a 3.2-mm Steinmann pin laterally and percutaneously under fluoroscopic guidance ( Figure 9-1 ).