Surgical Technique: Bone Graft for Avascular Necrosis of the Hip

Fig. 1

A guide wire is passed through the lateral femoral cortex into the necrotic area of the femoral head. The starting point should not be distal to the lesser trochanter as this may increase the risk of subtrochanteric fracture

Fig. 2

A cannulated drill is introduced over the guide wire into the subchondral bone. This is repeated in several directions to fully decompress the necrotic lesion

Fig. 3

Anteroposterior intraoperative view of the hip after the core has been filled with autologous bone graft followed by calcium phosphate bone void filler (Norian)

The rehabilitation protocol includes non-weight bearing with crutches for the first 6 weeks to minimize the risk of femoral neck fracture. The patient will begin supervised physical therapy immediately postoperatively to maintain hip range of motion. At 6 weeks after surgery, the patient is allowed to progressively weight bear until full weight bearing is achieved.

Summary

AVN often afflicts a younger demographic, making the prospect of undergoing THA at this age a difficult decision. Hip prostheses in this demographic often undergo greater wear than in older patients, which is important as the average survivorship of a total hip implant is inversely proportional to activity level [30], setting the patient up for several revision surgeries over his lifespan. Moreover, in a more athletic demographic, hip resurfacing and THA often signify the end of a competitive athletic career; therefore these procedures are typically deferred to as latter options [31]. In appropriately selected patients, core decompression with bone graft is a viable and reliable option to delay the need for arthroplasty.

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