Arthroscopic Core Decompression With Allogeneic Bone Grafting for Femoral Head Osteonecrosis and Femoral Head-Neck Junction Cysts

Abstract

Osteonecrosis of the femoral head is a debilitating condition that can lead to cysts at the head-neck junction. Without timely intervention, the disease often progresses to femoral head collapse, ultimately necessitating hip replacement surgery. This article describes a hip preservation treatment method that involves core decompression by drilling small holes in the femoral neck and hernia sac, followed by filling femoral pits with allogeneic bone. The advantage of this technique lies in its ability to reduce intracapsular pressure, enhance blood circulation, and stabilize the femoral head, thus preventing collapse. Additionally, the blood released during core decompression nourishes the transplanted bone, further supporting its integration and effectiveness.

Fig 1

Preoperative sagittal magnetic resonance imaging of the right hip joint shows an irregular “map sign” within the femoral head, indicative of heterogeneous signal intensity. A high-signal area measuring approximately 3 × 3 cm is visible at the anterolateral head-neck junction (red arrow).

Fig 2

The patient is positioned supine on a traction bed. Anterolateral and anterolateral auxiliary approaches are established at approximately 1 cm above the anterior trochanter of the femur and at the intersection of the tangent line at the tip of the greater trochanter and the extension line below the anterior superior iliac spine, with the lateral auxiliary approach used for visual inspection of the hip joint. On opening the joint capsule, the diseased synovium is debrided with a shaver, revealing a cyst containing necrotic bone tissue. (A) A plasma electric knife is used to stop bleeding, and the femoral neck is shaped with a burr. (B) Core decompression (CD) is performed at the head-neck junction using a 2.0-mm Kirschner wire, with evenly spaced holes drilled, leading to fresh blood oozing. (C) Fresh blood is observed oozing from the sites.

Fig 3

Arthroscopic view from anterolateral auxiliary approach, with procedures performed through anterolateral approach and patient positioned supine on traction bed. (A) A femoral head-neck junction cyst approximately 3 × 3 cm in size is observed. Necrotic tissue within the cyst is debrided. (B) Evenly spaced drilling is performed using a 2.0-mm Kirschner wire, resulting in fresh blood oozing from the sites. (C) Two packets of allograft bone strips (1 cm × 2 cm) are implanted into the cavity. (D) After filling the cyst, the surface is smoothed. The blue circle indicates the extent of the femoral head-neck junction cyst.

Fig 4

A sagittal computed tomography scan after right hip joint surgery shows the bone graft filling the femoral head-neck junction cyst (red arrow) and the core decompression holes in the femoral neck (blue arrow).