Core decompression and non-vascularized iliac crest graft in avascular necrosis of hip

  • Khare A This study is conducted in Global hospital, Ujjain
Keywords: Core decompression, iliac crest graft, avascular necrosis of hip


Background: Avascular necrosis of femoral head occurs due to impaired blood supply of the head of femur. Core decompression with non-vascularized iliac crest graft has been the treatment of choice in cases of early AVN.

Material and Method: This prospective, interventional study was conducted in Global hospital, Ujjain from jan-2022 to march -2023. We studied 20 hips having AVN of the femoral head treated by core decompression and autologous cancellous bone grafting with a graft taken from the iliac crest. Total number of 20 patients with AVN of the femoral head (up to grade 2b of Ficat and Arlet classification) were treated by use of non-vascularized bone graft.

Results: The mean HHS was 69.45 preoperatively and 83.55 at six months postoperatively (p ≤ 0.0003). Out of 20 hips, 14 had excellent (HHS >90) to good (HHS 80-90) outcomes, while six had fair (HHS 70- 80) to poor (HHS >70) outcomes. The mean VAS score was 6.3 preoperatively and 3.8 at six months postoperatively (p ≤ 0.0001). On radiographic and clinical evaluation, the patients showed significant improvement on the six-month follow-up.

Conclusion: Our study suggests that core decompression with autologous cancellous bone grafting might not reverse AVN progression, but can delay the progression of AVN, avoid collapse, reduce pain, and provide improvement in functional outcomes at least in the short term.



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1. Mont MA, Jones LC, Hungerford DS: Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am. 2006; 88:1107-29.
2. Sharma D, Maulik Jhaveri D, Urang Patel D, Jha A, Shah P, Golwala P: Pain relief with core decompression and autologous bone graft in osteonecrosis of femoral head in grade 2. Int J Orthop Sci. 2019, 5:369-72. 10.22271/ortho.2019.v5.i4g.1699 06, 88:1117-
3. Hua KC, Yang XG, Feng JT, Wang F, Yang L, Zhang H, Hu YC: The efficacy and safety of core decompression for the treatment of femoral head necrosis: A systematic review and meta analysis, journal ortho surg research, Sept 2019 14.1.306
4. Lavernia CJ, Sierra RJ: Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty. 2000, 15:171-8. 10.1016/s0883-5403(00)90132-3
5. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA: Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of onehundred and three hips. J Bone Joint Surg Am. 1995, 77:681-94.10.2106/00004623-199505000-00004
6. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995; 77:459.
7. Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg. 1999;7(4):250-61.
8. Steinberg ME. Diagnostic imaging and role of stage and lesion size in determining outcome in osteonecrosis of the femoral head. Tech Orthop. 2001;16:6-15.
9. Harkess JW.Arthroplasty of hip.,Campbells Operative Orthpeadics, Edited by Crenshaw AH, 8th edition, Vol. 1: CV Mosby Company, St. Louis, Washington DC, Torto, 1982.
10. Eftekhar NS. Total hip replacement using principles of lowfriction arthroplasty: The hip surgery of the musculoskeletal system, Edited by CM Evarts, Vol.3: Churchill Livingston, 1983.
11. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, Hartman KE: Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2001, 71-8. 10.1097/00003086- 200105000-00009
12. Steinberg ME: Core decompression of the femoral head for avascular necrosis: indications and results. Can J Surg. 1995, 38 Suppl 1:S18-24.
13. Babhulkar S: Osteonecrosis of femoral head: treatment by core decompression and vascular pedicle grafting. Indian J Orthop. 2009, 43:27- 35. 10.4103/0019-5413.45320
14. Yoo MC, Kim KI, Hahn CS, Parvizi J: Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res. 2008, 466:1133-40. 10.1007/s11999-008-0204- 9
15. Sen RK: Management of avascular necrosis of femoral head at pre- collapse stage. Indian J Orthop. 2009, 43:6-16. 10.4103/0019-5413.45318
16. Sanap A, Rabari YB, Teja V, Shah S: Management of avascular necrosis of famoral head by core decompression, International journal of research in orthopaedics, vol.4, no. 3, May- June 2018
How to Cite
Khare A. Core decompression and non-vascularized iliac crest graft in avascular necrosis of hip . ojmpc [Internet]. 2024Jan.31 [cited 2024Jul.18];29(02):50-5. Available from:
Original Article