Table 103-8.

Surgical Treatment of Osteonecrosis

Surgical Procedure	Rationale	Stages of Osteonecrosis	Outcome	Comments
Core decompression	Reduction of intraosseous and intramedullary pressure	Early stages	37% radiographic success, 48% clinical success	Success rate depends on disease stage
Structural bone grafting	Provide support to overlying subchondral bone	1 or 2	Poor in advanced disease	100% failure rate in stages 3 and 4
Vascularized fibula grafting	Increase blood flow to graft	2 to 4	96% success in stage 2, 90% in stage 3, and 57% in stage 4
Osteotomy	Shifting position of osteonecrotic segment out of weight-bearing region	2 and 3	Not available
Resurfacing arthroplasty	Preservation of bone and joint mechanics with metallic or ceramic shell over femoral head	Later stages	Mean 7-year success rate is 90%	An alternative to total hip arthroscopy in later stages of disease
Hemiarthroplasty	Replacement of femoral head, preservation of anatomic acetabulum	Later stages	Failure rate for unilateral hemiarthroplasties is 50%-60% at 3 years, for bilateral hemarthroplasties is 44%	Various techniques available, some with better outcome
Total hip replacement	Complete replacement of the hip joint	Late stages	17.4% required revision after 10 years	Eventually most patients will require multiple hip replacements