[Modified advanced core decompression (mACD)].

OBJECTIVE

The modified advanced core decompression (mACD) combines the advantages of a low invasive core decompression with maximal removal of osteonecrotic bone and a biologic reconstruction of the resulting bone defect.

INDICATIONS

Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stage II).

CONTRAINDICATIONS

Subchondral fractures (ARCO stage III); advanced osteoarthritis (e.g., ACRO stage IV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions.

SURGICAL TECHNIQUE

Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a 3.2 mm guide wire. Removal of a bone cylinder from a nonaffected area of the femoral neck using a hollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by a curette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute.

POSTOPERATIVE MANAGEMENT

Bed rest for 24 h, then partial weight bearing (20 kg) on crutches for 2-6 weeks depending on the bone quality in the defect zone and the applied bone substitute.

RESULTS

Midterm superiority (2 years) in hip survival of the mACD over advanced core depression and core depression, especially in ARCO stage II.