Ischemic necrosis of the femoral head. Treatment by core decompression.

Since 1977, we have performed twenty-one core decompressions in seventeen patients who had stage-I or II ischemic necrosis of the femoral head. The diagnosis was confirmed histologically in all but one patient. After a mean length of follow-up of thirty-nine months, healing was evident in eight hips (40 per cent) but not in the other twelve. All twelve hips required additional surgical treatment; the average length of time before the additional treatment was required was 9.2 months. The results of two intraoperative diagnostic tests (intramedullary pressure and saline stress tests) did not correlate with the results of biopsy. A perioperative fracture through the site of the decompression occurred in one of the twenty-one hips. Given the relatively poor long-term results and the considerable morbidity that was associated with core decompression, this treatment cannot be recommended.