Hip Avascular Necrosis (AVN): Treating a Femoral Head (Ball) Bone Lesion Using a Bone Marrow Graft

Hip Avascular Necrosis (AVN): Treating a Femoral Head (Ball) Bone Lesion Using a Bone Marrow Graft

This cadaveric demonstration shows a core decompression procedure performed on a right hip. Core decompression is a minimally invasive way to remove dead, referred to as necrotic, bone from the ball of the hip joints. For patients that have early-stage AVN, let's get oriented. Here we see a right hip. The head of the bed is to the left of the screen, and the foot of the bed is to the right.

The surgeon has a small camera called an arthroscope and a small incision called a portal. In another portal they are holding a drill guide. The surgeon uses the arthroscope along with an X-ray to visualize the hip joint and see where the tip of the drill guide needs to be to reach the area of dead necrotic bone. Once the drill guide is in position, using X-ray guidance, the surgeon will introduce the drill and advance it into bone.

This drill has measurements on it, so the surgeon can measure the depth from the end of the drill sleeve to the tip of the drill within the hip bone. They will then use this measurement to guide subsequent steps in the procedure. A slightly larger drill is introduced and advanced to the previously measured depth. Next, a rotational cutting tool called a reamer is introduced into the hip. This reamer can expand in size, allowing the surgeon to treat different-sized AVN lesions by hand, depending on the patient's needs.

The surgeon will start to rotate the reamer and gradually open the blade to reach the appropriate diameter. When the blade is open to the required size, the surgeon can now pull back on the blade while turning to ensure all the dead bone within the femoral head is removed. Once reaming is complete, the surgeon will collapse the blade back down and remove the instrument from the hip. They will check once again with the camera to ensure the drill has done no damage to the cartilage overlying the bone.

To fill the defect created by the bone removal, the surgeon can inject a biologic mixture to promote the formation of new blood vessels, which helps create new bone. This can include using bone marrow or platelet-rich plasma obtained from the patient, which is then mixed with bone graft and introduced into the hip.