Hip Avascular Necrosis (AVN): AVN Treatment With an Expandable Reamer Animation

Hip Avascular Necrosis (AVN): AVN Treatment With an Expandable Reamer Animation

This video demonstrates a core decompression procedure used to treat avascular necrosis of the hip joint. This is a minimally invasive way to remove dead, referred to as necrotic bone, from the ball of the hip joint, the femoral head. For patients who have early-stage AVN. Removal of the bone relieves pressure and promotes the formation of new blood vessels, with the goal of providing pain relief and, in some cases, preventing collapse of the femoral head and the development of arthritis.

Core decompression is completed with the assistance of a camera known as an arthroscope. Via small incisions on the outside of the hip joint, the camera is introduced into the hip joint allowing the surgeon to see where to place the guide for drilling into the ball of the hip joint. A drill is then introduced through the drill sleeve on the guide and using X-ray guidance, the surgeon will advance the drill to the area where bone needs to be removed. This drill has measurements allowing the surgeon to reference how deep they went into the bone.

The guide is then removed while the drill sleeve remains. A drill with a larger diameter is then introduced through the drill sleeve and again using X-ray guidance, is drilled to the same depth. Next, a rotational cutting tool called a reamer is introduced. This reamer can expand to different diameters to treat different lesion sizes. Incrementally, the surgeon will open the reamer to larger diameters and gradually twist the blade back and forth by hand, allowing for the removal of the area with dead bone.

Once removal is complete, the blade can be collapsed back down to its original size and removed from the hip. The decompression is now complete. After decompression, a surgeon may choose to add a biologic mixture to help aid in new bone formation. This mixture can include fluids like your own bone marrow or platelet rich plasma, PRP, mixed with a type of bone graft. The surgeon would then deliver the mixture into the area where the dead bone used to be to help aid in this regenerative process.