Avascular necrosis (AVN), also referred to as osteonecrosis, aseptic necrosis, or ischemic necrosis, is a degenerative disease that commonly affects the ends of the femur, the bone extending from the knee joint to the hip joint. The primary cause of AVN is the temporary or permanent loss of blood supply to the bones. Without sufficient blood flow to provide adequate nourishment, the bone in the head of the femur dies and gradually collapses. Along with the death of the bone, the articular cartilage covering the hip bones also collapses, which can lead to the development of disabling arthritis. AVN may impact a singular bone, multiple bones at different times, or multiple bones concurrently.

Percutaneous core decompression is an advanced surgical treatment option for osteonecrosis of the hip, and is an excellent treatment option for patients in the earliest stages of the disease, prior to the total collapse of the joint. The ultimate goal of the procedure is to minimize pain while slowing the progression of joint and bone deterioration, in the hopes of avoiding a total hip replacement surgery. When AVN of the hip is diagnosed early enough, core decompression can often successfully prevent the collapse of the femoral head and stave off the development of arthritis.

During the core decompression procedure, the inner cylinder of bone from the proximal femur is carefully removed, thereby reducing pressure within the bone, increasing blood flow to the bone, and expediting the formation of additional blood vessels. In order to achieve optimal results from your percutaneous core decompression, this procedure should only be performed by a skillful, experienced orthopaedic surgeon.

Our team of physicians specialize in micro-invasive and robotic surgical techniques for hip and knee reconstructive procedures, including percutaneous core decompression for the treatment of osteonecrosis of the hip. These advanced surgical approaches are designed to minimize pain, preserve soft-tissue, and shorten the length of his patients’ post-surgical recovery periods, helping to restore proper joint functionality while improving mobility.

Procedure and Recovery

During the core decompression procedure, one larger hole (or several smaller holes) are carefully drilled into the femoral head to alleviate pressure within the bone and create channels for new blood vessels to form, restoring nourishment to the affected areas of the hip. Core decompression is often performed in conjunction with bone grafting, in order to aid in the regeneration of healthy bone and support cartilage adjacent to the hip joint.

Although there are many bone graft procedural options, Dr. Gough utilizes the PRO-DENSE®Advanced Core Decompression System, which features the patented PRO-DENSE® Injectable Graft, a biocompatible paste that is ideally suited for backfilling the surgically-created defect. This synthetic bone graft substitute is reabsorbed by the body and replaced with natural bone during the healing process.

The PRO-DENSE®Advanced Core Decompression System provides a number of distinct benefits:

The reusable X-REAM® Percutaneous Expandable Reamer enables the surgeon to achieve optimal debridement of dead bone through a small incision, which minimizes post-surgical scarring
This minimally invasive surgical technique allows for a faster, more comfortable recovery period
Percutaneous core decompression with PRO-DENSE® has proven to be a more cost-effective option than alternative surgical approaches, and produces more consistently successful outcomes
Reduces the total time spent in surgery, facilitating a safer procedure with a lowered risk of surgical complications

The average procedural time for this surgery is approximately 1-1.5 hours, and most patients require minimal (if any) narcotic pain medication after surgery, as Tylenol and Celebrex generally suffice for pain management.

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