Core decompression for early osteonecrosis of the hip in high risk patients.

Thirty-four hips (22 patients) with history and physical findings consistent with osteonecrosis of the femoral head were evaluated preoperatively by radiographs, bone scans and magnetic resonance images. All patients with Stage 0, I, or II disease by the Ficat and Arlet classification underwent core decompression using the same technique. Osteonecrosis was confirmed histologically in all 34 hips. Eighteen of 22 patients had prognostic factors traditionally associated with poor outcome including collagen vascular diseases and continued use of steroids. Followup averaged 4 years for 18 patients with 29 hips. Four patients died secondary to systemic illness. Twelve patients had good or excellent results using the Modified Harris Hip Score with 6 patients needing hip arthroplasty. In this group of patients previously associated with poor prognosis, no hip fractures were seen and 66% good to excellent results were obtained.