Precollapse femoral head avascular necrosis after combined surgical-medical management.

Avascular necrosis of the femoral head occurs due to loss of blood supply leading to osteocyte death and progression to collapse if not treated early. Hence, we followed 60 patients (80 hips) with precollapse AVN (Modified Ficat-Arlet stage I and IIA) who underwent core decompression with autologous cancellous iliac crest grafting plus a fixed pharmacotherapy protocol for 48 weeks. Harris Hip Score improved serially, with unilateral hips reaching 87.5% and bilateral hips 90% good to excellent outcomes at final follow up and no hip remaining in poor category. Most hips were Stage I and idiopathic was the common etiology and the results support that combined surgical plus medical management gives meaningful short-term functional benefit when started early.