Arthroscopic assistance of core decompressions improved hip AVN staging

BARCELONA, Spain — Patients with avascular necrosis of the femoral head were satisfied after treatment that included arthroscopy to stage the condition, followed by core decompression and the application of bone morphogenetic protein or bone marrow aspirate concentrate, according to a surgeon from Dubai who presented results at the EFORT Annual Congress, here.

To aid early diagnosis of avascular necrosis of the femoral head, Mohammad A. Konchwalla, MD, said, “Hip arthroscopy should be performed alongside a core decompression. It can rule out intra-articular pathology, relieve mechanical symptoms.”

“Why I do hip arthroscopy? To find staging of the femoral head, to see how bad things are and to rule out any intra-articular pathology which can be dangerous or cause damage,” he said, noting arthroscopy facilitates examining the acetabulum, femoral head and labral tissue.

“It will show me the area of the necrotic tissue, but it also shows me a distinct border between the bleeding healthy bone and necrotic bone, which appears dirty and white,” Konchwalla said.

Konchwalla uses an 8-mm or 9-mm ACL drill to create a tunnel in the femur and then puts the arthroscopy camera in the femoral tunnel.

Arthroscopy also helps Konchwalla assess the extent of femoral head bleeding associated with core decompression and provides a pathway to curettage or to microfracture the area, if needed.

If a core decompression is indicated, which is the second step in the procedure, he introduces the instruments needed through the same tunnel.

As a third step in these cases, Konchwalla originally used bone morphogenetic protein (BMP) to stimulate healing, “but now I have been using stem cell bone marrow aspiration and injecting [it] with my bone graft.”

Among 30 hips in patients aged 28 to 45 years, which included 12 women, 29 hips were stage 1 or 2, and Konchwalla used the protocol he described. However, in the one hip in the series that was stage 3, he used BMP.

“All patients were satisfied and went back to their daily activity,” Konchwalla said. – by Susan M. Rapp

Reference:

Konchwalla MA. Paper 75. Presented at: EFORT Annual Congress; May 30-June 1, 2018; Barcelona, Spain.

Disclosure: Konchwalla reports no relevant financial disclosures.