This document discusses surgical procedures for osteonecrosis of the femoral head, including both joint preserving and replacing options. Key joint preserving procedures described are core decompression, various bone grafting techniques using vascularized and nonvascularized grafts, and proximal femoral osteotomies. Total hip arthroplasty and hip resurfacing are mentioned as joint replacing options.

1. OSTEONECROSIS OFOSTEONECROSIS OF
FEMORAL HEADFEMORAL HEAD
Dr. IMRAN JAN
DNB(ORTHO.)
Surgical procedures

2. Surgical proceduresSurgical procedures
Joint PreservingJoint Preserving Joint ReplacingJoint Replacing
 CoreCore
DecompressionDecompression
 VariousVarious
Nonvascularized &Nonvascularized &
Vascularized BoneVascularized Bone
Grafting ProceduresGrafting Procedures
 OsteotomyOsteotomy
ProceduresProcedures
 Total HipTotal Hip
ArthroplastyArthroplasty
 Hip ResurfacingHip Resurfacing
ProceduresProcedures

3. Indications:-Indications:-
 Core decompression is effective for symptomatic relief in nearlyCore decompression is effective for symptomatic relief in nearly
all stages in all patients who present with aall stages in all patients who present with a painful hippainful hip
secondary to ONsecondary to ON d/t of intramedullary pressure done by itd/t of intramedullary pressure done by it
 Transient symptomatic relief in an advanced stage & in alreadyTransient symptomatic relief in an advanced stage & in already
collapsing or when collapse is impendingcollapsing or when collapse is impending
 It is Most Effective inIt is Most Effective in Stage I & IIStage I & II lesions that arelesions that are size Asize A (15% of(15% of
head affected)head affected) & B& B (15%–30% of head affected)(15%–30% of head affected)
The larger the lesion, the less likely the patient is to have aThe larger the lesion, the less likely the patient is to have a
successful outcome.successful outcome.
–Core DecompressionCore Decompression

4. –HUNGERFORD METHOD : POSITION-SUPINE
–INCISION :MIDLATERAL LONGITUDINAL INCISION CENTERED
OVER SUBTROCHANTERIC REGION
–UNDER C ARM CONTROL ENTRY POINT IS PLACED OVER THE
LATERAL CORTEX OF THE INFERIOR PORTION OF THE GT THEN
3.2MM THREADED GUIDE PIN IS INSERTED ,THEN OVERREAM THE
GUIDE PIN WITH 8MM REAMER
–PARTIAL WT BEARING ON CRUTCHES FOR 6 WEEKS
–CAN BE PROLONGED IF DONE IN ADVANCED DISEASE

5. Standard Technique & its Variations:-Standard Technique & its Variations:-
 Ficat & ArletFicat & Arlet proposed creating anproposed creating an 8 to 10 mm dia core track8 to 10 mm dia core track &&
this became athis became a “standard”“standard”
 Recently some authors have suggested that the same effect ofRecently some authors have suggested that the same effect of
standard core can be achieved by producingstandard core can be achieved by producing Multiple SmallerMultiple Smaller
Core Tracks of 3-mm diaCore Tracks of 3-mm dia range. This can be donerange. This can be done
percutaneously & theoretically # risk & shortens the operativepercutaneously & theoretically # risk & shortens the operative
time & morbiditytime & morbidity
 Steinberg et alSteinberg et al proposed makingproposed making Smaller Angled Core TracksSmaller Angled Core Tracks
into the Necrotic Segment from the Central Core Canalinto the Necrotic Segment from the Central Core Canal
–Core DecompressionCore Decompression

6. Postoperative ManagementPostoperative Management
 The lateral cortical window produces a stress riser in theThe lateral cortical window produces a stress riser in the
proximal femur Soproximal femur So Protect the patient from unprotectedProtect the patient from unprotected
weightbearingweightbearing for the first 6 weeksfor the first 6 weeks
 Reported incidence of # with core decompression is <1% &Reported incidence of # with core decompression is <1% &
has almost always been associated with either a fall or failurehas almost always been associated with either a fall or failure
to use protective devices (crutches or a walker) in the first 6to use protective devices (crutches or a walker) in the first 6
weeksweeks
–Core DecompressionCore Decompression

7.  Supplemented with Core DecompressionSupplemented with Core Decompression
Principle:-Principle:-
The small no. of progenitor cells in the proximal extremity ofThe small no. of progenitor cells in the proximal extremity of
the femur with osteonecrosis of the femoral head causesthe femur with osteonecrosis of the femoral head causes
insufficient creeping substitution after osteonecrosisinsufficient creeping substitution after osteonecrosis
Red Bone Marrow Graft contains OsteogenicRed Bone Marrow Graft contains Osteogenic
Precursors,which repopulate the osteonecrotic bonePrecursors,which repopulate the osteonecrotic bone
–Bone Marrow InjectionsBone Marrow Injections

8. Bone Marrow InjectionsBone Marrow Injections
TechniqueTechnique
 Usual site =>Usual site => Anterior Iliac CrestAnterior Iliac Crest
A beveled metal trocar of 6 to 8 cmA beveled metal trocar of 6 to 8 cm
length & a bore of 1.5 mm is pushedlength & a bore of 1.5 mm is pushed
deep into the cancellous bonedeep into the cancellous bone
Marrow is aspirated with A 10 mlMarrow is aspirated with A 10 ml
syringe(flushed with heparin)syringe(flushed with heparin)
Aspirates pooled in plastic bagsAspirates pooled in plastic bags
containing an anticoagulant solutioncontaining an anticoagulant solution
Filtered to remove fat aggregates &Filtered to remove fat aggregates &
clotsclots
–Trocar

9. Bone Marrow InjectionsBone Marrow Injections
Current Indications:-Current Indications:-
 The best indications are hipsThe best indications are hips with osteonecrosis & withoutwith osteonecrosis & without
collapsecollapse
 In some patients who had Steinberg stage III (subchondralIn some patients who had Steinberg stage III (subchondral
crescent, no collapse), successful outcomes (no furthercrescent, no collapse), successful outcomes (no further
surgery) have been obtained between 5 and 10 years.surgery) have been obtained between 5 and 10 years.
Therefore,Therefore, in selected patients, even more advanced diseasein selected patients, even more advanced disease
can be considered for core decompressioncan be considered for core decompression

10.  Bone grafting procedures are a group of joint preserving techniquesBone grafting procedures are a group of joint preserving techniques
that involve the removal of the diseased femoral head segment, f/b itsthat involve the removal of the diseased femoral head segment, f/b its
replacement with 1or more of a variety of bone graft optionsreplacement with 1or more of a variety of bone graft options
 These are most valuable in treating patients withThese are most valuable in treating patients with Stage I & IIStage I & II
diseasedisease
–Bone Grafting ProceduresBone Grafting Procedures

11. Techniques:-Techniques:-
Grafting Through Lateral Core Track
Grafting Through Femoral Neck Window
Grafting Through Articular Surface Window
–Bone Grafting ProceduresBone Grafting Procedures

12. GraftingThrough Lateral CoreTrackGraftingThrough Lateral CoreTrack

13.  Watson-Jones or Smith-Peterson approach isWatson-Jones or Smith-Peterson approach is
usedused
 A window is created to expose the anteriorA window is created to expose the anterior
femoral neck, at the level of the junction of thefemoral neck, at the level of the junction of the
femoral head & neckfemoral head & neck
 When Combined with a Bone GraftingWhen Combined with a Bone Grafting
procedure,refered as theprocedure,refered as the “light bulb”“light bulb”
procedure.procedure.
 AdvantageAdvantage is the improved access to theis the improved access to the
necrotic femoral head segment & the avoidancenecrotic femoral head segment & the avoidance
of direct iatrogenic cartilage damageof direct iatrogenic cartilage damage
 DisadvantageDisadvantage is the creation of a cortical defectis the creation of a cortical defect
in the femoral neck, which raises the risk ofin the femoral neck, which raises the risk of
fracturefracture
–Grafting Through Femoral NeckGrafting Through Femoral Neck
WindowWindow

14. –Grafting Through ArticularGrafting Through Articular
SurfaceWindowSurfaceWindow

15.  The 3The 3rdrd
method of accessing the necrotic segment of the femoral head is known asmethod of accessing the necrotic segment of the femoral head is known as
thethe “Trapdoor” approach“Trapdoor” approach
 With this method, the hip is surgically dislocated using a technique aimed atWith this method, the hip is surgically dislocated using a technique aimed at
preserving the blood supply to the femoral head & neckpreserving the blood supply to the femoral head & neck
 Once exposed, a “trapdoor” window is made in the femoral head cartilage toOnce exposed, a “trapdoor” window is made in the femoral head cartilage to
access the diseased subchondral boneaccess the diseased subchondral bone
 When combined with a bone grafting procedure, refered as theWhen combined with a bone grafting procedure, refered as the “Trapdoor”“Trapdoor”
ProcedureProcedure
 AdvantageAdvantage : Exposure allows a direct evaluation of the cartilage surface &: Exposure allows a direct evaluation of the cartilage surface &
underlying diseased femoral head segment & allows forunderlying diseased femoral head segment & allows for
precise bone graft placement.precise bone graft placement.
 DisadvantageDisadvantage : Demanding technical nature: Demanding technical nature
Iatrogenic cartilage damage & osteonecrosisIatrogenic cartilage damage & osteonecrosis
–Grafting Through ArticularGrafting Through Articular
SurfaceWindowSurfaceWindow

16. Nonvascularized GraftsNonvascularized Grafts
 Nonvascularized corticalNonvascularized cortical
bone graftsbone grafts are typicallyare typically
prepared as several struts thatprepared as several struts that
provide structural supportprovide structural support
under the articular surfaceunder the articular surface
within the evacuated segmentwithin the evacuated segment
 This construct is oftenThis construct is often
augmented with cancellousaugmented with cancellous
bone graft in an effort tobone graft in an effort to
improve its osteoconductiveimprove its osteoconductive
and/or osteoinductiveand/or osteoinductive
propertiesproperties
– Vascularized GraftsVascularized Grafts
1.1. Local pedicledLocal pedicled
grafts,which do not requiregrafts,which do not require
microvascularmicrovascular
reanastomosisreanastomosis
eg :eg :Muscle-pedicle bone graftsMuscle-pedicle bone grafts
Vascularized pedicle boneVascularized pedicle bone
graftsgrafts
2.2. Free vascularized grafts,Free vascularized grafts,
which require awhich require a
microvascularmicrovascular
reanastomosis.reanastomosis.
eg:eg: Free vascularized fibulaFree vascularized fibula
–Types of Bone GraftsTypes of Bone Grafts

17. NONVASCULARISED GRAFTNONVASCULARISED GRAFT
 PHEMISTER
 FOR STAGES 1 & 2
 NOT PROVED OF MUCH
VALUE
 COMBINEDWITH CORE
DECOMPRESSION

18. VASCULARISED BONE GRAFTVASCULARISED BONE GRAFT
 USING CORTICAL ,CANCELLOUS,
VASCULARISED BONE GRAFT AND
 ACCURATE PLACEMENT WITHIN
THE LESION AND UNDER
SUBCHONDRAL BONE.
 ACCORDINGTO URBANIAK ET AL –
 1.DECOMPRESSION OFTHE HEAD
MAY INTERRUPTTHE ISCHEMIA AND
INTRAOSSEOUS HYPERTENSION
 2.EXICISION OFTHE SEQUESTRUM
WHICH MIGHT INHIBIT
REVASCULARIZATION.
 3.FILLINGTHE DEFECT WITH
OSTEOINDUCTIVE BONE GRAFT AND
AVIABLE CORTICAL STRUTTO
SUPPORTTHE SUBCHONDRAL
SURFACE ANDTO ENHANCE
REVASCULARIZATION.
 4.PROTECT OF HEALING
CONSTRUCT BY PERIOD OF LIMITED
WT BEARING.

19. –The harvested fibula with marbleized muscle attached confirming an
extraperiosteal dissection. The peroneal artery & two accompanying
veins

21. VASCULARISED BONE GRAFTVASCULARISED BONE GRAFT

22.  TWO TEAMS NEEDED
 POSITION –LATERAL
 APPROACH-ANTEROLATERAL EXPOSE THE
PROXIMAL FEMUR
 UNDER CARM CONTROL INSERT GUIDE PIN (AVOID
PENETRATION INTO ARTICULAR SURFACE) AND BY
USING SEQUENTIAL REAMING CREATE CORE
DIAMETER OF 16 -21MM BEGINNING FROM THE
LATERAL CORTEX JUST DISTAL TO VASTUS RIDGE
AND CORE EXTENDS WITHIN 3-5MM OF THE
ARTICULAR SURFACE.
 HARVEST CANCELLOUS GRAFT FROM GT AND
PACK IT INTO THE CAVITY USING IMPACTOR AND
PLACEMENT CONFIRM WITH C-ARM AND
CONTRAST MEDIUM

23.  13CM LONG FIBULA WITH AS LONG A
PEDICLE OF
 PERONEAL ARTERY AND VEIN CAN BE
OBTAINED.
 LEAVE AT LEAST 10CM OF FIBULA
PROXIMAL TO ANKLE MORTISE.
 PEEL 3-4MM OF PERIOSTEUM FROM DISTAL
END OF GRAFT AND ROLL IT OVER THE
BONE AND PLACE 3-0 ABSORBALE SUTURE
CIRCUMFERENTIALLY TO SECURE THE
PERIOSTEUM AND VASCULAR PEDICLE SO
THAT IT IS NOT STRIPPED WHEN GRAFT IS
INSERTED

24.  DIAMETER OF CORE IS 1-
2MM LARGERTHEN FIBULA
DIAMETER
 ORIGINS OFVASTUS
INTERMEDIUS AND
LATERALIS IS RELEASED SO
THAT PERONEAL AND
LATERAL FEMORAL
CIRCUMFLEXVESSELS CAN
ANASTOMOSED WITHOUT
TENSION.
 BLEEDING FROMTHE
CORTICAL BONE ATTHE
BASE OF GRAFT CONFIRMS
THEVASCULARITY
 STABILSETHE GRAFT
WITH .62MM K-WIRE
 DON’T REATTACHTHE
ORIGIN OFVASTUS
MUSCLES

25. MUSCLE PEDICLE BONE GRAFTMUSCLE PEDICLE BONE GRAFT
 MEYER’S
 USES QUADRATUS FEMORIS
 POSTERIOR APPROACH-
MOORE’S
 FOR STAGES 1 &2

26. IN B/L CASESIN B/L CASES
 SECOND GRAFT CAN BE DONE AFTER 3 MONTHS AFTER
FIRST PROCEDURE
 6 WEEKS BEFORETHE OPERATION ONTHE SECOND HIP
WT BEARING ONTHE SIDE OFTHE FIRST OPERATION IS
INCREASEDTO 50%.

27. BAKSIBAKSI
 USES TENSOR FASCIA LATA
 USUALLY ANTERIOR APPROACH
 FOR STAGES 1 & 2

28.  The main rationale proposed for the efficacy ofThe main rationale proposed for the efficacy of
osteotomies is theosteotomies is the biomechanical effect of movingbiomechanical effect of moving
the collapsed/necrotic segment of the femoral headthe collapsed/necrotic segment of the femoral head
from the principal weight-bearing area of the hip tofrom the principal weight-bearing area of the hip to
an area that bears less/no direct weight and toan area that bears less/no direct weight and to
allow weight-bearing contact to now happen in anallow weight-bearing contact to now happen in an
area of relatively normal bone and cartilagearea of relatively normal bone and cartilage
–Proximal Femoral OsteotomiesProximal Femoral Osteotomies

29.  AIM OF OSTEOTOMY:
1. RELIEF OF PAIN: Mechanical : reducing the ratio between
abductor and body weight, lever, relaxing capsule.
Haemodynamic: Also by decreasing the
intra osseous pressure.
2. CORRECTION OF DEFORMITY: flexion, adduction,
external rotation.
3. REVERSAL OF DEGENERATIVE PROCESS: helped by
increase in joint space.

30. Categories:-Categories:-
 Valgus or varus osteotomies usuallyValgus or varus osteotomies usually
combined with flexion or extensioncombined with flexion or extension
 Transtrochanteric rotationalTranstrochanteric rotational
osteotomiesosteotomies
–Proximal Femoral OsteotomiesProximal Femoral Osteotomies

31. Indications:-Indications:-
 For varus or valgus osteotomies depend onFor varus or valgus osteotomies depend on
the location & size of the lesionthe location & size of the lesion
 Osteotomies may be used for bothOsteotomies may be used for both
precollapse & postcollapse without notableprecollapse & postcollapse without notable
acetabular involvementacetabular involvement
–Proximal Femoral OsteotomiesProximal Femoral Osteotomies

32. VALGUS OSTEOTOMY WITHVALGUS OSTEOTOMY WITH
FLEXIONFLEXION
when the necrotic segment is located in
the anterosuperior part of the femoral
head with less than 20% posterior
involvement.
Optimal patient population would be
those that are less than 45 years of age
and are
not on steroids or chemotherapy

33. PAUWELS VALGUS OSTEOTOMYPAUWELS VALGUS OSTEOTOMY
AIM:
Valgus intertrochanteric femoral osteotomies transfer the center of
hip rotation medially from the superior aspect of the acetabulum to
decrease the weight bearing area of femoral head .
 Normally 15° of correction is required.
INDICATIONS:
◦ Trendelenburg Limb
◦ Adduction deformity
◦ Motion in adduction beyond adduction deformity
◦ Painful abduction
CONTRAINDICATIONS:
◦ Flexion of less than 60°
◦ Knock knees as this will increase the deformity at knee.

34. After insertion of guide wire & chisel
2cm proximal to osteotomy site
similar to explained before :-

35. VALGUS OSTEOTOMY WITH FLEXION ANDVALGUS OSTEOTOMY WITH FLEXION AND
BONE GRAFTINGBONE GRAFTING

36. PAUWEL’S VARUS OSTEOTOMYPAUWEL’S VARUS OSTEOTOMY
AIM :
Varus intertrochanteric femoral osteotomies are designed to
elevate the greater trochanter and move it laterally, while
moving the abductor and psoas muscles medially, to :
 Restore joint congruity
 Decrease the force acting on the edge of the acetabulum moves
to the middle of weight bearing surface.
INDICATIONS:
◦ Antalgic abductor limb
◦ Abduction deformity
◦ Painful adduction
◦ Neck shaft angle > 135° .

37. After insertion of guide wire & chisel
2cm proximal to osteotomy site
similar to mc murray’s.
–Oblique cut is
made parallel
to the chisel
inserted
–Proximal fragment is
rotated in varus .

38. –VARUS OSTEOTOMY WITH FLEXION ORVARUS OSTEOTOMY WITH FLEXION OR
EXTENSIONEXTENSION

39. ROTATIONALROTATIONAL
OSTEOTOMIESOSTEOTOMIES
Sugioka first reported a transtrochanteric
transposition osteotomy with anterior
rotation of the head and neck of
the femur

40. –Transposition of the necrotic focus to the ant. & inf. part of the femoral head away from the weight-
bearing area as a result of the ant. rotation of the head
– before rotation
–After rotation
–ROTATIONAL OSTEOTOMYROTATIONAL OSTEOTOMY

41. SUGIOKA ANT ROTATIONALSUGIOKA ANT ROTATIONAL
OSTEOTOMYOSTEOTOMY
 PREVENTS PROGRESSIVE
COLLAPSE OF ART SURFACE
 TO IMPROVE CONGRUITY OF
JOINT
 REPOSITIONTHE NECROTIC
ANT,SUP PART OF HEADTO
ANONWT BEARING AREA
 HEAD AND NECK SEGMENT
ROTATED ANT.LY AROUND ITS
LONG AXIS
 WT BEARING ISTRANSMITTED
TOTHE POST ARTICULAR
SURFACE.

42. SUGIOKA ANT ROTATIONALSUGIOKA ANT ROTATIONAL
OSTEOTOMY-TECHOSTEOTOMY-TECH
 LATERAL APPROACH
◦ EXPOSE CAPSULE
◦ OSTEOTOMISE GT,REFLECT
PROXIMALLY WITHTENDONS OF
GLU MED,MIN ANDPIROFORMIS
◦ TRANSECT SHORT EXT ROTATORS
◦ INCISE CAPSULE
CIRCUMFERENTIALLY
◦ PROTECT POST BRANCH OF MED
CIR FEMORAL ART
◦ PLACETWO PINS IN GT, LATTO
MED
◦ TROCHANTERIC OSTEOTOMY
10MM DISTALTO IT LINE
,PERPENDICULARTO LONG AXIS
OF NECK

43.  SECOND OSTEOTOMY
PERPENDICULARTO FIRST OVER
SUP MED ASPECT OF LT
 USE PROX PINTO ROTATE
PROXIMAL FRAGMENT 45TO 90
degrees
 FIXTHE OSTEOTOMYWITH 3 CC
SCREWS OR NAIL AND PLATE

44. –ROTATIONAL OSTEOTOMYROTATIONAL OSTEOTOMY

45. ARTHROPLASTY - TYPESARTHROPLASTY - TYPES
 RESURFACING ARTHROPLASTY(BIRMINGHAM)
 UNIPOLAR AND BIPOLAR HEMIARTHROPLASTY
 THR

46. Femoral & Acetabular Surface Replacement &Femoral & Acetabular Surface Replacement &
Hemi-Surface Replacement for Osteonecrosis ofHemi-Surface Replacement for Osteonecrosis of
the Hipthe Hip
Indications :-Indications :-
 Later stages of osteonecrosis (University of Pennsylvania Stage III–Later stages of osteonecrosis (University of Pennsylvania Stage III–
VI)VI)
 > 30% femoral head involvement> 30% femoral head involvement
–Hip Resurfacing ProceduresHip Resurfacing Procedures

47. RESURFACING HEMIARTHROPLASTYRESURFACING HEMIARTHROPLASTY
 WHEN AVN INVOLVES MORE
THAN 30% HEAD
 INTRA OP ASSESSMENT OFTHE
ACETABULAR CARTILAGETO BE
DONE IF ANY DOUBTTHENTHR
SHOULD BE PERFORMED.
 GOOD ALTERNATIVE FOR
YOUNG PATIENTSWITH
ADVANCED AVN AS LITTLE
BONE IS SACRIFICED

48.  TOC for advanced osteonecrosis of the hip (University ofTOC for advanced osteonecrosis of the hip (University of
Pennsylvania Stages IVB–VIC)Pennsylvania Stages IVB–VIC)
 Excellent pain relief & functional improvementsExcellent pain relief & functional improvements
 More recent studies at intermediate follow up up to 10 yearsMore recent studies at intermediate follow up up to 10 years
have demonstrated similar survivorship compared to total hiphave demonstrated similar survivorship compared to total hip
replacement for osteoarthrosis.replacement for osteoarthrosis.
–Total Hip ReplacementTotal Hip Replacement

49. –Bhumika – Non Cemented THR

50.  ARTHRODESISARTHRODESIS
 RESECTION ARTHROPLASTYRESECTION ARTHROPLASTY
 ACRYLIC CEMENT INJECTIONACRYLIC CEMENT INJECTION
–Miscllaneous ProceduresMiscllaneous Procedures

51.  Mostly a salvage procedure in contemporary orthopedicsMostly a salvage procedure in contemporary orthopedics
 In the patient with significant pain & disability & in whomIn the patient with significant pain & disability & in whom
nonsurgical T/t has failed with a contraindication to prostheticnonsurgical T/t has failed with a contraindication to prosthetic
replacementreplacement
 Clinical success can be achieved as it may relieve hip painClinical success can be achieved as it may relieve hip pain
 The recommended position is 0° to 5° of adduction, 25° to 30° ofThe recommended position is 0° to 5° of adduction, 25° to 30° of
flexion & 0° to 15° of external rotationflexion & 0° to 15° of external rotation
 Later revision to a THR has a significant complicationLater revision to a THR has a significant complication
rate with less functional outcomerate with less functional outcome
–ArthrodesisArthrodesis

52.  T/t of last resortT/t of last resort
 Complete resection of the head & neck of the femurComplete resection of the head & neck of the femur
 Can achieve a good range of pain-free motion & will be able to function reasonablyCan achieve a good range of pain-free motion & will be able to function reasonably
well for most activities of daily livingwell for most activities of daily living
 The use of a shoe lift is generally necessary as a result of the shortening of theThe use of a shoe lift is generally necessary as a result of the shortening of the
extremity, which averages approximatelyextremity, which averages approximately 1.5 inches1.5 inches
 There will be a noticeableThere will be a noticeable abductor lurchabductor lurch & patients will require some form of& patients will require some form of
assistive device for ambulationassistive device for ambulation
 Indication:-Indication:- patient with severe pain and disability who is not apatient with severe pain and disability who is not a
suitable candidate for reconstructionsuitable candidate for reconstruction
–Resection ArthroplastyResection Arthroplasty

53.  Debriding the necrotic zone then elevating & supporting the collapsedDebriding the necrotic zone then elevating & supporting the collapsed
segment by the injection of cementsegment by the injection of cement
 Wood and coworkersWood and coworkers reported on very preliminary results 21 of 20reported on very preliminary results 21 of 20
casescases
 All patients realized immediate pain relief with improved hip scores,All patients realized immediate pain relief with improved hip scores,
with 3 patients undergoing early conversion to total hip arthroplastywith 3 patients undergoing early conversion to total hip arthroplasty
 Relatively invasive but may have the advantage of maintainingRelatively invasive but may have the advantage of maintaining
femoral head congruityfemoral head congruity
 Long-term results with perhaps a randomized controlled series will beLong-term results with perhaps a randomized controlled series will be
necessary if this is a viable alternative to reconstructivenecessary if this is a viable alternative to reconstructive surgerysurgery
–Acrylic Cement InjectionAcrylic Cement Injection

54. POROUS TANTALUM ROD INSERTIONPOROUS TANTALUM ROD INSERTION
 A novel approach in T/t of stage I & II precollapse osteonecrosisA novel approach in T/t of stage I & II precollapse osteonecrosis
 This rod functions analogously to aThis rod functions analogously to a Cortical Strut GraftCortical Strut Graft allowingallowing
structural & osteoconductive propertiesstructural & osteoconductive properties

55. –POROUS TANTALUM ROD INSERTIONPOROUS TANTALUM ROD INSERTION

56. THANK YOUTHANK YOU
FOR PATIENT LISTENING