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Evidence summaries

Core Decompression and Conservative Treatment for Avascular Necrosis of the Femoral Head

Core decompression may be more effective than conservative treatment for Steinberg stage I avascular necrosis of the femoral head. Level of evidence: "C"

A systematic review 1 including 30 studies with a total of 1 082 subjects was abstracted in DARE. The most significant finding was that, with an average follow-up time of 42 months, core decompression was 23% more successful than conservative treatment for hips with Steinberg stage I AVN. This statistically-significant difference of 23% should be interpreted cautiously.

The success rates for surgical core decompression were 84, 63 and 29% for Steinberg stages I, II,and III, respectively. Conservatively- treated patients with stage 0, I, II and III AVN demonstrated success rates of 86, 61, 59 and 25%, respectively.

There were 33 (5%) complications in the 688 cases reported in the 13 studies. Reported complications were intertrochanteric fracture (n=14), technical errors in surgery (n=6), seromas and wound infections (n=8), femoral head fractures (n=3), deep vein thrombosis (n=1) and pulmonary embolus (n=1).

    References

    • Castro FP Jr, Barrack RL. Core decompression and conservative treatment for avascular necrosis of the femoral head: a meta-analysis. Am J Orthop 2000 Mar;29(3):187-94. [PubMed][DARE]

Primary/Secondary Keywords