✦ Hip Preservation Surgery

Hip Preservation Surgery

Q: What is hip core decompression?

Core decompression relieves the elevated pressure within the femoral head in early AVN by drilling or removing a core of bone, improving blood flow and potentially halting progression to collapse.

Q: How successful is core decompression for AVN?

Success rates of 65–80% are reported for Stage I–II AVN. Outcomes decline significantly for larger lesions, Stage III disease, and after femoral head collapse.

Q: What is avascular necrosis of the hip?

AVN is the death of bone tissue in the femoral head due to loss of blood supply — caused by steroid use, alcohol, trauma, sickle cell disease, or idiopathically. Early diagnosis and treatment are essential.

A bone-preserving procedure for early avascular necrosis of the femoral head — drilling a core to relieve intraosseous pressure and restore blood flow before the femoral head collapses.

30–60 min PROCEDURE

1–2 Days HOSPITAL STAY

65–80% SUCCESS (EARLY AVN)

2–4 Weeks PROTECTED WEIGHT-BEARING

What is Hip Preservation Surgery ?

Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the femoral head, leading to death of bone tissue and eventual collapse of the head if untreated. Core decompression is the most widely performed joint-preserving procedure for early-stage AVN, performed before the femoral head has collapsed (ARCO Stage I–III). By drilling a core cylinder through the femoral neck into the necrotic zone, the procedure reduces elevated intraosseous pressure, improves venous drainage, and promotes revascularisation of the affected segment — slowing or halting progression and potentially avoiding hip replacement altogether.

Suitable for patients with early-stage avascular necrosis of the femoral head (ARCO Stage I, II, or early III) before femoral head collapse — confirmed on MRI. Not appropriate for advanced or collapsed femoral heads where hip replacement provides more reliable outcomes.

How the Procedure Works

MRI Confirmation

MRI is essential to confirm the diagnosis, stage the disease, and assess lesion size and location before proceeding.

Patient Positioning & Approach

Patient positioned on a traction table; a lateral approach to the greater trochanter is used under fluoroscopic guidance.

Core Drilling

A 10 mm core drill or multiple 3 mm drill bits are introduced through the greater trochanter, across the femoral neck, and into the necrotic lesion — removing the dead bone and relieving pressure.

Biological Augmentation (Optional)

The decompression track can be augmented with autologous bone graft, demineralised bone matrix, platelet-rich plasma, or concentrated bone marrow aspirate to stimulate healing.

Protected Mobilisation

Toe-touch or partial weight-bearing for 2–4 weeks; progressive loading thereafter.

Outcomes

30–60 minDURATION

1–2 DaysHOSPITAL STAY

65–80%SUCCESS (STAGE I–II)

2–4 WeeksPROTECTED WEIGHT-BEARING

Who Needs This Treatment?

→Preserves the native hip joint — avoids or delays hip replacement
→Minimal incision — outpatient or 1-night admission
→Can be combined with biological augments to improve revascularisation
→Most effective when performed early — before femoral head collapse
→Allows return to protected weight-bearing in 2–4 weeks
→Significantly reduces intraosseous pressure and pain

"Core decompression works best when we intervene early. An MRI showing early AVN should prompt urgent referral — the window of opportunity to preserve the femoral head is narrow, and once collapse occurs, replacement becomes the only reliable solution."

— Dr. Satish Reddy Gandavarapu, Senior Orthopaedic & Trauma Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked

What is hip core decompression?+

How successful is core decompression for AVN?+

What is avascular necrosis of the hip?+

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