Role of Core Decompression in Avascular Necrosis (AVN)

Category: Orthopaedics July 3, 2023 Author: Dr Debashish Chanda

Avascular necrosis, also called osteonecrosis, is a medical condition that arises when there is inadequate blood supplied to the bone tissue. Due to lack of blood and oxygen the tissue starts decaying and eventually achieves the form of necrosis or decay. This fatal condition of avascular necrosis can affect any joint in the body, however, it has been observed that most reported cases are due to pain in the hip joint. Left untreated, the avascular necrosis of the hip can progress towards significant pain and disability. Surgery is the only option for restoring joint function.
Out of these surgical options, the most frequently chosen option is core decompression. In this process the goal is to relieve pressure within the bone tissue of the hip joint. In this blog post, we’ll explore what core decompression is, how it works, and what you can expect if you are considering this procedure.

Table of Contents

What is core decompression?

The surgical approach of core decompression aims to relieve pressure within the bone tissue of the hip joint. The major goals of this surgical approach are:

Enhancing the blood flow to the affected bone tissue
Slowing down the progression of avascular necrosis
Preventing further damage to the joint

Diagnosis of Core Decompression Surgery

This procedure will be recommended to individuals who are experiencing symptoms of AVN. Avascular necrosis of the hip has some significant symptoms which are pain, stiffness, and limited range of motion.
Core decompression is typically most effective in the early stages of avascular necrosis. In this stage the bone tissue damage is still relatively minor.
Your doctor will likely perform imaging tests, such as an X-ray, MRI, or CT scan, to help determine the extent of the damage and suitability of core decompression approach.
Once confirmed the doctor will chalk out a surgical plan and proceed with the surgery before AVN further deteriorates.

How is core decompression done?

Here is a step by step flow of how a core decompression surgery for AVN is performed:

Step 1: A tiny incision is made in the hip region to access the affected area.
Step 2: A surgical instrument is used to create a channel in the affected bone tissue.By extracting a small section of bone near the affected area, the pressure within the bone tissue is reduced. This helps to slow the progression of avascular necrosis and prevent further damage.
Step 3: This channel now enables the pressure within the bone tissue to be relieved. This releases the obstructed blood flow and provides a pathway for the growth of new, healthy bone tissue.
Step 4: In some special instances, bone grafting may be performed alongside to aid in the growth of new bone tissue. Over time, this new bone tissue can help to restore the strength and function of the affected joint.

Core decompression is performed under general anesthesia, and usually takes about an hour to complete. Patients are likely to go home in under 24 hours. This procedure can be done successfully in the initial stages of AVN. However, stage 4 level necrosis often poses a much bigger risk, hence timeliness and precision is vital.
Post-operative care is essential as this has an impact on your overall body balance. Patients sometimes may experience some pain and discomfort, for which pain medication is prescribed. Further physiotherapy may be prescribed to help improve the range of motion and strength in the affected hip joint. Some restrictions may be imposed on physical activity or weight-bearing, to ensure a full and speedy recovery.

Success Factors of Core Decompression

According to a study published in the Journal of Orthopaedic Surgery and Research, core decompression had a success rate of 76% in patients with early stage avascular necrosis of the hip. Factors affecting the outcome of a core decompression surgery are

Severity of the condition: Patients with early stage avascular necrosis of the hip have a higher success rate, as the bone tissue has not yet degenerated significantly.
Age and overall health of the patient: Younger patients with good overall health tend to have better outcomes from core decompression surgery.
Experience and skill of the surgeon: This approach is a technically demanding procedure that requires a high degree of experience & precision on the part of the surgeon.
Post-operative care: Proper post-operative care, including physiotherapy and follow-up reviews, is essential for holistic recovery.

The study also found that the success rate decreased to 60% in patients with more advanced stages of the condition. Other studies have reported similar success rates for core decompression in the treatment of avascular necrosis of the hip. However, it is important to note that these success rates can vary depending on the individual patient and the specific circumstances of their condition.

In Conclusion

The success rate of core decompression can be significantly improved by choosing a reliable healthcare partner and orthopaedic surgeons for the procedure. When choosing a healthcare provider opt for state-of-the-art facilities supported by experienced medical teams that deliver on the global healthcare standards. A study published in the Journal of Orthopaedic Surgery and Research found that a successful core decompression significantly relies on the skill and judgement of the surgeon.
In conclusion, if you are considering core decompression for avascular necrosis of the hip, it is important to talk to your doctor about the risks and benefits of this procedure, as well as what you can expect during and after the procedure. By working closely with your healthcare team and following their instructions, you can help to ensure the best possible outcome from core decompression. If you are facing any of the symptoms of AVN or need a second opinion, reach out to our award winning orthopaedic department at the CK Birla Hospital, Gurugram. We offer trusted expertise and personalised care across multiple specialties under one roof.

FAQs:

Who should I consult for AVN?

This is an orthopaedic ailment that can be treated by an experienced orthopaedic surgeon. This is a fatal condition and needs prompt attention, diagnosis and treatment to prevent death due to blocked blood circulation in the body.

Is AVN curable?

A cure for avascular necrosis does not exist. However, treatment can sometimes slow down the progress, but there is still no confirmed cure. Most people diagnosed with avascular necrosis eventually end up having surgery, which often includes joint replacement. However, in some cases, people with avascular necrosis can also develop a high risk of severe osteoarthritis.