Micro-core Decompression combined with Intralesional Zoledronic Acid as a treatment of Osteonecrosis of femoral Head: A Novel Technique

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 41-46 | Muhammed Ashraf, Jyothis George, Ibad Sha I

Author: Muhammed Ashraf [1], Jyothis George [1], Ibad Sha I [1]

[1] Department of Orthopedics, Government Medical College, Alappuzha.

Address of Correspondence
Dr. Muhammed Ashraf,
Professor and HOD
Department of Orthopedics
Government Medical College, Alappuzha


Background: Avascular Necrosis / Osteonecrosis of the femoral head is a debilitating condition affecting the hip joint especially in the younger population and is one of the most common causes of total hip replacement in this age group. The available treatments include pharmacological and surgical options with Total hip arthroplasty (THA) being the main stay of treatment. Because of the disadvantages like implant loosening and need for revision surgery especially in young patients. We here is studying a novel technique of combining micro core decompression with intra-lesional bisphosphonate as treatment for osteonecrosis of hip.
Materials and Methods: A prospective study of 19 hips in 15 patients was done. There were 11 males and 4 females with an average age of 54.3 years ranging between 42 – 63 years. Four hips were stage I , ten hips were stage IIA, three hips were stage IIb and two hips were stage III. 16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The minimum period of follow up was 24 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS) and radiologically by X-rays. The operative procedure include decompressing the avascular area with drilling then injecting the zolendronic acid locally through drill holes
Results: The mean preoperative modified Harris Hip Score in stage I(n=4), stage IIa(n=10), stage IIb(n=3) and Stage III(n=2) were 81.9, 72.7, 68.8 and 59.2 respectively. The mean postoperative modified Harris Hip Score at two years in stage I, stage IIa, stage IIb and Stage III were 97.3, 91.1, 88.4 and 82.5 respectively.
Conclusion: We found that the use of micro core-decompression with intra-lesional bisphosphonate will provide higher chances towards hip preservation especially in late cases or cases with larger lesions where core decompression may not be successful.
Keywords: Intra-lesional bisphosphonate, Avascular necrosis hip, Hip preservation surgery, Micro core-decompression.


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How to Cite this article: Ashraf N, George J, Sha II. Micro-core Decompression combined with Intralesional Zoledronic Acid as a treatment of Osteonecrosis of femoral Head: A Novel Technique. Journal of Clinical Orthopaedics Jan-Jun 2020;5(1):  41-46.

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