OSTEONECROSIS OF FEMORAL HEAD: OUTCOME OF CORE DECOMPRESSION WITH CANCELLOUS BONE GRAFTING.

Background: Osteonecrosis of femoral head results in femoral head collapse in 75-85 % of untreated patients. It is debilitating diseases which frequently progressing to femoral head collapse and secondary osteoarthritis of hip joint. Treatment of choice is total hip replacement in end stage of diseases. But it commonly affects males between age group of 20-40 years. Hence in younger age group patients total hip joint replacement is not ideal option in early stages of osteonecrosis. So there was need of study the efficacy of decompression of femoral head and bone grafting with cancellous bone. Material and Method: A prospective analytic study of 70 hips in 50 cases was done. 50 patients with osteonecrosis of femoral head treated between 2014 - 2016. All patients were evaluated clinically and radiologically. Selected cases were belonging to stage 1 and stage 2 modified Ficat and Arlet classification. We performed core decompression and cancellous bone grafting. Outcome was assed clinically with Harris hip score (HHS), Visual analogue score (VAS), and radiologically by x rays and MRI. MRI was done preoperatively to confirm the diagnosis and 3, 6, and 12 months post operatively for assessment of healing. Results: Outcome was assed clinically with Harris hip score (HHS) and Visual analogue score (VAS). In our series of 70 hips in 50 cases, 22 hips had excellent, 28 hips had good outcome, 8 fair and 12 poor. All excellent and good patients returned to their prior activity. Progressive pain and progression of collapse seen in 20 patients having poor and fair results and they eventually ended up in total hip replacement. Conclusion: We found that use of cancellous bone graft in the management of osteonecrosis of femoral head proved to be an excellent treatment modality. Procedure provides decompression of the avascular lesion, removal of necrotic bone and elevation of articular surface of head through core track