Objective: The management of pre-collapse osteonecrosis of the femoral head is controversial. Core decompression is a technique that theoretically decreases the intraosseos pressure of the femoral head, and is appropriate for Ficat Stage II AVN, and in a small proportion of patients at the transition from stage II to III. Arthroscopic evaluation can aid in staging femoral head AVN in cases in which X-ray and MRI findings are equivocal. We describe the technique of arthroscopic evaluation to aid in staging of femoral head osteonecrosis, and core-decompression of the femoral head.
Case Report: We present a case of AVN in a young SLE patient on chronic high-dose corticosteroid therapy, who we found appropriate for arthroscopic evaluation and treatment with core decompression due to inconclusive X-ray and MRI findings.
Conclusion: The advantages of arthroscopic evaluation and treatment include the ability to evaluate by direct visualization the articular surface for the presence or absence of articular cartilage injury, subchondral collapse, and guidance during reaming and curettage. It also allows the ability to address and concomitant soft-tissue or bony pathology associated with or in addition to the osteonecrotic lesion.
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