Arthroscopic-assisted core decompression for avascular necrosis of the femoral head demonstrates favorable clinical outcomes: a systematic review.

Abstract

This systematic review aims to evaluate clinical outcomes for arthroscopic-assisted core decompression (AACD) for avascular necrosis (AVN) of the femoral head. A literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in PubMed, Embase, and Scopus. Nine studies were included, five comparing AACD with isolated core decompression (CD) and four evaluating outcomes of only AACD. A total of 358 patients (462 hips, 71.8% male) underwent AACD. In the five comparative studies, the AACD and isolated CD groups had 97.6% (72.2-100.0%) and 98.5% (81.0-100.0%) of hips with precollapse AVN, respectively. The modified Harris hip score, reported in five comparative studies, was significantly higher in the AACD group in four studies and not significantly different in one study. The visual analog scale pain score, reported in two comparative studies, was significantly lower in the AACD group in one study and not significantly different in the other study. The collapse rate ranged from 2.9% to 14.0% at a mean follow-up of 37.9 months in the AACD group and from 14.6% to 28.6% at a mean follow-up of 34.7 months in the isolated CD group, with all five comparative studies reporting significantly higher collapse rates in the isolated CD group. In the four AACD only studies, 42.9-100.0% of hips had precollapse AVN with the collapse rate ranging from 23.2% to 45.5% at a mean follow-up of 39.2 months. Patients undergoing AACD for treatment of AVN of the femoral head demonstrate excellent patient-reported outcomes and low rate of collapse and complications, with a possibility of superior outcomes compared to isolated CD.