Endoscopic Sequential Decompression of Avascular Necrosis of the Femoral Head of Nontraumatic Origin: Description of a Surgical Technique

Introduction: Treatment options for nontraumatic avascular necrosis of the femoral head (NAVNT) aim to reduce intraosseous pressure and restore vascular flow to prevent the collapse of the femoral head. The objective of this study was to describe a modification of the standard central decompression technique, called sequential decompression, in patients with NAVNT. Materials and Methods: Sequential decompression consists of 4 stages: (1) negative pressure release with capsulotomy, (2) bone decompression by removing the cortical from the anterior superior part of the femoral head-neck junction, (3) intramedullary decompression and stimulation of osteogenesis through tunnels from the anterolateral aspect of the femoral neck, and (4) stimulation of angiogenesis with the application of platelet-rich plasma in the subchondral plate. Results: Five cases (4 men and 1 woman, age: 28.8±16.4 y) were treated with the sequential decompression technique. A decrease in pain and an improvement in function were observed in all cases. Conclusion: We believe that the approach offered by sequential decompression impacts the different pathophysiological pathways of NAVNT, which helps control intraosseous pressure, removal of necrotic tissue, stimulation of angiogenesis, and bone regeneration. Level of Evidence: Level V, expert opinion.