Arthroscopy Hip - Decompression

Hip core decompression is a surgical procedure used to treat osteonecrosis or avascular necrosis (AVN) of the hip. It involves drilling one larger hole, or several smaller holes into the dead bone of the femoral head (top of the thigh bone) in order to relieve pressure in the bone

Arthroscopy Hip Decompression is a less invasive outpatient procedure in which a surgeon makes a small hole outside the hip and taps into the diseased area. 

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When do Doctor suggest Arthroscopy Hip - Decompression?

There are many reasons why the doctor may recommend a hip arthroscopic surgery and some are listed as below:

  • Diagnostic hip arthroscopy (to determine the cause of hip pain).

  • Hip instability

  • Repair or remove tears in the hip.

  • To manage hip-joint infection.

  • Hip-lining inflammation.

  • To investigate a painful hip resurfacing or joint replacement.

  • To remove loose or foreign bodies.

  • Femoroacetabular impingement (FAI)

  • Acetabular labral tears.

What are the conditons of Arthroscopy Hip - Decompression?

The most commonly observed conditions, which need hip arthroscopic surgery, are FAI and acetabular labral tears.

Core decompression of the femoral head is performed by hip arthroscopy. This procedure is especially effective in osteonecrosis of the femoral head.

Core decompression is performed to defer or even prevent arthroplasty for the early stages of avascular necrosis. Core decompression involves first identifying the necrotic areas in the bone. These are generally identified by a fluorescent dye. 

Once identified, the surgeon drills holes up to 4mm in diameter. It could be a single hole or multiple holes depending on the affected area in the bone. 

This is to release the pressure built up in the joint and make way for new blood vessels to make channels and better vascularized the drilled area in the bone.

What is Procedure for Arthroscopy Hip - Decompression?

The doctor may combine one or more procedures along with core decompression.

These procedures include implanting a bone graft or other organic substances that facilitate tissue regeneration in the decompressed bone.

 Materials used as graft are as follows:

  • Autograft: 

Healthy bone from another area of the body (referred to as autograft), replaces the area of the decompressed region in the bone. 

The transplanted bone now gets integrated into the new location forming a new healthy bone. 

  • Vascularized bone graft: 

In this type, the bone segment is taken from the ankle or lower leg and the doctor may also include an intact artery or vein. 

This is called a vascularized bone graft. This graph helps restore blood supply in the decompressed bone. 

This source of graft is considered only for healthy individuals, where the donor site poses no risk of complication. 

  • Allograft: 

When the graft cannot be taken from the patient's own body because the bone is not healthy to support the blood vessels, a graft from a donor is taken. This is then called an allograft. 

It may take a longer duration for this kind of graft to integrate into the body, but is known to produce similar kinds of results. 

  • Biologic injections:

 Along with core decompression, the doctor may also prefer to inject organic material called biologics. 

These could be specialized cells programmed for a particular purpose, which in this case is the generation of healthy bone tissue. Or, stimulate the production of chemicals or growth factors at the decompressed sites. The recipient's bone absorbs these. 

What are the Post surgery care to be taken?

Once the procedure concludes, the incision sights are sutured. 

The patient may or may not have to stay overnight at the hospital. Sutures are subsequently removed in the follow-up appointment with the doctor.

 This appointment is generally scheduled two weeks after the procedure. The doctor then schedules monthly appointments to evaluate the healing of the bone. 

 The doctor may also periodically recommend X-ray or MRI scans during the recovery period. 

It takes around 6 - 12 months for the patient to heal completely, while the bone recovers and the blood supply in it re-establishes. 

During the recovery period, the patient may have to use crutches or a walker, as there should be minimum pressure exerted on the hip. 

Many patients undergoing this procedure have experienced complete relief from pain. 

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