Modified technique of advanced core decompression for treatment of femoral head osteonecrosis

Figure 1 The tool for the surgery (Yierkang Technology Development Co. , Ltd, Beijing, China). A: Single blade expandable reamer; B: 2.5 mm guide wire; C: The guiding device with a convex tip (introducer) for fixing it on the lateral cortical bone of femur; D: Retainer of the introducer; E: Trephine; F: Cannulated drill; G: Handle of the trephine and cannulated drill; H: Bone graft funnel; I: Pestles.

Figure 2 Association Research Circulation Osseous classification system. CT: Computed tomography; MRI: Magnetic resonance imaging.

Figure 3 The main steps of the percutaneous expanded decompression and mixed bone graft technique under C-arm fluoroscopy. A: Intraoperative posture of the patient; B: A 12 mm trephine into the lesion area under guidance of the introducer; C: Turning the handle and the blade control knob on it. The reamer can be rotated and the blades expanded; D: The residual necrotic lesions are removed by cleaning with a sharp spoon; E: Autologous bone from the ipsilateral ilium mixing allogeneic bone pieces with bone marrow aspirate; F: a: Before bone grafting; b: Introduce the bone graft funnel into the drilling channel; c: Tamp the mixture with a pestle; d: Bone graft completed.

Figure 4 Radiography and computed tomography of the implanted bone. A: Preoperative radiograph; B: Preoperative magnetic resonance imaging; C: Postoperative radiograph; D: Postoperative computed tomography.