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A case of Bilateral AVN that has been treated with Core decompression.

Core decompression

intra operative image by C arm of the hip shows core decompression technique
Core decompression is a surgical procedure performed to treat osteonecrosis that involves drilling into the area of necrotic bone near the joint. This reduces intraosseos pressure, allows for increased blood flow, and slows or sometimes stops bone and/or joint destruction.

Avascular necrosis of the head of the femur is caused by disruption of the blood supply of the femoral head, which finally results in hip pain and osteoarthritis. Non traumatic osteonecrosis may be related with corticosteroid , alcohol , SLE, hemoglobinopathies or cytotoxic agents.

Stages of osteonecrosis (AVN) 
Stage 1 
 normal x-rays and MRI shows the dead bone. 
Stage 2 
 Sclerosis and radiolucent areas on regular x-ray but there is no collapse of the femoral ball. 
Stage 3
signs of collapse, a crescent sign. 
Stage 4 
collapse on x-ray and signs of cartilage damage (osteoarthritis).

Case presentation 

28 years old case of bilateral AVN. She was complaining of pain with weight bearing. The condition started 1 year ago, but there was a delay in requesting X ray and MRI. The was limitation of range of motion with painful internal rotation of the both hips, more on the right hip. 

X ray and MRI show bilateral AVN of the head of the femur. It was grade ll on the left and grade lll on the right hip. 

Core decompression was done in both hips that was done with only 10 mm incision on each side.