Core Decompression
Overview
Dr. Aaron used Grafton DBM Gel. The following are Dr. Aaron's recommended guidelines for Core Decompression.
Patient Background
The patient is a 47-year-old female with systemic lupus erythematosus who received a kidney transplant one year before this procedure. She was administered a high dose of corticosteroids and, as a result, developed osteonecrosis in both hips. There was typical patchy sclerosis involving almost the entire femoral head, but with a well-preserved joint space and no evidence of collapse.
Procedure
- The patient is placed supine on a fracture table and the procedure is carried out with biplane image fluoroscopy.
- A midlateral incision is made beginning at the vastus ridge and extending distally for approximately 8-10cm. The fascia lata and vastus lateralis are opened in line with the incision. A guide wire is placed over the femoral neck and the appropriate location for entry to the lateral cortex is identified fluoroscopically.
- 4.5mm hole is drilled in the lateral cortex and a guide wire is passed into the zone of necrosis. The position of the guide wire is in the central portion of the necrotic zone, taking care to stay appropriate 5mm from the subchondral bone plate.
- An 8mm cannulated hip reamer is used to over-ream the guide wire up to the zone of necrosis. The guide wire and hip reamer are both withdrawn.
- A trephine is then used to obtain a specimen for histological examination. The core track can be completed with either the trephine or the hip reamer to within 5mm of the subchondral plate.
- Grafton DBM Gel in 1cc tuberculin syringes is then used to fill the core track. The entire syringe is inserted into the core track and 1cc of Grafton DBM Gel is delivered as deeply as possible. It is then gently pressed into the necrotic zone using a tamp. A series of Grafton DBM Gel syringes is utilized to fill the core track with gentle tamping after each syringe. Generally approximately 6cc of Grafton DBM Gel are required. Grafton DBM Gel should reach the lateral cortex.
- It is important to place a finger over the drill hole in the lateral cortex to prevent Grafton DBM Gel from extruding while the soft tissues are copiously irrigated to remove any Grafton DBM Gel that may have leaked into the vastus lateralis.
- The vastus lateralis fascia is closed with a running 2-0 Vicril. The fascia lata is closed with a running 0 Vicril. Subcutaneous tissues are irrigated and closed with 2-0 Vicril and the skin is approximated with skin clips. A sterile dressing is applied.