Arthroscopic Management of Avascular Necrosis

Avascular necrosis of the hip occurs as blood flow to the femoral head becomes compromised, leading to necrosis of osteocytes, localized resorption of bone, and collapse of the unsupported articular cartilage. Historically, the management of avascular necrosis has included bisphosphonates, core decompression, vascularized or nonvascularized bone grafting, osteotomy, joint resurfacing, and total hip arthroplasty for end stage disease. The use of hip arthroscopy has opened new diagnostic and therapeutic avenues to surgeons that were not previously available for the treatment of avascular necrosis in the hip. Hip arthroscopy offers a direct, minimally invasive technique to accurately classify patients with later-stage disease who may or may not benefit from free vascularized fibula grafts, core decompression with or without grafting, autologous bone marrow transplantation, nonvascularized bone grafting, or other resurfacing procedures. Hip arthroscopy can help improve overall diagnostic accuracy and serve as a direct means of treatment or adjunct to the application of more traditional techniques in avascular necrosis management.