Image Quiz Part 2: Treatment Alternatives for Osteonecrosis of the Femoral Head Amar D. Rajadhyaksha, MD and Michael A. Mont, MD* The Sinai Hospital of Baltimore, The Institute of Advanced Orthopaedics, Department of Orthopaedic Surgery, Baltimore, Maryland

Introduction: We ended last month's Image Quiz on osteonecrosis of the femoral head with a proposed treatment algorithm based on findings of radiographic and magnetic resonance imaging. This month we will discuss various treatment alternatives for this disease.

Core Decompression: This procedure is believed to decrease intraosseous pressure, thus improving intraosseous circulation and preventing further ischemia1-4. Some authors advocate core decompression as a treatment for precollapsed, small to medium-sized (having a combined necrotic angle of < 200°) Ficat and Arlet stage-I and stage-II central lesions4. Poor results have been reported in large (having a combined necrotic angle of ³ 200°) stage-I and stage-II lesions, collapsed lesions, and stage-III lesions. Since core decompression has achieved variable success rates (range, 33% to 95%)4 , indications for this procedure remain controversial.

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*Michael A. Mont, MD Department of Orthopaedic Surgery The Sinai Hospital of Baltimore Sinai Medical Office Building, Suite 102 2411 West Belvedere Avenue Baltimore, Maryland 21215

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