Fig. 1
From: Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head
The main steps of the modified Advanced Core Decompression technique under fluoroscopic guidance: (a) A 3.2-mm diameter fluted guide wire is introduced close to the tuberculum innominati into the necrotic lesion. b Then a 9-mm cannulated drill bit is used to extend the diameter of the drill hole and a wire-guided trephine (see also Fig. 2) is used to harvest the cancellous bone from the femoral neck. c The next step is the introduction of the X-Ream® expandable reamer into the drilling channel. This instrument is rotated and the blades expanded under fluoroscopic monitoring to debride as much of the dead bone as possible. d A sharp spoon is used for further debridement. e Finally, the core and the surgically created bone defect are backfilled first with autologous bone, (f) then with the PRO-DENSE® injectable graft under fluoroscopic guidance