[Modified advanced core decompression (mACD)].

[Modified advanced core decompression (mACD)].
Oper Orthop Traumatol. 2020 Mar 09;:
Authors: Landgraeber S, Jäger M
Abstract
OBJECTIVE: The modified advanced core decompression (mACD) combines the advantages of a low invasive core decompression with maximal removal of osteonecrotic bone and a biologic reconstruction of the resulting bone defect.
INDICATIONS: Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stage II).
CONTRAINDICATIONS: Subchondral fractures (ARCO stage III); advanced osteoarthritis (e.g., ACRO stage IV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions.
SURGICAL TECHNIQUE: Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a 3.2 mm guide wire. Removal of a bone cylinder from a nonaffected area of the femoral neck using a hollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by a curette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute.
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Source: Operative Orthopadie und Traumatologie - March 8, 2020 Category: Orthopaedics Authors: Landgraeber S, Jäger M Tags: Oper Orthop Traumatol Source Type: research