{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:15:00Z","timestamp":1793222100073,"version":"4.5.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Osteonecrosis of the femoral head (ONFH) is caused when circulation within the femoral head is disrupted. Etiology of this disease is characterized by either traumatic events or atraumatic risk factors, such as chronic alcohol consumption or glucocorticoid use. ONFH commonly presents as pain in the groin, gluteus muscles, and\/or knee with reductions in internal rotation range of motion of the hip. ONFH pathology can be confirmed with radiographic or advanced imaging and characterized by stage, size and location of the lesion. Treatment for ONFH consists of conservative and therapeutic methods as well as surgical intervention. Historically, ONFH has been treated using total hip arthroplasty (THA), but with increasing incidence in a younger, active population, measures to preserve the native hip joint have been explored. Recent advancements in hip arthroscopy and arthroscopy-assisted core decompression have led to improved outcomes, reduced pain and higher hip survival rate for early onset ONFH compared with more invasive approaches such as THA. Biologic treatments combined with arthroscopic core decompression have also shown improved outcomes and quality of life in few reports, suggesting a potential role for biologic adjuncts. The current study provides a comprehensive review and update on the literature surrounding arthroscopy-assisted core decompression for patients with ONFH.<\/jats:p>","DOI":"10.3389\/fsurg.2022.662722","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T05:13:04Z","timestamp":1649394784000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Updates on Management of Avascular Necrosis Using Hip Arthroscopy for Core Decompression"],"prefix":"10.3389","volume":"9","author":[{"given":"Kyle N.","family":"Kunze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer W.","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict U.","family":"Nwachukwu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1016\/S0020-1383(16)30835-X","article-title":"The physiopathology of avascular necrosis of the femoral head: an update","volume":"47","author":"Guerado","year":"2016","journal-title":"Injury."},{"key":"B2","first-page":"284","article-title":"Nicolas Andry award. The biology of osteonecrosis of the human femoral head and its clinical implications: 1. Tissue biology","author":"Glimcher","year":"1979","journal-title":"Clin Orthop."},{"key":"B3","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1097\/00003086-197903000-00040","article-title":"The biology of osteonecrosis of the human femoral head and its clinical implications: II. The pathological changes in the femoral head as an organ and in the hip joint","volume":"139","author":"Glimcher","year":"1979","journal-title":"Clin Orthop."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e3171","DOI":"10.7759\/cureus.3171","article-title":"Osteonecrosis of the femoral head: etiology, investigations, and management","volume":"10","author":"Baig","year":"2018","journal-title":"Cureus."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.2106\/JBJS.O.00071","article-title":"Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update","volume":"97","author":"Mont","year":"2015","journal-title":"J Bone Joint Surg Am."},{"key":"B6","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s12178-015-9277-8","article-title":"Pathophysiology and risk factors for osteonecrosis","volume":"8","author":"Shah","year":"2015","journal-title":"Curr Rev Musculoskelet Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"590","DOI":"10.5312\/wjo.v6.i8.590","article-title":"Current concepts on osteonecrosis of the femoral head","volume":"6","author":"Moya-Angeler","year":"2015","journal-title":"World J Orthop."},{"key":"B8","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/j.ocl.2013.07.004","article-title":"Osteonecrosis of the hip: treatment options and outcomes","volume":"44","author":"Banerjee","year":"2013","journal-title":"Orthop Clin North Am."},{"key":"B9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1093\/bmb\/ldw010","article-title":"Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis","volume":"118","author":"Sadile","year":"2016","journal-title":"Br Med Bull."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1016\/S0140-6736(17)30190-3","article-title":"Total joint arthroplasty in younger patients: heading for trouble?","volume":"389","author":"Schreurs","year":"2017","journal-title":"Lancet."},{"key":"B11","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.ocl.2018.10.001","article-title":"Osteonecrosis of the femoral head","volume":"50","author":"Cohen-Rosenblum","year":"2019","journal-title":"Orthop Clin North Am."},{"key":"B12","doi-asserted-by":"publisher","first-page":"455","DOI":"10.5435\/JAAOS-22-07-455","article-title":"Osteonecrosis of the femoral head: evaluation and treatment","volume":"22","author":"Zalavras","year":"2014","journal-title":"J Am Acad Orthop Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1097\/00003086-200401000-00006","article-title":"Core decompression for osteonecrosis of the hip","volume":"418","author":"Lieberman","year":"2004","journal-title":"Clin Orthop."},{"key":"B14","doi-asserted-by":"publisher","first-page":"16","DOI":"10.2106\/JBJS.F.00457","article-title":"Systematic analysis of classification systems for osteonecrosis of the femoral head","volume":"88","author":"Mont","year":"2006","journal-title":"JBJS."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1007\/s00264-018-4018-4","article-title":"Classification systems of hip osteonecrosis: an updated review","volume":"43","author":"Sultan","year":"2019","journal-title":"Int Orthop."},{"key":"B16","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/s13018-018-0836-8","article-title":"Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: a meta-analysis and systematic review","volume":"13","author":"Zhang","year":"2018","journal-title":"J Orthop Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1093\/jhps\/hnaa059","article-title":"Arthroscopic assessment of concomitant intraarticular pathologies in patients with osteonecrosis of the femoral head","volume":"7","author":"Serong","year":"2020","journal-title":"J Hip Preserv Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e1531","DOI":"10.1016\/j.eats.2020.06.015","article-title":"Arthroscopic-assisted intraosseous bioplasty of the acetabulum","volume":"9","author":"Ankem","year":"2020","journal-title":"Arthrosc Tech."},{"key":"B19","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s00064-011-0072-4","article-title":"Arthroskopisch gest\u00fctzte Behandlung der aseptischen H\u00fcftkopfnekrose [Arthroscopically assisted therapy of avascular necrosis of the femoral head]","volume":"25","author":"Ellenrieder","year":"2013","journal-title":"Oper Orthop Traumatol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1007\/s00167-011-1587-9","article-title":"Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip","volume":"20","author":"Guadilla","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"B21","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3969\/j.issn.1003-0034.2018.01.010","article-title":"[Arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for treatment of early stage avascular necrosis of femoral head]","volume":"31","author":"Guo","year":"2018","journal-title":"Zhongguo Gu Shang."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1016\/j.eats.2013.08.002","article-title":"Arthroscopic-assisted core decompression for osteonecrosis of the femoral head","volume":"3","author":"Gupta","year":"2013","journal-title":"Arthrosc Tech."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e225","DOI":"10.1016\/j.eats.2012.08.004","article-title":"Endoscopic and arthroscopic assistance in femoral head core decompression","volume":"1","author":"Pierannunzii","year":"2012","journal-title":"Arthrosc Tech."},{"key":"B24","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s00064-019-00643-w","article-title":"Nontraumatic avascular necrosis of the femoral head arthroscopic and navigation-supported core decompression","volume":"32","author":"Theopold","year":"2020","journal-title":"Oper Orthop Traumatol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1186\/s12891-019-2853-0","article-title":"Mid-term outcomes of arthroscopic-assisted core decompression of precollapse osteonecrosis of femoral head-minimum of 5 year follow-up","volume":"20","author":"Nazal","year":"2019","journal-title":"BMC Musculoskelet Disord."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.662722\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T05:13:08Z","timestamp":1649394788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.662722\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,8]]},"references-count":25,"alternative-id":["10.3389\/fsurg.2022.662722"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.662722","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,8]]},"article-number":"662722"}}