Arthroscopic core decompression results in improved clinical outcomes compared to standard core decompression of femoral head osteonecrosis at 4 years

Osteonecrosis of the femoral head (ONFH) is a debilitating condition that often progresses to total hip arthroplasty (THA) if untreated. Core decompression is a standard surgical intervention, but the role of arthroscopic-assisted core decompression in improving outcomes remains under investigation. This study aimed to compare patient-reported outcomes, complication rates, and conversion to THA following arthroscopic core decompression versus standard core decompression in patients with ONFH. A total of 49 patients were included in this retrospective case control study, 24 patients underwent arthroscopic core decompression and 25 patients received standard core decompression. The primary outcomes were conversion to THA, complication rates, the modified Harris Hip Score (mHHS) at a minimum follow-up of 4 years. Preoperative demographics, symptom duration, and disease stages were similar between groups. Postoperatively, the arthroscopic group had significantly higher mean mHHS scores than the standard group (P < 0.001). Conversion to THA was similar between groups (arthroscopic n = 1, 4% versus standard n = 5, 20%, P = 0.09). Minor complication rates were similar (arthroscopic n = 6, 25% versus standard n = 6, 24%, P = 0.94); however, the arthroscopic group had more pudendal nerve neuropraxias, while the standard group experienced more wound-related complications. Hips that underwent arthroscopic core decompression demonstrated similar survival rates, with higher postoperative clinical outcome scores in terms of mHHS than those in the standard group. This suggests that arthroscopic core decompression enables the treatment of additional intra-articular pathologies, such as femoroacetabular impingement syndrome, cartilage defects, and labral tears, which could improve clinical outcomes.