Introduction Osteoporosis of the femoral neck contributes significantly to hip fracture risk and remains challenging to treat due to the limitations of systemic pharmacotherapies. We investigated whether direct intra-medullary visualization of the femoral neck is feasible and could support localized therapeutic delivery. Methods Four cadaveric femoral specimens were evaluated. A guidewire was placed into the femoral neck under biplanar fluoroscopy, followed by canal access using a 5 mm reamer. A 4 mm standard arthroscope was inserted, and the cavity was irrigated and debrided using a 3.5 mm shaver and a radiofrequency probe. Tetracycline and Alizarin Red dyes were instilled and visualized under ultraviolet and green light, respectively. Results The intramedullary cavity of the femoral neck was easily accessed and visualized. Loose cancellous bone, fibrous, and adipose tissue were observed and removed. The inferior femoral neck appeared softer than the superior portion. Bi-portal access allowed effective irrigation, visualization, and working space maintenance. Fluorochrome-based imaging revealed patchy areas of fluorescence, demonstrating potential for localized labeling and future targeted delivery. No obstruction to fluid inflow or visualization was noted. Discussion Intraosseous visualization enabled both structural assessment and localized labeling of the femoral neck intramedullary canal. This approach may support novel future strategies to prevent fractures of the femoral neck from osteoporosis. Conclusion This pilot cadaveric study demonstrates that the femoral neck intramedullary canal can be accessed and visualized using standard arthroscopic tools. This approach allows for real-time visualization and cavity preparation, providing a potential route for targeted osteoporosis therapies. Further development of endoscopic imaging systems and localized delivery agents may enable biologic reconstruction of compromised bone while minimizing systemic exposure.
Qureshi et al. (Tue,) studied this question.