In core decompression, a surgeon uses a drill to remove diseased tissue from the inside of the bone affected by osteonecrosis. This procedure relieves pressure within the bone, increasing blood flow and allowing new blood vessels to form.
A doctor may also perform one or more additional procedures at the same time as core decompression. These allow the surgeon to insert a bone graft or organic materials into the decompressed bone to help tissue regenerate.
Surgeons may take healthy bone tissue from another part of your body and use it to replace the diseased bone. This type of bone graft is called an autograft. The transplanted tissue grows in its new location, and the new, healthy bone cells generate strong bone tissue.
Vascularized Bone Graft
When a segment of bone is taken from another part of your body—typically the lower leg or ankle—doctors may remove an intact artery and vein as well. This is called a vascularized bone graft. These transplanted blood vessels help to restore blood supply to the bone.
Vascularized bone grafts are used only in those with healthy blood vessels. People who smoke or have peripheral artery disease may not be candidates. The possibility of complications at the donor site may also affect the decision to use a vascularized graft.
If bone can’t be taken from a person’s own body because the bones or supporting blood vessels aren’t healthy enough, doctors use bone tissue that was donated to a bone bank. Called an allograft, this type of bone graft may take longer to incorporate into the bone, but when incorporated, it produces similar results as a graft taken from your own bone.
Allograft bone can be combined with other biologic materials to help the transplanted tissue incorporate into the surrounding bone.
Another procedure sometimes performed during core decompression is the injection of organic materials called biologics. These can be living cells that have been customized to perform a specific function—in this case, to regenerate healthy bone cells or to produce growth factors and other chemical substances that aid in bone healing.
Doctors inject biologics into the interior of the bone during core decompression, and they are absorbed into the bone.
Stem Cell Transplantation
Stem cell transplantation is an experimental technique performed at NYU Langone that uses stem cells harvested from a person’s own bone marrow to stimulate the growth of new, healthy bone cells.
First, doctors use local anesthesia to numb the area, then extract bone marrow from the pelvic bone using a needle. After the stem cells are separated from blood and other substances, doctors inject them into the hollow part of the diseased bone, where they create new bone cells and speed healing.
What to Expect After Core Decompression
Typically, procedures that involve core decompression—which may or may not also include a bone graft or injection of organic materials—take 6 to 12 months to heal fully. You may or may not need to stay overnight in the hospital. Sutures are usually removed during a follow-up appointment scheduled two weeks after surgery, and additional appointments are usually scheduled monthly so your surgeon can monitor how your bones heal.
You may be on crutches for 6 to 12 weeks immediately after your surgery. Doctors can monitor healing progress using X-rays or MRI scans. During that time, your surgeon works closely with NYU Langone physical therapists to customize a timeline for your return to physical activity.