Concomitant Hip Arthroscopy Is Associated With Improved Outcomes of Core Decompression for Osteonecrosis of the Femoral Head: A Systematic Review.

Purpose: To evaluate the effectiveness of core decompression (CD) with concomitant arthroscopic treatment of intra-articular pathologies for improving outcomes for patients with osteonecrosis of the femoral head (ONFH) and intra-articular pathology and to compare results with patients undergoing isolated CD. Methods: A systematic literature review was conducted using PubMed, MEDLINE, and Cochrane Library databases through July 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing CD with and without hip arthroscopy (HA) were included, provided they reported patient-reported outcomes (PROs), survivorship, or total hip arthroplasty (THA) conversion rates. Studies were excluded if HA was solely diagnostic. Quality was assessed using Methodological Index for Non-Randomized Studies and Risk Of Bias In Non-randomised Studies - of Interventions. Data extracted included demographics, surgical techniques, PROs, and THA-free survivorship. Results: Six studies (4 Level III, 2 Level IV) met the inclusion criteria, comprising 632 hips with mean ages ranging from 35.5 to 41.1 years. All studies reported pre- and postoperative Harris Hip Score, and one included visual analog scale pain scores. Patients undergoing CD with HA had significantly greater postoperative Harris Hip Score (71.41-93.33) and improved THA-free survivorship compared with CD alone. Three of four comparative studies showed significantly lower THA conversion rates and femoral head collapse in the HA group. However, no study directly showed that HA improved bone healing. Conclusions: CD with HA results in better PROs and femoral head survivorship compared with CD alone, likely because of intra-articular pathology treatment and improved joint function. Core decompression with concomitant hip arthroscopy to address intra-articular pathology should be considered for pre-collapse ONFH. Level of Evidence: Level IV, systematic review of Level III and IV studies.