The controversy regarding the efficacy of core decompression as a treatment for osteonecrosis of the femoral head began with initial reports by Ficat (I), Ficat and Arlet (2), and Hungerford (3,4). These authors reported several series of patients for whom the coring procedure was the preferred therapy for osteonecrosis of the femoral head, particularly when performed prior to collapse. More recent studies by Dr. J. F. Camp and myself (3, followed by additional investigations by Hopson and Siverhus (6), have demonstrated a success rate significantly lower than those noted in previous reports.
The basis of this controversy centers on the etiology and pathogenesis of osteonecrosis of the femoral head. In the area of etiology, .there are three distinctive causes for this condition: 1) osteonecrosis secondary to trauma, such as fracture of the femoral neck, with vascular compromise, 2) osteonecrosis associated with known disease processes that have a known pathogenic pathway, such as sickle cell anemia and Gaucher's disease, and 3) osteonecrosis in which a specific mechanism has not been ascertained and, therefore, the pathogenesis has not been well established. Diseases of this type include alcohol-related osteonecrosis, steroid-related osteonecrosis, and a third group identified as idiopathic osteonecrosis. It is