Core decompression for avascular necrosis (AVN) of the femoral head continues to be a controversial procedure. Meta-analysis techniques were employed to identify 22 studies with a single surgical core decompression technique. A similar procedure identified eight studies that treated patients conservatively. The success rates for core decompression were 84%, 63%, and 29% for Steinberg stages I, II, and III, respectively. Conservatively treated patients with stage 0, I, III, and III AVN demonstrated success rates of 86%, 61%, 59%, and 25%, respectively. Chi-square analysis showed the success rate of core decompression to be statistically higher than conservative treatment for stage I hips only. Large multicenter prospective double-blinded studies with patients randomized to either core decompression or conservative treatment, then stratified by stage, cause, and bilaterality, are needed to determine the best treatment for early-stage AVN.
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