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The following is a summary of “Personalizing core decompression grafting technique for osteonecrosis of the femoral head: calculating the volume of bone resected and adjunct volume required to fill the defect,” published in the March 2025 issue of the Journal of Orthopaedic Surgery and Research by Bergemann et al.

Osteonecrosis of the femoral head (ONFH) is a progressive and debilitating condition that can ultimately lead to femoral head collapse and necessitate hip arthroplasty. Core decompression has become a widely utilized intervention aimed at preventing disease progression, often supplemented with adjunctive therapies such as bone grafts, bone marrow aspirate concentrates, or synthetic bone substitutes to enhance native bone regeneration. However, accurately determining the volume of bone resected and the corresponding amount of adjunct required remains a significant challenge, particularly with the advent of newer minimally invasive reamers. Inadequate or excessive filling of the defect may compromise treatment outcomes by either failing to sufficiently support bone regeneration or causing undue pressure and morbidity.

To address this issue, we introduce a straightforward intraoperative mathematical method for accurately estimating the volume of bone resected during core decompression performed with an expandable reamer. This approach models the core decompression defect as two cylindrical volumes, allowing for precise calculations based on simple intraoperative measurements. The method is adaptable for use with various expandable reamer systems and enables surgeons to personalize the amount of adjunct material required for each patient, optimizing treatment efficacy.

By implementing this technique, surgeons can achieve a more standardized and reproducible approach to defect filling, minimizing the risks associated with under or over-filling. To facilitate clinical application, we provide a user-friendly worksheet that allows for rapid intraoperative calculations, assisting surgeons in making evidence-based decisions regarding adjunctive material usage. Given the critical role of adjunctive therapies in core decompression procedures, ensuring proper defect filling is essential for improving patient outcomes, reducing complication rates, and maximizing the long-term success of ONFH treatment.

Source: josr-online.biomedcentral.com/articles/10.1186/s13018-025-05606-5