The role of arthroscopic debridement in the management of avascular necrosis (AVN) of the femoral head is limited. Arthroscopic debridement has been used for end-stage disease in young patients as an effort to delay the eventual need for total hip replacement. For this circumstance, the results are uniformly poor.69,70 Symptomatic improvement, at best, is brief and rarely justifies the procedure. Ruch et al. explored the role of arthroscopy in staging of AVN of the femoral head.71 They found arthroscopy to be of no benefit in the evaluation of stage II (precollapse) disease or in young patients (<30 years of age) with stage III (sub-chondral fracture) disease. These are thought to be the best candidates for free-vascularized fibular grafting, and none of these cases had delamination of the articular surface. They advocate diagnostic arthroscopy for stage IV (postcollapse) patients who are otherwise candidates for osteotomy or vascularized graft. If complete delamination of the articular surface was encountered, they would debride the fragment and perform a simple core decompression. These patients also often have coexistent labral pathology and acetabular fragmentation that can be debrided. O'Leary et al. reported their retrospective experience in patients with osteonecrosis.72 In general, osteonecrosis was found to be a poor prognostic indicator but was not a contraindication to arthroscopy. Accompanying mechanical symptoms were a better prognostic indicator of potentially treatable pathology, delaying the eventual need for arthroplasty. However, they would not recommend arthroscopy in the presence of osteonecrosis and absence of mechanical symptoms.
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.