Procedures

Core Decompression
Augmented with Grafton® DBM Gel

Roy K. Aaron, M.D.
Clinical Associate Professor
Department of Orthopedics, Brown University
The patient is a 47-year-old female with systemic lupus erythematosus who received a kidney transplant one year before this procedure. She was administered a high dose of corticosteroids and, as a result, developed osteonecrosis in both hips. There was typical patchy sclerosis involving almost the entire femoral head, but with a well-preserved joint space and no evidence of collapse.

A 4.5mm hole is drilled in the lateral cortex and a guide wire is passed into the zone of necrosis.
The guide wire and hip reamer are both withdrawn.
Grafton® DBM Gel in 1cc syringes is then used to fill the core track.
 Generally, approximately 6 cc of Grafton® DBM Gel are required. Grafton® DBM Gel should reach the lateral cortex.

¹ For postoperative care:
* All patients will be placed on a protective weight-bearing 3-point gait with crutches for 6 weeks
General Remarks
Dr. Aaron used Grafton® DBM Gels that were processed by Osteotech, Inc. Following are Dr. Aaron's recommended guidelines for Core Decompression.
Indications for Use of the Grafton® DBM Gel
If Core Decompression is appropriate for the patient, Grafton® DBM Gel can be used to augment.

Detailed Description
  • The patient is placed supine on a fracture table and the procedure is carried out with biplane image fluoroscopy.

  • A midlateral incision is made beginning at the vastus ridge and extending distally for approximately 8-10 cm. The fascia lata and vastus lateralis are opened in line with the incision. A guide wire is placed over the femoral neck and the appropriate location for entry to the lateral cortex is identified fluoroscopically.

  • 4.5mm hole is drilled in the lateral cortex and a guide wire is passed into the zone of necrosis. The position of the guide wire is in the central portion of the necrotic zone, taking care to stay appropriate 5 mm from the subchondral bone plate.
  • An 8mm cannulated hip reamer is used to over-ream the guide wire up to the zone of necrosis. The guide wire and hip reamer are both withdrawn.
  • A trephine is then used to obtain a specimen for histological examination. The core track can be completed with either the trephine or the hip reamer to within 5 mm of the subchondral plate
  • Grafton® DBM Gel in 1cc tuberculin syringes is then used to fill the core track. The entire syringe is inserted into the core track and 1 cc of Grafton DBM Gel is delivered as deeply as possible. It is then gently pressed into the necrotic zone using a tamp. A series of syringes is utilized to fill the core track with gentle tamping after each syringe. Generally approximately 6 cc of Grafton® DBM Gel are required. Grafton® DBM Gel should reach the lateral cortex.

  • It is important to place a finger over the drill hole in the lateral cortex to prevent Grafton® DBM Gel from extruding while the soft tissues are copiously irrigated to remove any Grafton® DBM Gel that may have leaked into the vastus lateralis.

  • The vastus lateralis fascia is closed with a running 2-0 Vicril. The fascia lata is closed with a running 0 Vicril. Subcutaneous tissues are irrigated and closed with 2-0 Vicril and the skin is approximated with skin clips. A sterile dressing is applied

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