Core decompression is a procedure which entails drilling into the femoral neck, up into the necrotic area of the femoral head, to get the bone to heal faster. Theoretically, removing this central core of bone will lower the intraosseous pressure, which is thought to be one of the etiologies of the disease. When properly done, this procedure has minimal morbidity.
In reviewing the literature there is clearly a disparity of results in the use of core decompression regardless of the Ficat stage. In selected patients, core decompression may be indicated for stages 1 and 2. However, for more advanced stages (e.g. 3 and 4) the results are much less predictable. This procedure appears to be best suited for the stage 1 and early stage 2 hips in which pain relief and preservation of the femoral head are relatively predictable (>70%).
Patients must remain non-weight bearing on crutches for 6 weeks following the procedure in order to prevent a small but real risk of fracture.