Low Rate of Return to Impact Activity Following Core Decompression for Femoral Head AVN in Military Servicemembers.

Introduction: Femoral head avascular necrosis (AVN) is a debilitating disease with core decompression commonly performed for early stage disease. However, the ability to return to high-activity levels following treatment is largely unknown.

Materials and Methods: Active military patients undergoing core decompression for femoral head AVN were reviewed. Demographic variables were identified and visual analog pain data was collected at a minimum of 2-year post-surgery or prior to total hip arthroplasty (THA). Patient outcomes, need for THA, and ability to remain on active service were recorded from chart review. Imaging studies were reviewed to classify the lesion stage and size for correlation with progression to THA or discharge from military service.

Results: A total of 29 active duty patients met inclusion criteria (22 male, 7 female; 32.3 years). Seven patients (24%) progressed to THA and they were more likely to have bilateral disease (86%) and be older (35.4 years versus 31.2 years). At final follow-up, 86% of patients had significant hip-related activity restrictions, with only 6 (21%) remaining on active military service. Neither Steinberg stage nor modified Kerboul necrotic angle was associated with progression to THA or military discharge.

Conclusion: Military servicemembers undergoing core decompression for femoral head AVN experienced mild clinical improvement with moderate survivorship from THA (74%) at mid-term follow-up. However, servicemembers have a low likelihood of returning to preoperative physical function and running activities (13.7%). Older patients and those with bilateral disease were at a higher risk of progressing to THA.