Management of osteonecrosis of the femoral head: A novel technique.

Sir,

We read with interest the article titled, “Management of osteonecrosis of the femoral head: A novel technique”.1 We appreciate the work of author; however, we would like to share our queries regarding the study.

In osteonecrosis of femoral head, the aim is to prevent collapse of articular surface which is lined by cartilage. Removal of necrotic bone by making trapdoor is well described in literature. Mont et al. in their technique removed the necrotic bone from femur head by making a trapdoor at damaged articular surface and finally replaced that trap door, preserving the articular cartilage whatever present.2 Samy in his technique approached the necrotic bone by removing articular surface, curetted the whole necrotic bone, filled the cavity with cancellous bone mixed with platelet-rich plasma, and finally covered it with collagen sheet. Did author conclude in his study that collagen sheet, along with increasing reparable capacity of subchondral bone? Also provides satisfactory alternative to the damaged articular cartilage?

Core decompression is the most common procedure done to salvage the joint in osteonecrosis of femoral head. Standard technique of core decompression includes removal of 8–10 mm of bone core, but with time, this technique has been improved and nowadays multiple drill holes of small diameter have been found to be equally effective with lesser chances of complications.3 Drilling is done starting from subtrochanteric femur cortex to reach the necrotic lesion (very specific) to relieve the raised pressure in bone. Authors in his technique removed all necrotic bone by curettage, so what was the rationale behind drilling normal cancellous bone that too with 1.5 cm depth, irrespective of thickness of remained normal bone in femur head

What was the reason for giving 3 days skin traction postoperatively? If it was intended to relieve the pressure at articular surface to allow healing, did author find skin traction sufficient to provide adequate traction at hip joint? And did author believe that 3 days period was sufficient for healing at femoral head site?

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Conflicts of interest

There are no conflicts of interest.