When properly done, this procedure has minimal morbidity. 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. 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. Besides non-operative management and core decompression, there are several other treatment modalities, which include osteotomies, bone grafting, and total hip arthroplasty.
Bone grafting can either be of the non-vascularized or vascularized types.
In the latter the blood vessels of the fibular graft are preserved and transferred along with the graft and subsequently reattached to the blood vessels of the hip. Data has shown encouraging results. Disadvantages of this procedure include a longer recovery period, less complete relief of pain than after total hip arthroplasty. No matter what type they all have the same goal, which is to preserve the femoral head by altering the pattern of stress transfer. A varus osteotomy attempts to shift the most involved portion of the head medially.