BACKGROUND
ARCO stage IIIA osteonecrosis of the femoral head (ONFH) means early collapse, but total hip replacement may be premature in relatively young patients. This retrospective study aimed to compare outcomes between hip arthroscopy combined with triangular drilling and suction decompression versus standard drilling alone.
MATERIAL AND METHODS
We analyzed 63 patients (76 hips) with ARCO IIIA ONFH treated from January 2018 to October 2022. The triangular group (19 patients, 19 hips, all unilateral) received arthroscopy plus triangular drilling with suction decompression. The standard group (44 patients, 57 hips, including 13 bilateral) received standard drilling alone. Outcomes included visual analog scale (VAS) score, modified Harris Hip Score (mHHS), KaplanMeier femoral head survival, operative time, and postoperative hospital stay. No patients were lost to followup.
RESULTS
At 3, 6, and 12 months postoperatively, the triangular group had lower VAS (P=0.009, 0.001, 0.004) and higher mHHS (P=0.006, <0.001, <0.001) than the standard group. Operative time was longer in the triangular group (142.23±22.64 vs 43.18±10.82 minutes, P<0.001), but hospital stay did not differ. During followup (1245 months), femoral head collapse occurred in 3 hips in the triangular group and 11 hips in the standard group. KaplanMeier survival was significantly better in the triangular group (logrank P=0.040).
CONCLUSIONS
Hip arthroscopy combined with triangular drilling and suction decompression was associated with better short to midterm pain relief, functional improvement, and femoral head survival in ARCO stage IIIA ONFH compared with standard drilling alone, although operative time was longer. These findings should be interpreted as unadjusted associations, and further prospective multicenter studies are needed.

Keywords: Arthroscopy; Decompression, Surgical; Femur Head Necrosis; Hip Joint; Orthopedics