Core decompression is a treatment for early stage osteonecrosis and most commonly used for disease that affects the hip joint. The operation is based on the finding that the area of bone around the necrotic area is under a higher pressure. By decompressing this area the pressure decreases and allows blood flow to continue to the necrotic area. Blood flow is necessary for the remodeling of the necrotic area with new, live bone.

The operation is an open procedure and the surgeon uses x-ray guidance (fluoroscopy) to be able to clearly visualize the area. The surgeon takes a “plug” of bone out of the affected area and often places bone chips back into the area to provide an osteoinductive (bone forming) environment. As blood flow is restored to the area, the bone chips provide a scaffolding and stimulus for new bone to form. 

Illustration of core decompression of the femoral head.	X-ray following core decompression with "back grafting" using bone chips.