Microvascular Perfusion Assessment During Core Decompression For Avascular Necrosis Of The Femoral Head: A Novel Intraoperative Monitoring Approach – A Case Report

Abstract

Background: Avascular necrosis (AVN) of the femoral head results from impaired bone microcirculation and can progress to collapse if untreated. Core decompression is the standard joint-preserving option in early stages, but assessment of its effect relies on delayed postoperative imaging. Real-time intraoperative perfusion evaluation is rarely used, though it may demonstrate immediate vascular improvement. Indocyanine green (ICG) near-infrared fluorescence provides dynamic perfusion imaging, but its role in AVN surgery remains scarcely documented.

Case Presentation: We report a 32-year-old male presenting with eight months of right groin pain aggravated by weight-bearing. MRI confirmed Ficat–Arlet stage II AVN of the right femoral head. The patient underwent fluoroscopy-guided core decompression. Intraoperative microvascular perfusion assessment was performed using ICG near-infrared fluorescence imaging. Baseline imaging demonstrated delayed and diminished fluorescence of the femoral head. Following core decompression and curettage, repeat ICG injection revealed significant improvement in fluorescence intensity and reduced time-to-peak signal, indicating enhanced microvascular perfusion. The procedure was completed without complications. Postoperatively, the patient followed a partial weight-bearing protocol and demonstrated progressive symptomatic improvement. At one-year follow-up, the patient remained pain-free with preserved femoral head architecture and no radiological evidence of collapse. The case reports the feasibility and clinical utility of intraoperative microvascular perfusion assessment during core decompression for AVN. Real-time perfusion imaging provides functional confirmation of revascularization, potentially enhancing surgical decision making and prognostication.