When a patient is diagnosed with avascular necrosis (AVN) of the hip in its early stages, the most common question Dr. Supreet Bajwa hears is: "Is there anything we can do before I need a hip replacement?"
The answer, for patients in Stage 1 or 2, is yes. Core decompression is the most studied and widely performed joint-preserving procedure for AVN - and for the right patient, it can delay or prevent the need for hip replacement by years.
What Is Core Decompression?
Core decompression is a minimally invasive surgical procedure in which a series of small holes are drilled into the necrotic (dead) zone of the femoral head. This achieves two things:
- Pressure relief - AVN creates abnormally high pressure inside the femoral head, which is itself believed to worsen the condition by further compromising blood flow. Decompression reduces this pressure.
- Biological stimulation - The channels created by drilling allow new blood vessels to grow into the area (a process called neovascularisation), potentially restoring some blood supply to the dying bone.
The procedure is performed under general or spinal anaesthesia and takes approximately 30-60 minutes. It is done with the patient on a traction table using X-ray guidance. No large incision is required the drill enters through tiny punctures in the skin.
Who Is a Good Candidate?
Core decompression gives the best results in:
- Stage 1 or Stage 2 AVN - Before femoral head collapse
- Small to medium-sized lesions - Covering less than 30-40% of the femoral head weight-bearing area
- Patients under 50 - Better biological response
- Those with the underlying cause controlled - Steroid use reduced, alcohol stopped
- Active, motivated patients - Who will comply with post-operative protected weight-bearing
It is generally not recommended for Stage 3 or beyond, where the femoral head has already begun to collapse.
Does Core Decompression Actually Work?
The honest answer is: it works well in early-stage AVN, and less predictably in more advanced cases.
Published studies consistently show that approximately 70-80% of Stage 1 patients and
60-70% of Stage 2 patients show stabilisation or improvement following core decompression, with delay or prevention of progression to hip replacement.
The results are significantly less favourable in Stage 3, where collapse has begun. This is why timing catching AVN early is the critical factor.
Dr. Bajwa's experience aligns with published literature: patients who come in with early-stage AVN and undergo timely core decompression, combined with appropriate lifestyle modifications, have a meaningful chance of preserving their natural hip for an additional 10-15 years or more.
Core Decompression Combined with Stem Cells
An evolution of the standard procedure involves concentrating the patient's own bone marrow stem cells (from the pelvis or tibia) and injecting them into the femoral head alongside the decompression channels. Early evidence suggests this biological augmentation improves outcomes, particularly in Stage 2 AVN in younger patients.
This is not yet universally available, but is offered at select specialised centres.
What Happens After Surgery?
Immediately after: The procedure is typically a day surgery or short overnight stay.
Weeks 1-3: Protected weight-bearing on crutches. The joint is protected while healing occurs inside the femoral head. This is the most critical phase - rushing this risks early failure.
Month 1: Gradual return to weight-bearing as tolerated.
Month 3: Return to normal activity. Follow-up MRI is performed to assess response.
Long-term: Annual or biannual follow-up with X-ray to monitor for progression.
Cost of Core Decompression in India
Core decompression is significantly less expensive than hip replacement. In India, the cost typically ranges:
| Procedure | Estimated Cost |
|---|---|
| Core decompression (standard) | ₹60,000 – ₹1,20,000 |
| Core decompression + stem cell augmentation | ₹1,00,000 –₹2,00,000 |
The cost varies based on hospital grade, surgeon expertise, and whether stem cell augmentation is included. Most health insurance policies cover core decompression for AVN under orthopaedic procedures verify your policy's terms before surgery.
Core Decompression vs Hip Replacement: How to Think About It
Core decompression is not a guaranteed cure it is a joint-preserving attempt in early disease. If it succeeds, you may have 10-20 additional years before needing a hip replacement. If it does not succeed (failure is typically evident within 12-18 months as the femoral head progresses), hip replacement remains available and is not made more difficult by having had core decompression.
For a 35-year-old with Stage 2 AVN, even a 70% chance of preserving the natural hip for another decade is worth attempting. For a 68-year-old with Stage 3 AVN and significant pain, going directly to hip replacement is likely the wiser path.
This is precisely the kind of nuanced, patient-specific decision-making that an experienced specialist like Dr. Bajwa can help with.
Why Choose Dr. Supreet Bajwa?
Fellowship-trained in Australia, Dr. Supreet Bajwa is one of India's leading hip and knee specialists, 12+ years, 3300+ surgeries, 35+ research publications.
He brought the Direct Anterior Approach (DAA) to India, is the only orthopaedic surgeon in Mumbai performing Cooled RFA, and uses Robotic Knee Surgery for precision most patients never knew was possible.
No long recovery. No unnecessary restrictions. Most patients walk within hours.
📍 Wockhardt Hospital, Mumbai Central & Mira Road
Frequently Asked Questions
Is core decompression painful?
Discomfort is manageable. Most patients report mild to moderate pain for 1 week, controlled with oral medications. The procedure involves small puncture incisions and is well-tolerated.
Can both hips be done at the same time?
Yes. In bilateral AVN, both hips can be decompressed in a single anaesthetic sitting, reducing recovery time and total cost.
How soon will I know if core decompression is working?
Pain often improves within 4-8 weeks if the procedure is successful. An MRI at 6 months confirms whether the necrotic zone is stabilising or progressing.
Can I go back to work after core decompression?
Desk-based workers can typically return within 1-3 weeks. Physical or standing work takes 3-6 weeks depending on recovery.
What if core decompression fails?
Hip replacement remains available and outcomes are not compromised by a prior core decompression. You are not worse off for having tried.
Book a Consultation: For a transparent, no-pressure discussion about hip replacement costs and options in Mumbai, contact Dr. Supreet Bajwa at Wockhardt Hospital, Mumbai Central & Miraroad. Call or WhatsApp: +91 9820727046