EP97 Innovative Modified Light Bulb Technique with Custom Offset Curettes for Treating Pre-Collapsed Femoral Head Osteonecrosis

Abstract Osteonecrosis of the femoral head is a devastating disease that accounts for 10-15% of all hip arthroplasty cases in the USA, eventually leading to femoral head collapse and joint destruction. Even the current forms of treatment only slightly slow down the progression of the disease itself. This article describes a modified lightbulb technique, which perfects the method, the instrument, and the flap used in order to ensure hip musculature preservation and improved outcomes. With the direct anterior approach, there is no need to perform surgical dislocation, so the time of the surgery is reduced, as well as the risk of vascular injury. The necrotic bone can be precisely removed using custom-made offset curettes, and a bone graft substitute and autograft can be placed under C-arm guidance. This technique may be beneficial in treating early osteonecrosis of the femoral head by reducing operative time and reducing the risk of complications related to surgical dislocation. In contrast to the original "light bulb " which is done through an anterolateral approach; we utilized a direct anterior approach to the hip. A fine, mushroom-tipped burr is used to create a channel into the femoral head. Under C-arm guidance, a custom offset curette that designed by authors is maneuvered to the necrotic area identified in preoperative imaging, ensuring precise debridement while avoiding cartilage penetration. The resulting cavity, which is in a lightbulb shape, is thoroughly cleared of necrotic bone, and samples may be sent for pathological confirmation.