subchondral insufficiency fracture of the femoral head treated with core decompression and bone void filler support

subchondral insufficiency fracture of the femoral head (siffh) is characterized by acute onset hip pain without overt trauma. it appears as a low intensity band with bone marrow edema on t1-weighted mri. the most common course of treatment is protected weight bearing for a period of several weeks. total hip arthroplasty (tha) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. we present a case of a 48-year-old male with siffh who was treated with core hip decompression and bone void filler as a hip-preserving alternative to tha. the patient has an excellent clinical and radiographic result at final follow up. core hip decompression with bone void filler is a less invasive alternative to tha, and may be a preferred initial treatment strategy for siffh in the young and active patient who has failed conservative measures.