Rehabilitation pathway for patients after core decompression for avascular necrosis: the role of early weight bearing, physiotherapy, and telemonitoring of hip joint function

Abstract

Avascular necrosis (AVN) of the femoral head is a progressive disorder that may lead to femoral head collapse and substantial disability. Core decompression is a joint-preserving treatment for early-stage AVN, although postoperative rehabilitation remains insufficiently standardized. Purpose. This study aimed to evaluate a rehabilitation pathway incorporating early graded weight bearing, physiotherapy, and telemonitoring after core decompression. Materials and Methods. A prospective–retrospective cohort study included 51 patients with ARCO/Ficat stages I–II AVN who underwent core decompression between 2020 and 2025 in orthopedic centers in Odesa and Kyiv, Ukraine. Rehabilitation comprised graded axial loading, kinesitherapy and proprioceptive training, physiotherapy, and progressive functional restoration. Telemonitoring included inertial measurement unit (IMU) sensors, digital pain assessment, and functional questionnaires. Outcomes were assessed using the Harris Hip Score (HHS), visual analogue scale (VAS), gait parameters, range of motion, and MRI. Results. Mean patient age was 34.8±7.1 years; glucocorticoid exposure was the leading etiological factor (64.7%). By postoperative week 4, 82.3% tolerated partial weight bearing without increased pain. HHS improved from 64.2±5.9 to 78.5±6.3 (p<0.01), while VAS decreased from 5.2±1.3 to 2.8±0.9 (p<0.001). Gait support-phase asymmetry improved by 22% by week 12. Physiological hip flexion was restored in 74.5%, while femoral head collapse occurred in 7.8% during six-month follow-up. Full functional recovery (HHS≥85) was achieved in 72.5%. Conclusions. The proposed personalized rehabilitation pathway combining graded loading, targeted physiotherapy, and telemonitoring improved functional recovery, pain, and gait biomechanics following core decompression.