Retrieval of a Sunken Interference Screw during Core Decompression and Autologous Adult Live-cultured Osteoblast Injection for Bilateral Hip Avascular Necrosis - A Case Report

Sep 29, 2026

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A case report describes a rare intraoperative complication during bilateral hip core decompression for avascular necrosis (AVN) treated with autologous adult live-cultured osteoblasts (AALCO). An 8 mm interference screw used as a temporary stopper migrated into the femoral neck and became sunken, creating a challenging retrieval scenario. The screw was successfully retrieved using minimally invasive, instrument-assisted techniques with standard orthopedic operating room tools, avoiding additional morbidity. Planned AALCO injection proceeded as scheduled with an uneventful postoperative recovery.

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CategoryHealthcare

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 125-128 Retrieval of a Sunken Interference Screw during Core Decompression and Autologous Adult Live-cultured Osteoblast Injection for Bilateral Hip Avascular Necrosis: A Case Report Alok C Agrawal1, Harshal Sakale1, Darshan Temker1, Shubham Sakarkar1 Learning Point of the Article: An interference screw sinking during core decompression for avascular necrosis of the hip is a dreaded complication during surgery and this time, it was successfully retrieved using Schanz pins in a minimally invasive manner. Abstract Introduction: Interference screws are commonly used implants, particularly in arthroscopic cruciate ligament reconstruction, where they achieve fixation by compression and friction rather than bythreads. Wereporta case ofa sunken interference screw, used asa stopper during core decompression and autologous adult live-cultured osteoblast (AALCO) injection for avascular necrosis (AVN) of the hip, which was successfully managed using a minimally invasive instrument-assisted retrieval technique. Case Report: A 67-year-oldmale with bilateral hip AVN underwent bilateral core decompression andAALCOinjection. Aftertrack preparation and drilling of the necrotic areas in the femoral head with an 8 mm reamer, an 8 mm interference screw was inserted before injection of the AALCO. The screw migrated into the femoral neck and became sunken, complicating retrieval. Using a combination ofstandard orthopedic operating room instruments, i.e., without specialised instruments for retained implant removal, the screw was retrieved without additional morbidity. TheAALCOwas injected as planned, and the patient had an uneventful post-operative recovery. Conclusion: A sunken interference screw in the proximal femur is a rare but challenging intraoperative complication. Our retrieval method usingreadily available instruments offers a safe and reproducible solution in such scenarios. Keywords: Avascular necrosis, interference screw, sunken screw, implant retrieval. Introduction Avascular necrosis (AVN) of the femoral head is a progressive disorder that, when leftuntreated, leads to collapse of the femoral head and hip arthritis. Core decompression is a well-established joint-preserving modality of treatment in Ficat andArlet Stage I and II AVN [ 1 ] . Recently, with the advent of biological augmentation methods, autologous adult live-culturedosteoblast (AALCO) has shown promise in improving outcomesby promoting boneregeneration [2,3]. The procedure involves two stages, the first being aspiration of 12 mL of bone marrowfrom theiliac crest and cultivation ofmesenchymal stem cells with induction towards osteoblastic lineage at Regrow Biosciences Pvt Ltd, Mumbai, India. The second stage involves injecting the cultivated 48 million osteoblasts, 3–4 weeks later after a core decompression under fluoroscopic guidance. To prevent backflow of the injected material following the decompression, an interference screw can be temporarily inserted at the mouth of the track in the lateral cortex of the |
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DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6476](https://doi.org/10.13107/jocr.2025.v15.i12.6476) | Author’s Photo Gallery | | | | | --- | --- | --- | --- | --- | | | | | |
Dr. Shubham Sakarkar | | |
1Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Address of Correspondence:
Dr. Darshan Temker,
Department of Orthopaedics, All India Institute of Medical Sciences, Raipur-492099, Chhattisgarh, India.
E-mail: [temker1997@gmail.com](temker1997@gmail.com) | | | | | Submitted: 08/09/2025; Review: 03/10/2025; Accepted: November 2025; Published: December 2025 | | | | | | DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6476](https://doi.org/10.13107/jocr.2025.v15.i12.6476)
© The Author(s).

FAQs

What surgical complication is described in this case report?

A metal interference screw used during core decompression migrated into the femoral neck and became sunken, complicating retrieval during bilateral hip surgery.

How was the sunken interference screw retrieved?

The authors retrieved it using minimally invasive, instrument-assisted technique with readily available standard orthopedic operating room instruments, avoiding specialised retained-implant tools.

What was the patient outcome after retrieval and AALCO injection?

AALCO injection was completed as planned, and the patient had an uneventful postoperative recovery.

Sep 29, 2026

Uploaded by hdkawk