Avascular necrosis hips: management with core decompression bone graft and bone marrow aspirate concentrate
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20233266Keywords:
AVN, Harris hip score, Core decompression, Bone marrow aspirate concentrate, Morselized bone graft, Clinical and functional outcomesAbstract
Background: Avascular necrosis of the femoral head is a disorder that can lead to the collapse of the femoral head and can progress to secondary osteoarthritis, which would ultimately require a total hip replacement. It can be avoided if the disease is diagnosed at an early stage. Intra-osseous pressures can be reduced, thereby aiding in halting the disease progression by core decompression along with bone marrow aspirate concentrate with morselized bone allograft. Aim was to evaluate the role of core decompression with BMAC with bone grafting for the treatment of early stage AVN of the hip by clinical and functional outcomes of the patient.
Methods: A prospective observational study done to evaluate the clinical and functional outcomes by using the Harris hip score with domains for pain, functional activity, range of motion, and gait. Pre-operative and 18-months post-operative HHS was calculated in 30 samples between 30-50 years undergoing core decompression with BMAC and bone grafting in AVN hip upto Ficat Arlet stage IIb.
Results: There was a significant increase in HHS from 67.66±9.87 pre-operatively to 92.4±7.4 post-operatively (p<0.05) which is statistically significant), indicates marked pain relief and functional well-being of the patients.
Conclusions: Core decompression with BMAC and bone grafting is safe and effective in the early stages of AVN of the femoral head and is helpful in delaying the progression of AVN leading to THR based on clinical and functional outcomes of the patients at 18 months follow up.
References
Arbab D, König DP. Atraumatic femoral head necrosis in adults: epidemiology, etiology, diagnosis and treatment. Dtsch Arztebl Int. 2016;113(3):31-8.
Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg Br. 1985;67:3-9.
Arbeloa-Gutierre L. Core Decompression Augmented With Autologous Bone Marrow Aspiration Concentrate for Early Avascular Necrosis of the Femoral Head. Arthros Tech. 2016;5(3):615-20.
Gangji V, Hauzeur JP, Matos C, De Maertelaer V, Toungouz M, Lambermont M. Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study. J Bone Joint Surg Am. 2004;86:1153-60.
Tabatabaee RM, Saberi S, Parvizi J, Mortazavi SM, Farzan M. Combining concentrated autologous bone marrow stem cells injection with core decompression improves outcome for patients with early-stage osteonecrosis of the femoral head: A comparative study. J Arthroplasty. 2015;30:11-5.
Persiani P, De Cristo C, Graci J, Noia G, Gurzì M, Villani C. Stage-related results in treatment of hip osteonecrosis with core-decompression and autologous mesenchymal stem cells. Acta Orthop Belg. 2015;81:406-12.
Hernigou P, Poignard A, Zilber S, Rouard H. Cell therapy of hip osteonecrosis with autologous bone marrow grafting. Indian J Orthop. 2009;43(1):40-2.
Hernigou PH, Beaujean F, Lambotte JC. Decrease of mesenchymal stem cell pool in the upper femoral extremity of patients with osteonecrosis related to corticosteroid therapy. J Bone Joint Surg Br. 1999;81: 349-55.
Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect. 2003;52:337-55.
Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996; 3:169-78.
Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH. Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. J Bone Joint Surg Br. 1995;77:870-4.
Hernigou P, Poignard A, Manicom O. The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone. J Bone Joint Surg Br. 2005;87:896-902.
Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002;405:14-23.
Mont MA, Jones LC, Einhorn TA, Hungerford DS, Reddi AH. Osteonecrosis of the femoral head. Potential treatment with growth and differentiation factors. Clin Orthop Relat Res. 1998;355:S314-35.
Vardhan H, Tripathy SK, Sen RK, Aggarwal S, and Goyal T. Epidemiological Profile of Femoral Head Osteonecrosis in the North Indian Population, Indian J Orthop. 2018;52(2):140-6.
Martin JR, Houdek MT, Sierra RJ. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis. Croat Med J. 2013; 54:219-24.
Wojciech P. Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis: a randomized prospective study. Orthoped Rev. 2016;8:61-2.
Agarwal T, Patel PS, Sooknundun M, Mohapatra AR, Joshi HS, Salgia A. Management of stage I and II A/B avascular necrosis of femoral head with core decompression autologous cancellous bone grafting and platelet rich plasma factors. Med J DY Patil Univ. 2015;8:713-8.
