Functional outcomes of core decompression and autologous cancellous bone grafting with and without platelet rich plasma in early avascular necrosis of head of femur

Rajesh K. Sharma; Anuradha Upadhyay

doi:10.18203/issn.2455-4510.IntJResOrthop20243899

Authors

Rajesh K. Sharma Department of Orthopaedics, P.D.U. Medical College and D.B. Hospital, Churu, Rajasthan, India https://orcid.org/0000-0002-3336-3006
Anuradha Upadhyay Department of Physiology, S. K. Government Medical College and Hospital, Sikar, Rajasthan, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243899

Keywords:

Avascular necrosis, FICAT-ARLET grade, Harris hip score, VAS

Abstract

Background: Early diagnosis and management of avascular necrosis (AVN) is of paramount importance in order to preserve the femoral head. Early intervention, if implemented at the pre-collapse stage, has favourable impact on the prognosis of disease. This study was conducted to compare the functional outcome of core decompression and autologous cancellous bone grafting with and without platelet rich plasma in early avascular necrosis of head of femur and to evaluate the complications associated with the procedure.

Methods: It was a comparative, and prospective study. After obtaining ethics committee approval, total 30 hips (19 patients) divided randomly into two groups for treatment, as per inclusion and exclusion criteria. Group A (core decompression with autologous cancellous bone grafting with PRP), and group B (core decompression with autologous cancellous bone grafting without PRP). Assessment of the results, was based on the Harris hip score (HHS) and visual analogue scale (VAS) at preoperative, 2 weeks, 4 weeks, 6 weeks and 3, 6, and 9 months post-operatively.

Results: There was no statistical difference seen between two groups in terms of distribution of cases based on age, gender, side, duration of symptoms, etiology, Ficat-Arlet grade, and surgical time. Mean HHS and mean VAS was found to be comparable in two groups postoperatively at all follow ups. Excellent to good results were obtained on functional assessment by HHS grading at final follow up of 9 months in patient treated under group A while patients treated under group B showed good to fair results. Both groups showed statistically significant improvement in HHS grade at 9 months as compared to preoperative HHS. In both groups, there was a statistically significant improvement in mean VAS at 9 months as compared to preoperative VAS.

Conclusions: When combined with core decompression and bone grafting, PRP produces better HHS/functional outcomes as compared to core decompression and bone grafting alone for the treatment of early avascular necrosis of head of femur.

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References

Narayanan A, Khanchandani P, Borkar RM, Ambati CR, Roy A, Han X, et al. Avascular Necrosis of Femoral Head: A Metabolomic, Biophysical, Biochemical, Electron Microscopic and Histopathological Characterization. Sci Rep. 2017;7(1):10721.

Ikeuchi K, Hasegawa Y, Seki T, Takegami Y, Amano T, Ishiguro N. Epidemiology of nontraumatic osteonecrosis of the femoral head in Japan. Mod Rheumatol. 2015;25(2):278-81.

Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T. Epidemiological Profile of Femoral Head Osteonecrosis in the North Indian Population. Indian J Orthop. 2018;52(2):140-6.

Vardhan H, Tripathy SK, Goyal T. Epidemiological Profile of Femoral Head Osteonecrosis in the North India Population. Indian J Orthop. 2018;52(2):140-6.

Hsu H, Nallamothu SV. Hip Osteonecrosis. Statpearls Publishing; Treasure Island (FL). 2020.

Soni SK, Chouhan VS, Joshi V. Study of functional outcome of core decompression with platelet rich plasma enhanced cancellous bone graft in avascular necrosis of femoral head grade I and II. Int J Orthop Sci. 2019;5(2):710-3.

Rocchi M, Del Piccolo N, Mazzotta A, Giavaresi G, Fini M, Facchini F, et al. Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up. Hip Int. 2020;30(2):3-12.

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 Dr. D.Y. Patil University. 2015;8(6);713-8.

Yan ZQ, Chen YS, Li WJ, Yang Y, Huo JZ, Chen ZR, et al. Percutaneous decompression and autologous bone marrow mononuclear cell infusion are used to treat osteonecrosis of the femoral head. Chin J Traumatolol. 2006;9(3):3-7.

Han J, Gao F, Li Y, Ma J, Sun W, Shi L, et al. The Use of Platelet-Rich Plasma for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review. Biomed Res Int. 2020;2020:2642439.