Treatment of avascular osteonecrosis of femoral head by core decompression and platelet-rich plasma: a prospective not controlled study

Abstract

Purpose Core decompression is a surgical option since the 1960s for hip osteonecrosis treatment. This technique promotes bone repair by reducing intramedullary pressure, but this is not often enough to stop the progression of necrosis. The aim of this study was to associate core decompression with the regenerative stimulus provided by platelet-rich plasma (PRP) and compare our results with other regenerative techniques. Methods Femoral head osteonecrosis was prospectively evaluated in 30 hips (22 patients, 15-60 years) treated by core decompression and PRP graft. Patients presented monolateral or bilateral osteonecrosis in stage I-IIA-IIB according to Arlet and Ficat classification. The outcome was assessed by changes in Harris Hip Score (HHS) and the need for total hip replacement (THA). Results The mean preoperative HHS was 64 points, at two years from surgery was roughly 84 points. Sixteen of 30 hips showed osteonecrosis progression of the femoral head and were converted to THA. At the five year follow-up, the survival rate was 100% for patients at stage I, 67% for stage IIA, and 0% for stage IIB and was 68% and 32% for idiopathic and secondary osteonecrosis, respectively. Conclusion Core decompression combined with PRP could be indicated as a treatment for the I and IIA stages of osteonecrosis, as it significantly reduces joint pain and delays THA. This procedure should be avoided in AVNFH related to cortisone therapy because only a few benefits have been proven. It also has the advantage of being technically simple, minimally invasive, and free from complications.

Femoral Head Necrosis Due to Brucella Infection in China: Case Series and Literature Review

“… 29 Conservative treatment is appropriate for patients in Ficat stages I or IIa; the effect of core decompression is evident in patients with femoral head cysts and dead bone in Ficat stage IIb. 30 , 31 Patients with Ficat stages III and IV are contraindicated for conservative treatment and require total hip arthroplasty in the majority of cases. 32 Following conservative treatment and core decompression, patients with osteonecrosis of the femoral head should undergo routine X-ray and computed tomography examinations; if the condition worsens, a total hip replacement may be necessary.…”

A Comprehensive Rehabilitation of a known Case of Leprosy Operated for Midshaft Femur Fracture

“…We encouraged the strengthening of the gluteal muscles and quadriceps [7,8] in the hip joint to preserve the strength of the muscles.…”

Osteonecrosis

“…A meta-analysis from China showed that core decompression combined with bone marrow stem cell injection was more effective than core decompression alone in delaying the collapse of the femoral head 7 . Use of platelet-rich plasma as an adjunct to core decompression has also been studied and did result in an initial decrease in pain, but no data were presented regarding the need for total hip arthroplasty 8 . A different pooled analysis from Europe showed only short-term clinical relief, possibly because of non–weight bearing during rehabilitation, and that 38% of the patients had a total hip arthroplasty an average of 26 months after the core decompression 9 .…”