Assessing the Impact of a Modified Core Decompression Technique on Early-Stage Avascular Necrosis of the Hip Using Bone Marrow Concentrate Adjuvant Therapy: A Retrospective Study

Background: Osteonecrosis is characterized by the necrosis of trabecular bone and cells within the femoral head, which often results in the subchondral collapse and deformation of the articulating surface of the head. For the treatment of early stages of this condition, specifically Stage I and Stage II, bone marrow-derived stem cells have been employed effectively for several years. In our approach, we have utilized a modified technique to collect bone marrow aspirate, which has yielded favorable outcomes.

Methods: In our study, we performed surgeries on 32 hips afflicted with early-stage osteonecrosis of the femoral head. Each patient underwent core decompression and the injection of bone marrow concentrate, guided by C-arm imaging in the operating theater. Evaluations were conducted using the Harris Hip Score and the Visual Analogue Scale (VAS), along with radiological assessments to track the progression of osteonecrosis stages before and after the surgical procedure.

Results: The comparison of pre- and post-surgery data, including the Harris Hip Score, VAS, progression of osteonecrosis stages, and radiological findings, revealed significantly positive outcomes. Since May 2013, 32 hips, regardless of the etiology of avascular necrosis (AVN), have been treated with this procedure. Notably, only four patients with bilateral AVN progressed to Stage III in one hip, while the other hip remained stable. In the remaining patients, pain was alleviated, and none progressed to later stages. No complications were observed in this study.

Conclusion: This minimally invasive technique, characterized by its simplicity and lack of associated complications or donor site morbidity, has proven to be an effective joint-preserving surgical intervention for early stages of femoral head osteonecrosis (Stages 1 and 2).