Bone marrow aspirate concentrate (Stem cells) therapy for pre-collapse stage of AVN of femoral head: An interventional comparative study

Abstract

Introduction: Osteonecrosis of the hip is an incapacitating disease where the goal of management is to diagnose and treat it early in the pre-collapse stage. Core decompression (CD) is an established modality to treat the pre- collapse stage. We aimed to evaluate the outcome of CD alone versus CD with Bone Marrow Aspirate Concentrate infiltration. Materials and Methods: We conducted a retrospective cum prospective cross sectional randomized study comparing CD and CD + BMAC. Post-operative radiographs were taken and the patient was reviewed every 3 months with radiographs. Harris Hip score (HHS) and Visual Analog Scale (VAS) score were assessed on the follow up. A paired-T test was used for analysis of results. Results: 23 patients (32 hips) were included in which 15 hips were treated in the form of CD+ BMAC and 17 hips treated with CD alone with a mean follow up 14.4 months for the study. There was significantly lowered Harris Hip Score in the Core Decompression group and a significantly lowered VAS score (i.e. reduced pain) in the Core Decompression + BMAC group. As compared to the pre-op Harris hip Score, the follow up HHS increased in 8 of the 15 patients in CD+BMAC group and 2 of the 17 patients in CD group. As compared to the pre-op VAS Score, the follow up VAS reduced in 8 of the 15 patients in CD+BMAC group and 2 of the 17 patients in CD group. Conclusion: Our study concludes that BMAC + CD is a safe, efficient and a less technically demanding modality for the treatment of non-traumatic avascular necrosis of femoral head in pre-collapse stage. BMAC significantly improves the results of Core decompression both functionally and radiologically. Patient satisfaction and pain relief is better than CD alone.