Abstract
BackgroundTreatment of avascular necrosis of the femoral head (ANFH) in young patients remains a clinical challenge. A current controversy is whether hip-preserving surgery results in better outcomes. The adverse effects of hip-preserving surgery are associated with the fill material for the necrotic areas. This study aims to evaluate the early effects of autologous bone marrow buffy coat (BBC) and angioconductive bioceramic rod (ABR) grafting with advanced core decompression (ACD) on early ANFH.MethodsForty-four (57 hips) patients with early ANFH from 2015 to 2020 were recruited for this study. They were randomized into two groups: group A received ACD, BBC, and ABR grafting; group B received treatment of ACD with β-tricalcium phosphate (β-TCP) granules and ABR grafting. The outcomes were assessed using the Harris Hip Scores (HHS) and survival rate analysis. The follow-up endpoint was defined as conversion to total hip arthroplasty (THA).ResultsForty patients (51 hips) were ultimately included in this study for analysis. Compared with group B, patients in group A had higher postoperative function score (P = 0.032) and postoperative Harris Hip Scores (HHS) (P = 0.041). Kaplan-Meier analysis showed a trend that the survivorship of the femoral head was higher in group A than in group B.ConclusionThe short-term follow-up results showed that the autologous bone marrow buffy coat and angioconductive bioceramic rod grafting with advanced core decompression is effective in the treatment of early ANFH.Trial registrationChictr.org.cn, ChiCTR2000039595. Retrospectively registered on 11 February 2015.
Highlights
Treatment of avascular necrosis of the femoral head (ANFH) in young patients remains a clinical challenge
Kaplan-Meier analysis showed a trend that the survivorship of the femoral head was higher in group A than in group B
The short-term follow-up results showed that the autologous bone marrow buffy coat and angioconductive bioceramic rod grafting with advanced core decompression is effective in the treatment of early ANFH
Summary
Treatment of avascular necrosis of the femoral head (ANFH) in young patients remains a clinical challenge. Avascular necrosis of the femoral head (ANFH) is a common, refractory disease with multiple etiologies including long-term use of glucocorticoids, alcohol abuse, and hip trauma [1, 2]. The disease often progresses and results in femoral head collapse and hip osteoarthritis over time [3]. Despite the excellent survivorship of total hip arthroplasty (THA), the majority of patients who receive THA surgery are young. THA is not an optimal therapy for young patients with ANFH [4, 5]. Hip-preserving surgery includes different methods such as core decompression (CD), femoral osteotomy, bone grafting (vascularized or nonvascularized), porous tantalum rod grafts, and cell-based therapy
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