Outcomes of Core Decompression and Bone Marrow Aspirate Concentrate Injection for Osteonecrosis of the Femoral Head

Abstract

AbstractWithout intervention, 80% of hips with osteonecrosis (ON) will progress. Core decompression (CD) has shown favorable results (60–80% survivorship) in early stage ON, and recently, bone marrow aspirate concentration (BMAC) injection into the decompressed femoral head has been proposed to stimulate healing of the necrotic lesion and improve outcomes and survivorship. We reviewed the clinical and radiographic outcomes of 51 Steinberg stage 2 hips in 31 patients who underwent CD + BMAC for ON with a minimum of 1 year follow-up. We evaluated preoperative visual analog pain scores (VAS), Steinberg stage based on radiographs, and Kerboul angle as measured on magnetic resonance imaging. Clinical outcomes were reported as a change in VAS at final follow-up, hip and disability osteoarthritis score for joint replacements (HOOS, JR) score at final follow-up, advancement in Steinberg stage based on radiographs, or decision to proceed with total hip arthroplasty (THA). At an average of 27 months, VAS scores improved from 7 to 2.3 (p < 0.001). In total, 38 of 51 hips (75%) had stable radiographs, while 13 of 51 hips (25%) progressed radiographically or proceeded to THA. The average HOOS JR score in patients at final follow-up was 87.5, indicating excellent hip function. Of the patients that went on to THA, all were preoperative Steinberg stage 2C and the preoperative Kerboul angle in this cohort was 241, compared with 163 in those hips that did not go on to THA (p < 0.001). In preoperative hips that were Steinberg stage 2B or less, there was no advancement in the radiographic stage, whereas 67% of patients with preoperative stage 2C hips progressed (p < 0.001). CD + BMAC significantly improves pain and helps prevent the progression of ON when performed on patients in whom ON is classified as Steinberg stage 2B or less or in whom the Kerboul angle is 180 or less. Level of evidence was level III.