Abstract
Head preserving procedures for Early Avasculathe Necrosis of hip are invariably effective in early stage. Core decompression (CD) is mostly performed modality for early stages of AVN having different success rates. Current review aims at determining efficiency of Bone marrow aspirate concentrate, Platelet rich Plasma, Bone morphogenic proteins and combining it with Core Decompression for early AVN stage, before femoral head collapse. To preserve a femur head damaged by osteonecrosis, treatment options should be applied early in the disease process for best results. When the articular cartilage becomes deficient to nutrients, it become more difficult to save a particular femur head, and eventually bone destruction occur, affecting hip biomechanics; articular changes eventually develop, necessitating arthroplasty or arthrodesis. Other early treatment techniques has been identified & improved to improve femur head survival & delay replacement. Analysis of 20 studies published between 2011 and 2020 was done of which 6 were retrospective & 14 were prospective. PRP showed better survival and functional outcome, however 3 studies showed inconclusive evidence for its regular usage. BMAC enhanced efficiency of CD & cell increment or combination of PRP for growth stimulation. Concluding, CD and BMAC worked effectively that CD only before femoral head collapse. But, PRP need more evidences for extensive utilization. Adding PRP to BMAC or culturing it would increase potency of CD with BMAC. Less data is available to assess efficiency of BMP-7 & role of Intraosseous bisphosphonate therapy could be studied for inexpensive & better alternate.
Highlights
Femur head AVN is progressive intraosseous condition leading to limitation of function as condition progress [1]
The etiology of atraumatic osteonecrosis hip includes steroid, alcohol, coagulopathies, and others resulting in decreasing mesenchymal stem cells & increasing quantity of adipose cells & apoptotic cells, according to studies conducted over the last decade and a half [6,7,8]
Surgical methods for preserving the femur head damaged by AVN were included in study
Summary
Femur head AVN is progressive intraosseous condition leading to limitation of function as condition progress [1]. The goal of core decompression is to relieve intraosseous pressure & enhance blood supply to femur head in order to slow/stop progression of osteonecrosis It had shown promise for the early phases of osteonecrosis, allowing for blood vessel growth & restoration of vascularity. Transtrochanteric rotational and varus or valgus osteotomies transfer sick region of head away from weight bearing area in early stages of disease process, allowing unaffected portion to take its place; they have previously been reported to preserve the damaged head [12,13] The outcomes of these procedures have been mixed, and their use has fallen in recent years [13]. In order to improve the findings, we looked into other ways to administer these adjuvants
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