Abstract
Introduction
Without intervention 80% of hips with osteonecrosis (ON) will progress. Core decompression 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.
Methods
We retrospectively reviewed the clinical and radiographic outcomes of 42 hips in 26 patients who underwent core decompression with BMAC for ON with a minimum of 1 year follow up. We evaluated pre-op visual analog pain scores (VAS), Steinberg class based on radiographs, as well as Kerboul angle as measured on MRI. Clinical outcomes were reported as change in VAS at final follow up, advancement in Steinberg classification based on radiographs at final follow up, or decision to proceed with THA.
Results
At final follow up, VAS scores had improved from 7 to 2.6 (P<0.05). A total of 33 of 42 hips (78.5%) had stable radiographs without collapse or progression to a higher Steinberg class, while a total of 9 of 42 hips (21.4%) went on to THA. Of the patients that went on to THA, all had a pre-operative Steinberg classification of 2C or higher, and the pre-op Kerboul angle in this cohort was 243, compared to 171 in the group that did not go on to THA (p<0.05). In patients with pre-op Steinberg class 2B or less, there was no advancement in radiographic grade, whereas 61% of patients with pre-op Steinberg grade 2C or higher progressed on to a more advanced stage.
Conclusion
Core decompression with BMAC significantly improves clinical symptoms and helps prevent the advancement of ON when performed on patients in whom ON is classified as Steinberg class 2B or less, or in whom the Kerboul angle is 180 or less.
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