Osteonecrosis of the femoral head: treatment before the collapse. Experience with decompression and biological therapy.

Abstract

Introduction: Osteonecrosis is a disabling condition and one of the most frequent causes of hip arthroplasty in the young population. Early detection and treatment in stages prior to femoral head collapse are essential to prevent progression and conversion to total hip arthroplasty (THA). The present study aims to demonstrate the results obtained in the treatment of patients with initial stages of ONFH, treated with a decompression system that associates biologic therapy (platelet-rich plasma and mesenchymal stem cells) (PERFUSE).

Methodology: Retrospective unicentric study, in which all patients with ONFH treated with decompression of the necrotic area and biological therapy between May 2018 and May 2023, was collected. Demographic data of the patients (age and gender), risk factors for AVN, area of necrosis (Kerboul), ARCO classification, collapse rate, and conversion to THA were obtained.

Results: Twenty-four patients with ONFH were treated using the PERFUSE system. The mean age was 47.67 years old, and the mean follow-up was 26.1 months. The mean improvement in the modified Harris Hip Score (mHHS) was 10.11 (from 70.79 to 80.56; p = 0.018). Patients who developed femoral head collapse had worse mHHS scores. Six patients (25%) progressed to femoral head collapse, of which 2 (8.33%) were converted to total hip arthroplasty (THA). The probability of collapse-free survival at 12 months was 90.9% (SD 6.2; 95%CI, 79.5%-100%), and at 18 months, it was 85.2% (SD 8.0; 95%CI, 70.9%-100%), and at 24 months, it was 65.7% (SD 11.7; 95%CI, 46.3%-93.2%).

Conclusion: Core decompression with bone aspirate marrow and platelet-rich plasma can enhance bone regeneration and delay femoral head collapse, especially when implemented in early-stage ONFH. In this sense, combining both, core decompression with biological support can offer a promising approach for managing early-stage ONFH. Despite encouraging outcomes, further research is needed to optimize treatment protocols and evaluate long-term efficacy.