Core decompression with autologous adult live-cultured osteoblast implantation for osteonecrosis of the femoral head: a prospective mid-term outcome analysis.

Osteonecrosis of the femoral head (ONFH) is a challenging condition that mainly affects young and middle-aged adults, causing pain, disability, and joint collapse. Current treatment options include medications, physical therapy, and surgical interventions such as core decompression and total hip replacement. However, there is growing interest in regenerative medicine for managing ONFH. This study evaluated the outcomes of core decompression augmented with adult autologous live cultured osteoblasts (AALCO) in patients with early-stage ONFH. Patients diagnosed with ONFH, Ficat-Arlet Grades 1, 2, and 3, underwent a staged procedure involving bone marrow aspiration and the cultivation of 48 million osteoblastic lineage cells. Subsequently, this culture was injected following core decompression and curettage of the necrotic area in the femoral heads. Patients were then followed for 18 to 26 months and evaluated for radiological progression of the disease and changes in functional outcome using the Harris Hip Score (HHS) and Visual Analog Scale (VAS). Forty-eight hips (34 patients with 14 bilateral ONFH) were included in the study and followed up for 18 to 26 months. During this period, 29 patients (40 hips) exhibited progressive signs of healing, resulting in a significant improvement in the mean HHS and a reduction in VAS scores. Core decompression augmented with implantation of autologous live cultured osteoblasts is a reliable treatment approach for managing the early stages of ONFH in young patients caused by various factors. The method aims to halt disease progression through osteoblastic stem cell-mediated new bone formation, leading to improved functional outcomes and potentially delaying or avoiding the need for total hip arthroplasty.