scholarly journals Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip

2020 ◽  
Author(s):  
Prasoon Kumar ◽  
Vijay D Shetty ◽  
Mandeep Singh Dhillon
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Bone Morphogenetic Proteins ◽  
English Language ◽  
Platelet Rich Plasma ◽  
Core Decompression ◽  
Limited Data ◽  
Early Stages ◽  
Potential Alternative

Abstract Head preserving modalities in avascular necrosis (AVN) hip are variably effective in early stages, and further options that could prevent head distortion and osteoarthritis are needed. Core decompression (CD) is the most commonly used surgery in the early stages of osteonecrosis with variable rates of success. The present review aimed to determine the effectiveness of bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), bone morphogenetic proteins (BMP) or their combination with CD in early stages of AVN hip, prior to collapse of femoral head. Additionally, any newer unexplored modalities were also searched for and ascertained. PubMed and SCOPUS databases were searched for relevant articles in English language describing CD with aforementioned orthobiologics. We analysed a total of 20 studies published between 2011 and 2020. There were 6 retrospective and 14 prospective studies. PRP showed improved survival and functional outcomes; however, with only three studies, there is inconclusive evidence for its routine utilization. BMAC enhances the efficacy of CD which can further be increased by culture and expansion of cells or combining it with PRP to stimulate growth. In conclusion, CD with BMAC works more efficiently than CD alone prior to collapse of femoral head in AVN. However, PRP needs more evidence for extensive application. Addition of PRP to BMAC or culturing the latter could further enhance the potency of CD + BMAC combination. Very limited data is available for the efficacy of BMP-7 and the role of intraosseous bisphosphonates should be evaluated for a cheaper and potential alternative.

scholarly journals What is the role of core decompression in the early stages of osteonecrosis of the femoral head? Evaluation of the surgical result by functional score and radiological follow-up

2018 ◽  
Vol 53 (5) ◽  
pp. 537-542 ◽  
Author(s):  
Helder de Souza Miyahara ◽  
Bruno Berbert Rosa ◽  
Fabio Yuiti Hirata ◽  
Henrique de Melo Campos Gurgel ◽  
Leandro Ejnisman ◽  
...  
Keyword(s):  
Femoral Head ◽  
Core Decompression ◽  
Functional Score ◽  
Surgical Result ◽  
Early Stages

scholarly journals Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 3-12
Author(s):  
Martina Rocchi ◽  
Nicoladrea Del Piccolo ◽  
Alessandro Mazzotta ◽  
Gianluca Giavaresi ◽  
Milena Fini ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Platelet Rich Plasma ◽  
Core Decompression ◽  
Joint Surface ◽  
Harris Hip Score ◽  
Functional Scores

Introduction: Avascular necrosis of femoral head (AVN) is 1 of the main factors causing disability in young adults. Hip prosthesis can be considered an effective treatment of the painful symptoms but it is a major surgical intervention for this type of population. Thus, a large space should be left to therapeutic alternatives such as regenerative medicine. This retrospective study evaluates 52 AVN treated by core decompression, bone chips allograft, fibrin platelet-rich plasma (PRF) and concentrated autologous mesenchymal stromal cells (MSCs). Methods: The AVN was diagnosed using magnetic resonance imaging (MRI) and graded according to ARCO classification: a patient was classified stage 1 (21 patients), stage 3 (26 patients), and 4 patients were classified as stage 4. We evaluated patients with functional scores (Harris Hip Score) and radiological analysis at 3, 6, 12 and 24 months after the procedure. Patients requiring prosthetic replacement of the joint were included; in these cases, follow-up was interrupted at the time of the joint replacement procedure. Results: Our statistical analysis showed differences between survived and failed treatments, in terms of patient profile and ARCO radiological classification. The best result occurred in patients with ARCO grades 1 and 2, while the more advanced grades showed a high failure rate. It is interesting to note that ARCO quantification, conceived as the joint surface involved in the necrosis, has a negative influence on the outcome of the procedure. Indeed, patients affected by ARCO 3a, where necrosis involved a small portion of the femoral epiphysis and the collapse of the articular surface was limited to 2 mm, showed results similar to those obtained in patients with ARCO 1 and 2. Conclusions: In conclusion, compared with the alternative technique of decompression, our data suggest that post-collapse cases with a small area of necrosis and the use of bone grafts may show better results compared to those of the literature.

scholarly journals Role of core decompression and bone marrow grafting in treatment of early avascular necrosis of femoral head

2020 ◽  
Vol 6 (3) ◽  
pp. 443-448
Author(s):  
Dr. Sanjiv Gaur ◽  
Dr. Anil Chouksey ◽  
Dr. Harendra Singh ◽  
Dr. Vipin Singh ◽  
Dr. Tapan Jain
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Core Decompression ◽  
Necrosis Of Femoral Head ◽  
Bone Marrow Grafting

scholarly journals Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Stefan Landgraeber ◽  
Sebastian Warwas ◽  
Tim Claßen ◽  
Marcus Jäger
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Core Decompression
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