ANALYSING THE OUTCOME OF AVASCULAR NECROSIS OF FEMORAL HEAD TREATED BY CORE DECOMPRESSION WITH PRP INJECTION AND BONE GRAFTING.

Abstract

Background: Femoral head is the most common bone affected by avascular necrosis. Core decompression procedure, when done in the initial stages, before collapse, may arrest or reverse the progress of avascular necrosis and thereby may preserve the normal femoral head. Hence, we have analysed the clinical, functional and radiological outcome of core decompression with PRP injection and bone grafting in patients with Osteonecrosis of the femoral head (ONFH) upto stage IIB (Ficat & Arlet).
Materials and method: A study was undertaken at our institute from June 2017 to June 2020 wherein 15 patients (18 hips) of ONFH upto grade II B (Ficat & Arlet) were treated with core decompression and the outcomes were studied. Patients were subjected to core decompression of the affected hip. Patients were operated in supine position. In 16/18 hips, cancellous grafting was done after harvesting graft from the posterior iliac crest. In 2 patients cortical nonvascularised fibular graft was used. PRP injection in all patients.
Results: Functional outcome was assessed by Harris hip score, wherein 12 hips (67%) had good or excellent outcome; 1 hip (5.6%) had fair outcome, However 5 hips (27.8%) showed poor result. In stage I, 7/8 hips (87.5%) improved, whereas in Stage IIA, 4/7 hips (57.14%) showed improvement and in stage IIB only 1/3hips (33.33%) showed improvement. Less than 25% of the hips required a replacement or salvage procedure. Strict non weight bearing was compliant by 15 hips (83.33%), whereas 3 hips (16.7%) were not compliant.
Conclusion: Core decompression with bone grafting and PRP injection provide satisfactory outcome when patients are carefully selected in early stages of the disease.