Core Decompression Combined with Implantation of Autologous Bone Marrow Concentrate with Tricalcium Phosphate Does Not Prevent Radiographic Progression in Early Stage Osteonecrosis of the Hip
Hernandez, Alejandro (Hospital Universitari Vall d'Hebron)
Nuñez, Jorge H. (Hospital Universitari Vall d'Hebron)
Sallent, Andrea (Hospital Universitari Vall d'Hebron)
Gargallo-Margarit, Albert (Hospital Universitari Vall d'Hebron)
Gallardo Calero, Irene (Hospital Universitari Vall d'Hebron)
Barro, Victor (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Untreated osteonecrosis of the femoral head ultimately leads to secondary coxarthrosis. The aim of this study was to determinate if the core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate could be used to prevent radiographic progression of early stage osteonecrosis of the hip. We also sought to determine whether this treatment improved clinical outcomes and reduced the need for total hip arthroplasty. Eighteen hips were included in the present study. All of them underwent core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate between 2007 and 2012. The cell concentrate was obtained from the posterior iliac crest and processed and implanted during the same surgical procedure. Patient demographic data, clinical data including modified Harris hip score, and radiological data were collected preoperatively, postoperatively, and during the follow-up period. Also, survival endpoints were analyzed: time of femoral head collapse and need for total hip arthroplasty. The mean age of patients was 37. 8 years (standard deviation [SD], 9. 31 years). The mean follow-up was 68. 9 months (SD, 15. 0 months). In most cases (70. 6%), the etiology of the osteonecrosis of the femoral head was corticosteroid use; in the remaining cases, secondary to alcohol use. Core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate did not prevent progression to collapse (< 80% at 5 years) although modified Harris hip scores improved. Overall median survival with the total hip arthroplasty as endpoint was 23 months (95% confidence interval [CI], 14. 9 to 31. 1 months). Overall median survival time with any degree of collapse as endpoint was 7 months (95% CI, 2. 0 to 12. 0 months). The results obtained in this study suggest that core decompression combined with implantation of autologous bone marrow concentrate and tricalcium phosphate will not prevent radiographic progression of early stage osteonecrosis of the hip. These finding also suggest that the absence of indications for hip replacement alone is not an indicator of good response to the treatment, and it is important to note the radiological results.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Hip ; Osteonecrosis ; Orthopedic procedures ; Bone marrow ; Bone substitutes
Publicat a:	Clinics in Orthopedic Surgery, Vol. 12 (may 2020) , p. 151-157, ISSN 2005-4408

DOI: 10.4055/cios19033
PMID: 32489535

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