Core decompression and bone marrow aspirate injection in avascular necrosis of the femoral head

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Abstract
To evaluate the clinical and radiological outcomes of core decompression combined with bone marrow aspirate injection (BMAI) in patients with femoral head avascular necrosis (AVN) before articular surface collapse. Twenty-two patients with AVN underwent core decompression and BMAI. The patients were followed for at least 12 months. Radiological assessments were performed using plain radiography and magnetic resonance imaging, and staging was conducted based on the Association Research Circulation Osseous system. Clinical outcomes were evaluated using the Harris Hip Score and Merle d’Aubigne-Postel scoring systems. At the 12-month follow-up, hip function scores showed significant improvement. The mean Harris Hip Score increased by 23 points (P < .001), and the mean Merle d’Aubigne-Postel score increased by 1 point (P < .001). Radiologically, all stage I lesions regressed to stage 0 (P < .001). Among stage II lesions, 83% remained stable, while progression was observed in 17%. 75% of the stage IIIA lesions showed radiological progression. Core decompression combined with BMAI effectively halts the progression of early-stage AVN, preserving joint integrity and delaying the need for total hip arthroplasty. Further studies are warranted to explore the efficacy of biological therapy in treating femoral head AVN.

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