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Treatment of avascular osteonecrosis of femoral head by core decompression and platelet-rich plasma: a prospective not controlled study

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Abstract

Purpose

Core decompression is a surgical option since the 1960s for hip osteonecrosis treatment. This technique promotes bone repair by reducing intramedullary pressure, but this is not often enough to stop the progression of necrosis. The aim of this study was to associate core decompression with the regenerative stimulus provided by platelet-rich plasma (PRP) and compare our results with other regenerative techniques.

Methods

Femoral head osteonecrosis was prospectively evaluated in 30 hips (22 patients, 15–60 years) treated by core decompression and PRP graft. Patients presented monolateral or bilateral osteonecrosis in stage I–IIA–IIB according to Arlet and Ficat classification. The outcome was assessed by changes in Harris Hip Score (HHS) and the need for total hip replacement (THA).

Results

The mean preoperative HHS was 64 points, at two years from surgery was roughly 84 points. Sixteen of 30 hips showed osteonecrosis progression of the femoral head and were converted to THA. At the five year follow-up, the survival rate was 100% for patients at stage I, 67% for stage IIA, and 0% for stage IIB and was 68% and 32% for idiopathic and secondary osteonecrosis, respectively.

Conclusion

Core decompression combined with PRP could be indicated as a treatment for the I and IIA stages of osteonecrosis, as it significantly reduces joint pain and delays THA. This procedure should be avoided in AVNFH related to cortisone therapy because only a few benefits have been proven. It also has the advantage of being technically simple, minimally invasive, and free from complications.

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Authors and Affiliations

  1. Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126, Torrette di Ancona, Italy

    Marco Grassi, Paolo Salari, Daniele Massetti, Giuseppe F. Papalia & Antonio Gigante

Authors
  1. Marco Grassi
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  2. Paolo Salari
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  3. Daniele Massetti
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  4. Giuseppe F. Papalia
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  5. Antonio Gigante
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. Marco Grassi, Dr. Paolo Salari, Dr. Daniele Massetti, and Dr. Giuseppe F. Papalia. The last draft of the manuscript was written by and Prof. Antonio Gigante. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marco Grassi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The protocol of the present study and other requested documents were reviewed and approved by the Department of Clinical and Molecular Science (DISCLIMO) board in according to the Policy of Clinical Orthopaedics (Università Politecnica delle Marche, Italy). All procedures were conducted in accordance of good clinical practice and Declaration of Helsinki 1964.

Informed consent

Informed consent in paper form was obtained from all individual participants and attached to the patient’s medical record.

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SPSS vs 23.0, Chicago, Illinois, United States (software application).

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Grassi, M., Salari, P., Massetti, D. et al. Treatment of avascular osteonecrosis of femoral head by core decompression and platelet-rich plasma: a prospective not controlled study. International Orthopaedics (SICOT) 44, 1287–1294 (2020). https://doi.org/10.1007/s00264-020-04628-4

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  • DOI: https://doi.org/10.1007/s00264-020-04628-4

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