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Hip survival after plain core decompression alone versus bone morphogenetic protein and/or bone marrow reinjection with core decompression for avascular osteonecrosis of the femoral head: a retrospective case control study in ninety two patients

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Abstract

Introduction

Injecting bone marrow or bone morphogenetic protein 7 (BMP) during core decompression for avascular osteonecrosis (AVN) may improve survival. We hypothesized that adding a complementary technique (injection of BMP and/or non-concentrated bone marrow) to core decompression would reduce the number of patients requiring a subsequent total hip arthroplasty (THA).

Methods

We retrospectively reviewed 92 cases from 2003 to 2018 with a minimum of 2 years of follow-up and an average follow-up of 64 months (24–204). Twenty-four patients had a core decompression (CD) (26.1% (24/92)), 25 had a CD associated with reinjection of bone marrow and BMP (rhBMP7) (27.2% (25/92)), and 43 patients had a CD with bone marrow reinjection (46.7% (43/92)).

Results

Hip survival after CD was 66.3% (61/92) at two years and 59.8% (55/92) at 10 years. CD with bone marrow and BMP reinjection had a better hip survival at ten years (HR: 0.492 (CI95%: 0.254–0.952) p = 0.035). A volume of necrosis greater than 30% (HR = 12.97 (CI95 [3.88–43.3] (p < 0.001))) and a Kerboul angle greater than 60° (HR: 12.5 (CI95 [2.84–54.6] (p < 0.001))) were risk factors for a subsequent THA.

Conclusions

CD is an interesting non-invasive technique to preserve the native hip after AVN of the femoral head. Reinjection of bone marrow and/or BMP improved CD hip survival.

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Authors and Affiliations

  1. CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France

    Pierre Martinot, J. Dartus, J. T. Leclerc, S. Putman, J. Girard & H. Migaud

  2. Service d’Orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France

    Pierre Martinot, J. Dartus, J. T. Leclerc, S. Putman, J. Girard & H. Migaud

  3. Department of Orthopedic Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada

    J. T. Leclerc

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Contributions

PM: data acquisition, analysis and interpretation, writing of the article. JD: critical review of the article for its intellectual content. JTL: writing of the article and critical review of the article for its intellectual content. SP: critical review of the article for its intellectual content. JG: critical review of the article for its intellectual content. HM: critical review of the article for its intellectual content, final approval of the submitted version.

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Correspondence to Pierre Martinot.

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Conflict of interest

The authors declare that they have no competing interest. Otherwise, HM is an education and research consultant for Zimmer, Corin, SERF, MSD and chief editor for Orthopaedics & Traumatology: Surgery & Research (Elsevier). SP is an education and research consultant for Corin. JG is an education and research consultant for Microport, Smith and Nephew and Zimmer-Biomet.

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Level of evidence: III, case control retrospective study

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Martinot, P., Dartus, J., Leclerc, J.T. et al. Hip survival after plain core decompression alone versus bone morphogenetic protein and/or bone marrow reinjection with core decompression for avascular osteonecrosis of the femoral head: a retrospective case control study in ninety two patients. International Orthopaedics (SICOT) 44, 2275–2282 (2020). https://doi.org/10.1007/s00264-020-04692-w

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