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Updated: Nov 16, 2025
Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head
Published on: April 12, 2022
Modified Kerboul Angle Predicts Outcome of Core Decompression With or Without Additional Cell Therapy
Krit Boontanapibul1, James I Huddleston2, Derek F Amanatullah2
1Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Redwood City, CA; Department of Orthopaedic Surgery, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
Bone marrow aspirate concentrate (BMAC) combined with core decompression improves outcomes for early osteonecrosis of the femoral head (ONFH) when necrotic angles are less than 250°. BMAC reduces femoral head collapse and the need for total hip arthroplasty in these patients.
Area of Science:
- Orthopedic Surgery
- Regenerative Medicine
- Biomaterials
Background:
- Osteonecrosis of the femoral head (ONFH) is a debilitating condition often treated with core decompression.
- Early-stage ONFH requires effective interventions to prevent femoral head collapse and the need for total hip arthroplasty.
- The efficacy of core decompression combined with bone marrow aspirate concentrate (BMAC) in ONFH is under investigation.
Purpose of the Study:
- To investigate the outcomes of core decompression with or without BMAC in early-stage ONFH.
- To evaluate the impact of Kerboul combined necrotic angles on treatment success.
- To compare the rates of femoral head collapse and conversion to total hip arthroplasty between the two treatment groups.
Main Methods:
- A retrospective review of 66 patients (83 hips) with Association Research Circulation Osseous stages I-IIIa ONFH.
- Patients underwent either core decompression alone or core decompression with BMAC.
- Kaplan-Meier survival analysis and subgroup analysis based on modified Kerboul angles (grades I-IV) were performed.
Main Results:
- Femoral head collapse was significantly lower in the BMAC group (32%) compared to the non-BMAC group (58%) (P = .019).
- Conversion to total hip arthroplasty was significantly lower with BMAC (28%) versus without (58%) (P = .007).
- BMAC demonstrated improved outcomes in grades I and II (necrotic angles <250°), with significantly reduced collapse rates.
Conclusions:
- Core decompression with BMAC shows improved outcomes for precollapse ONFH when combined necrotic angles are less than 250°.
- The addition of BMAC to core decompression is more reliable than isolated core decompression for specific patient subgroups.
- High failure rates were observed for both treatment modalities when combined necrotic angles exceeded 250°, necessitating total hip arthroplasty.
