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Core decompression with bone marrow aspirate concentrate in post collapse avascular necrosis of hip: A systematic
Karan Jindal1, Sameer Aggarwal1, Prasoon Kumar1
1Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Core decompression (CD) with bone marrow aspirate concentrate (BMAC) does not delay radiographic progression or total hip replacements (THRs) in advanced avascular necrosis (AVN) of the femoral head. CD alone may be considered for stage 3 AVN in younger patients to postpone THRs.
Area of Science:
- Orthopedic surgery
- Regenerative medicine
- Hip joint pathology
Background:
- Avascular necrosis (AVN) of the femoral head is a debilitating condition often leading to total hip replacements (THRs).
- While core decompression (CD) with bone marrow aspirate concentrate (BMAC) shows promise in early AVN stages, its efficacy in advanced, post-collapse stages remains uncertain.
- Delaying arthroplasty in AVN patients is crucial due to the high rates of revision surgery.
Purpose of the Study:
- To evaluate the effectiveness of combining CD and BMAC in delaying radiographic progression and the need for THRs in advanced AVN of the hip.
- To compare the outcomes of CD + BMAC with CD alone in post-collapse AVN stages.
Main Methods:
- A systematic review and meta-analysis of relevant studies was performed.
- Searches were conducted across PubMed, EMBASE, and SCOPUS databases.
- The review included 12 studies, with 3 contributing to the meta-analysis, encompassing 270 hips (196 treated with CD + BMAC).
Main Results:
- In advanced AVN stages (3 and 4), 39.8% of cases progressed radiographically, and 38.3% ultimately required THR.
- The combination of CD + BMAC demonstrated no significant improvement in delaying radiographic progression compared to CD alone (OR: 1.41; 95% CI: 0.55-3.62).
- Similarly, CD + BMAC did not show enhanced efficacy in reducing the need for conversion to THR versus CD alone (OR: 0.92; 95% CI: 0.41-2.06).
Conclusions:
- Core decompression (CD) may be considered for stage 3 AVN in younger patients to potentially delay arthroplasty, possibly augmented with bone grafts or tantalum rods.
- Bone marrow aspirate concentrate (BMAC) has not demonstrated additional benefits over CD alone in advanced AVN stages.
- The findings suggest that BMAC is less effective in advanced AVN compared to its established benefits in earlier stages.
Background:
Avascular necrosis (AVN) of femoral head is commonly seen in middle age groups and in its advanced stages, it is a common indication for total hip replacements (THRs). These patients invariably require revision surgeries in their lifetime and modalities to delay the first arthroplasty are necessary. Core decompression (CD) with bone marrow aspirate concentrate (BMAC) have proved successful in early stages of AVN, but their role in advanced stages remains unclear. The present review was done to assess the same.
Research Question:
Is CD and BMAC combination effective in delaying radiographic progression and THRs in post collapse stages of AVN hip?
Methodology:
A systematic review and meta-analysis was conducted to determine the overall efficacy of CD and BMAC in post collapse stages of AVN hip and to specifically compare primary outcomes like radiographic progression along with need of THR, with CD alone.Three data bases (PubMed, EMBASE and SCOPUS) were searched to identify relevant articles.
Results:
The present review included 12 studies with 3 studies included in the meta-analysis. There were 270 hips across the 12 studies out of which 196 hips were treated with CD + BMAC.
Primary Outcomes:
39.8% cases worsened from stage 3 to stage 4, while the overall incidence of THR in stages 3 and 4 was 38.3%. On comparison with CD alone the combination of CD + BMAC did not show any enhanced efficacy in either delaying progression (Odds ratio of 1.41 (95% CI = 0.55-3.62) or in conversion to THR (Odds Ratio: 0. 92; 95% CI = 0.41-2.06).
Conclusion:
CD can be considered in stage 3 of AVN in younger population to delay the need of arthroplasty, before severe head distortion and arthritis sets in, and can be supplemented with bone strut grafts or tantalum rods, for supporting the articular cartilage. BMAC that has shown better results in early AVN, has not shown any additional benefits when compared to CD alone in advanced cases.
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