Core Decompression With Bone Marrow Aspirate Concentrate for Avascular Necrosis of the Femoral Head

Avascular necrosis (AVN) of the femoral head is a complex and debilitating condition that predominantly affects a relatively young population. Core decompression of the femoral head is the primary surgical option for joint preservation, most commonly used in the early stages. However, clinical and radiological outcomes are variable in the literature. Biological therapies, such as bone marrow aspirate concentrate (BMAC), have also been used as adjuvants to complement this procedure. This study aims to evaluate the outcomes of this surgical intervention.

From 2012 to 2022, we conducted a retrospective study at a small Portuguese National Health Service hospital of all patients who underwent core decompression combined with the use of BMAC. Clinical data were reviewed, and telephone interviews were conducted, with functional scores completed and radiological criteria assessed. The primary outcome was preservation of the native hip at two years postoperatively.

The series included 18 patients, totaling 24 affected hips. The average survival time after core decompression with BMAC was 14 months. The outcome was favorable in six (25%) hips, while 18 (75%) hips required a salvage arthroplasty. Patients with smaller preoperative lesions had more favorable outcomes than those with larger lesions.

The results of this study seem to confirm the importance of lesion size as a prognostic factor in the treatment of AVN lesions. Early stages alone do not guarantee surgical success.