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The fate of bone marrow edema after core decompression and bone marrow aspiration concentrate grafting for the hip
Weiping Su1, Boyan Ma1, Wenjie Leng2
1Department of Orthopedics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China.
Background:
Bone marrow edema (BME) of the femoral head is a prevalent condition that can cause hip pain and is observed in patients as a standalone finding or in conjunction with degenerative or inflammatory conditions. There has been a lack of extensive study on the effectiveness of combining surgery with biological treatment for BME. The objective of this study was to evaluate the efficiency of core decompression (CD) with bone marrow aspirate concentrate (BMAC) augmentation in alleviating pain and enhancing the quality of life in patients with BME in the hip.
Materials And Methods:
We conducted a retrospective analysis of patients who underwent treatment for BME of the hip using CD combined with BMAC between June 2021 and July 2023. Inclusion criteria consisted of patients diagnosed with BME in the hip (presence of BME on T2-weighted MRI in the femoral head or neck with pain corresponding to the same compartment as the BME). The patients' demographic information, presence of other medical conditions, body mass index (BMI), etiology, and assessments using the visual analog scale (VAS) and Harris hip score (HHS) were recorded. Pre- and postoperative radiographic imaging (XR) and magnetic resonance imaging (MRI) were analyzed.
Results:
This study included 28 patients (40 femoral heads) who underwent CD with BMAC grafting at our institution. Among these patients, 9 had normal or non-diagnostic radiographs, 11 were at ARCO stage Ⅰ, and 8 were at ARCO stage Ⅱ. The mean age at the time of operation was 45.21 years (SD 13.17, range 21-75), and the mean BMI was 24.61 (SD 3.75, range 16.6-32.05). The area of BME showed a significant decrease from 954.21 ± 224.68 mm2 to 162.21 ± 189.05 mm2 3 months following surgery (P < 0.001). The VAS showed a substantial reduction from 4.86 ± 1.24 points to 1.86 ± 1.27 points at 3 months post-surgery, and further decreased to 1 ± 1.68 points at 12 months post-surgery (P < 0.001). HHS increased from 48.14 ± 4.4 points to 72.79 ± 8.96 points at 3 months after surgery and further increased to 86.39 ± 11.82 points at 12 months after surgery (P < 0.001). Two patients experienced the resolution of BME 3 months following surgery, whereas 3 femoral heads of 3 patients with ARCO 2 stage collapsed.
Conclusion:
Treatment of BME of the hip using CD combined with BMAC is effective and provides short-term pain relief for BME.
