A comparison of functional outcomes between core decompression for avascular necrosis of the femoral head with and without bone marrow aspirate.

Abstract

There has been a recent increase in research focused on the combination of bone marrow aspirate concentrate (BMAC) with core decompression (CD) in the treatment of avascular necrosis of the femoral head (ANFH). However, the effects on patient functional outcomes have not specifically been determined. This systematic review and meta-analysis of previous studies assess the functional outcomes of combined BMAC with CD compared to those of CD alone. A systematic review and meta-analysis were conducted according to the PRISMA 2020 guidelines. Five online databases were searched using key terms to identify studies. Included in the analysis were randomized controlled trials (RCTs), retrospective reviews, and comparative studies that utilized BMAC with CD, BMAC, or CD as a treatment for ANFH and reported Harris Hip Scores (HHS) or Western Ontario and McMaster Universities Arthritis Index (WOMAC) pre- and post-treatment. 9 studies, evaluating 388 hips total, met inclusion criteria. HHS and WOMAC scores were compared between baseline and 4 ± 2.5 years post-treatment to represent overall physical functionality, pain severity, absence of deformity, range of motion, and stiffness. Significant increases in HHS and decreases in WOMAC were found between baseline and 4 ± 2.5 years follow-up, representing an improvement in overall physical functionality, pain severity, absence of deformity, range of motion, and stiffness. A large effect size was found for CD with BMAC and CD alone, supporting utilization for both CD with BMAC or CD alone with no evidence that CD with BMAC is more effective. Core decompression with and without BMAC shows large improvements in functional outcomes compared to baseline. Future high-quality RCTs would aid in elucidating our understanding of the effects of BMAC with CD on mitigating symptoms and increasing overall function.