Magnesium-Doped Artificial Bone Combined With Pedicled Peri-Acetabular Bone Flap for ARCO Stage II Osteonecrosis of the Femoral Head: A Comparative Study.

Abstract

Magnesium (Mg) ions promote bone regeneration. Combined with a vascularized periosteal flap providing blood supply and mechanical support, this approach may improve outcomes for osteonecrosis of the femoral head (ONFH), but its clinical efficacy is unclear. This study compared this approach with conventional core decompression (CD) for Association Research Circulation Osseous (ARCO) Stage II ONFH. A retrospective analysis was conducted on 76 patients (82 hips) with ARCO Stage II ONFH. The observation group (OG) (39 patients, 44 hips) received Mg-doped artificial bone combined with pedicled peri-acetabular bone flap (MAB-PPBF), while the control group (CG) (37 patients, 38 hips) underwent CD. Operative time, intraoperative blood loss, Harris Hip Score (HHS), Visual Analog Scale (VAS), ARCO stage, Kerboul angle, and hip-preserving success rate were compared. Baseline characteristics were comparable between groups. The OG had longer operative time (47.9 ± 7.2 vs. 44.2 ± 3.5 min) and greater blood loss (36.2 ± 8.1 vs. 27.3 ± 7.1 mL) than the CG (p < 0.05). At final follow-up, the OG showed significantly higher HHS (84.12 ± 3.14 vs. 81.94 ± 2.09) and lower VAS (2.97 ± 0.43 vs. 3.32 ± 0.76) compared with controls (p < 0.05). The OG also had a higher proportion of ARCO Stage II (47.6% vs. 30.0%) and lower proportion of Stage IV (4.8% vs. 16.7%, p < 0.05). The Kerboul angle was significantly smaller in the OG (203.54° ± 32.84° vs. 221.39° ± 31.82°, p < 0.05). The hip-preserving success rate was significantly higher in the OG (90.9%, 40/44) than in the CG (65.8%, 25/38, p < 0.05). For ARCO Stage II ONFH, MAB-PPBF achieves more thorough necrotic bone removal, adequate grafting, accelerated bone regeneration, effective hip pain relief, improved hip function, and delayed disease progression compared with CD, showing superior clinical outcomes.