Hip Decompression Augmented With Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for Corticosteroid-Induced Osteonecrosis of the Femoral Head: A Minimum 10-Year Follow-Up.

Abstract

Biologic augmentation with bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) has been used in conjunction with hip decompression (HD) for the treatment of pre-collapse osteonecrosis (ON) of the femoral head. This study reports a concise minimum 10-year follow-up of a previously published prospective cohort of patients who had corticosteroid-induced ON treated with HD augmented with BMAC and PRP. There were 21 patients (34 hips) who had pre-collapse corticosteroid-associated ON who underwent HD combined with BMAC and PRP. Their mean age and body mass index at surgery were 43 years (range, 22 to 66) and 31 (range, 22 to 41), respectively. Survivorship free from femoral head collapse and conversion to total hip arthroplasty (THA) was assessed using Kaplan-Meier analysis. Risk factors for failure were evaluated using Cox regression analyses. Functional outcomes were assessed using the Harris Hip Score (HHS). At a mean follow-up of 11 years (range, 10 to 13), survivorship free from conversion to THA was 62%. Indications for conversion included femoral head collapse (n = 5), persistent pain without collapse (n = 5), and progression of osteoarthritis (n = 2). Patients who had low preoperative Kerboul angles (KA) (grades 1 to 2) demonstrated 11-year survivorship of 91% free from collapse and 66% free from THA, whereas those who had high KA (grades 3 to 4) demonstrated survivorship of 40% for both outcomes (P = 0.0004 and P = 0.083, respectively). High preoperative KA independently increased the risk of femoral head collapse (hazard ratio (HR) 13.2; P = 0.005). In hips not converted to THA, mean HHS improved from 58 preoperatively to 86 at final follow-up (P < 0.0001). There were no additional conversions to THA beyond the previously reported mean 7-year follow-up. At a minimum of 10 years, HD augmented with BMAC and PRP resulted in sustained hip preservation in patients who had corticosteroid-induced osteonecrosis. Lesion size, as defined by the KA, remains the most important predictor of longer-term success.