Summary

CORE DECOMPRESSION AUGUMENTED WITH BONE MARROW ASPIRATE IN STAGE 1 & 2 AVN HIP-Single Hole Tecnique

Abstract

Introduction- The management of early-stage osteonecrosis of the femoral head remains challenging. In the current series, core decompression with multiple pinning was done with autologous bone marrow obtained from the iliac crest of patients operated on for osteonecrosis of the hip. We describe the use of bone marrow aspirate to stimulate a healing response in 1 st & 2 nd stage of AVN of hip with core decompression. Bone marrow aspirate is a rich source of MSCs and osteoprogenitor cells in the body.
Methord –We evaluated 12 patients with a non traumatic FHN during the period of 2-5 years after intervention.The inclusion criteria for this study were age over 18 years and presence of stage 1&2 femoral head necrosis according to the ARCO classification. All the patients evaluated with X rays of pelvis AP view and MRI of the affected hips.
Surgical procedure -The core decompression was performed in all procedures under spinal anesthesia. Under the guidance of image intensifier the multiple pinning was done with 2 mm k- wires were drilled trough base of trochanter .The multiple k wire were drilled through single hole after analyzing the necrotic areas in the MRI .The bone marrow aspirate was instilled in the multiple holes with epidural needle.

Results

-12 hips were operated of 6 patients from 2015-2017 .The clinical and radiological outcome was evaluated at 3 months postoperatively by VAS and HHS and 1-2 years on radiological. There was significant improvement in the pain and the healing patch was formed in xray and MRI.

Conclusion

– The trial could detect that the additional injection of BMA In the hip region gives benefit of improvement in the functional and radiological outcome with regards of bone regeration in the AVN stage 1 ST and 2 ND . The single hole tecnique gives benefit of less chances of stress and fracture and single tract instilling of bone marrow aspirate.