Jindal Karan, Aggarwal Sameer, Kumar Prasoon, Rathod Pratik
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Clin Orthop Trauma. 2021 Feb 17;17:78-87. doi: 10.1016/j.jcot.2021.02.010. eCollection 2021 Jun.
Avascular necrosis (AVN) of femoral head is commonly seen in middle age groups and in its advanced stages, it is a common indication for total hip replacements (THRs). These patients invariably require revision surgeries in their lifetime and modalities to delay the first arthroplasty are necessary. Core decompression (CD) with bone marrow aspirate concentrate (BMAC) have proved successful in early stages of AVN, but their role in advanced stages remains unclear. The present review was done to assess the same.
Is CD and BMAC combination effective in delaying radiographic progression and THRs in post collapse stages of AVN hip?
A systematic review and meta-analysis was conducted to determine the overall efficacy of CD and BMAC in post collapse stages of AVN hip and to specifically compare primary outcomes like radiographic progression along with need of THR, with CD alone.Three data bases (PubMed, EMBASE and SCOPUS) were searched to identify relevant articles.
The present review included 12 studies with 3 studies included in the meta-analysis. There were 270 hips across the 12 studies out of which 196 hips were treated with CD + BMAC.
39.8% cases worsened from stage 3 to stage 4, while the overall incidence of THR in stages 3 and 4 was 38.3%. On comparison with CD alone the combination of CD + BMAC did not show any enhanced efficacy in either delaying progression (Odds ratio of 1.41 (95% CI = 0.55-3.62) or in conversion to THR (Odds Ratio: 0. 92; 95% CI = 0.41-2.06).
CD can be considered in stage 3 of AVN in younger population to delay the need of arthroplasty, before severe head distortion and arthritis sets in, and can be supplemented with bone strut grafts or tantalum rods, for supporting the articular cartilage. BMAC that has shown better results in early AVN, has not shown any additional benefits when compared to CD alone in advanced cases.
股骨头缺血性坏死（AVN）常见于中年人群，在其晚期，是全髋关节置换术（THR）的常见指征。这些患者一生中总是需要翻修手术，因此有必要采取措施延迟首次关节成形术。骨髓抽吸浓缩物（BMAC）辅助的髓芯减压（CD）已被证明在AVN早期阶段是成功的，但其在晚期阶段的作用仍不清楚。本综述旨在对此进行评估。
CD与BMAC联合使用在延迟AVN髋关节塌陷后阶段的影像学进展和THR方面是否有效？
进行了一项系统综述和荟萃分析，以确定CD与BMAC联合使用在AVN髋关节塌陷后阶段的总体疗效，并特别比较影像学进展以及THR需求等主要结局与单纯CD的差异。检索了三个数据库（PubMed、EMBASE和SCOPUS）以识别相关文章。
本综述纳入了12项研究，其中3项研究纳入了荟萃分析。12项研究共涉及270个髋关节，其中196个髋关节接受了CD + BMAC治疗。
39.8%的病例从3期恶化至4期，而3期和4期THR的总体发生率为38.3%。与单纯CD相比，CD + BMAC联合使用在延迟进展（优势比为1.41（95%CI = 0.55 - 3.62））或转换为THR（优势比：0.92；95%CI = 0.41 - 2.06）方面均未显示出任何增强疗效。
对于年轻人群的AVN 3期患者，在严重的股骨头变形和关节炎出现之前，可考虑采用CD来延迟关节成形术的需求，并可辅以骨支撑移植或钽棒，以支撑关节软骨。BMAC在早期AVN中显示出较好的效果，但在晚期病例中，与单纯CD相比未显示出任何额外益处。
