Patro Bishnu Prasad, Jeyaraman Naveen, Jayakumar Tarun, Das Gurudip, Nallakumarasamy Arulkumar, Jeyaraman Madhan
Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India.
Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600077 India.
Indian J Orthop. 2024 Jun 24;58(8):1053-1063. doi: 10.1007/s43465-024-01203-6. eCollection 2024 Aug.
Avascular Necrosis (AVN) of the femoral head, a condition characterized by the interruption of blood supply leading to bone tissue death, presents significant therapeutic challenges. Recent advancements in orthobiologics, including the use of Autologous Adult Live-Cultured Osteoblasts (AALCO), combined with core decompression, offer a novel approach for managing AVN. This study assesses the efficacy of this treatment modality in improving functional outcomes and hindering disease progression.
This retrospective observational study encompassed 30 patients treated between 2020 and 2023 for idiopathic AVN of the femoral head, grades I to III, who had not responded to conservative treatment. Patients were excluded based on specific criteria including age, secondary AVN causes, and certain health conditions. The treatment involved a two-stage surgical procedure under spinal anesthesia with OSSGROW for AALCO generation. Post-operative care emphasized early mobilization, DVT prevention, and avoidance of NSAIDs. Outcome measures were evaluated using the Visual Analog Scale (VAS) for pain, modified Harris Hip Score, and annual MRI imaging for up to 36 months.
Among 26 patients (41 hips) completing the study, statistically significant improvements in pain and hip functionality were documented, alongside positive radiological signs of osteogenesis in the majority of cases. However, four instances required advancement to total hip replacement due to disease progression.
The combination of core decompression and AALCO implantation shows promise as an effective treatment for AVN of the femoral head, with notable improvements in functional and radiological outcomes. This study supports the potential of orthobiologic approaches in AVN treatment, warranting further investigation through comprehensive randomized controlled trials.
股骨头缺血性坏死（AVN）是一种因血液供应中断导致骨组织死亡的病症，带来了重大的治疗挑战。包括使用自体成年活培养成骨细胞（AALCO）在内的骨科生物制剂的最新进展，与核心减压相结合，为管理AVN提供了一种新方法。本研究评估了这种治疗方式在改善功能结局和阻碍疾病进展方面的疗效。
这项回顾性观察研究涵盖了2020年至2023年间因I至III级特发性股骨头AVN接受治疗且对保守治疗无反应的30例患者。根据包括年龄、继发性AVN病因和某些健康状况等特定标准排除患者。治疗采用在脊髓麻醉下进行的两阶段手术，使用OSSGROW生成AALCO。术后护理强调早期活动、预防深静脉血栓形成以及避免使用非甾体抗炎药。使用视觉模拟量表（VAS）评估疼痛、改良Harris髋关节评分，并进行长达36个月的年度MRI成像以评估结局指标。
在完成研究的26例患者（41髋）中，记录到疼痛和髋关节功能有统计学意义的改善，大多数病例还出现了成骨的积极放射学迹象。然而，有4例因疾病进展需要进行全髋关节置换。
核心减压与AALCO植入相结合显示出有望成为股骨头AVN的有效治疗方法，在功能和放射学结局方面有显著改善。本研究支持骨科生物制剂方法在AVN治疗中的潜力，需要通过全面的随机对照试验进行进一步研究。
