Ferozkhan S, Sivakumar A P, Elumalai Sathish Balaji, Jeyaraman Naveen, Jeyaraman Madhan
Department of Orthopaedics, Government Medical College, Ramanathapuram, Tamil Nadu, India.
Department of Orthopaedics, Tagore Medical College and Hospital, Chennai, Tamil Nadu, India.
J Orthop Case Rep. 2024 Aug;14(8):192-199. doi: 10.13107/jocr.2024.v14.i08.4696.
Osteonecrosis of the femoral head (ONFH), resulting from impaired blood supply to the head of the femur, presents a significant challenge to clinicians due to its debilitating nature. Conservative treatment often offers insufficient pain relief and debilitating functional outcomes which necessitate alternative therapies. Bone marrow aspirate concentrate (BMAC), a potent orthobiologics and rich in mesenchymal stromal cells and growth factors, holds good promise as the minimally invasive procedure for ONFH. With the preceding research suggesting clinical and functional efficacy, we assessed the therapeutic effectiveness of BMAC in ONFH management in joint preservation.
A prospective cohort study was conducted with 20 patients suffering from ONFH who failed to respond to 6 months of conservative treatment. A uniform surgical procedure was performed by a single surgeon, involving bone marrow extraction from the anterior iliac crest and subsequent processing into an 8-10 mL of BMAC concentrate. The BMAC was then injected into the implanted into the decompressed femoral head. The post-operative protocol comprised weight-bearing mobilization, physiotherapy, and a 4-week NSAID-free regimen. Outcome measures included pain scores, hip function, knee symptoms, sports activities, patient satisfaction, and recommendation of the procedure.
Of the 20 patients suffering from ONFH, primarily the left side, most of whom were at stage 2b, significant pain reduction and functional improvement were observed over 24 months. The mean pain score decreased from 9.00 to 3.55, while the hip function score increased from 46.12 to 88.60. However, some patients encountered complications such as symptom recurrence (5%), disease progression (10%), and persistent pain (5%).
Core decompression with BMAC implantation emerges as a promising, effective, and safe treatment for ONFH with better costeffectiveness and minimal side effects, making it a feasible treatment alternative.
股骨头坏死（ONFH）是由于股骨头血液供应受损所致，因其具有使人衰弱的特性，给临床医生带来了重大挑战。保守治疗往往无法充分缓解疼痛，且功能恢复不佳，因此需要其他替代疗法。骨髓抽吸浓缩物（BMAC）是一种有效的骨科生物制剂，富含间充质基质细胞和生长因子，作为治疗ONFH的微创手术具有很大的前景。先前的研究表明其具有临床和功能疗效，我们评估了BMAC在保留关节治疗ONFH中的治疗效果。
对20例ONFH患者进行了一项前瞻性队列研究，这些患者对6个月的保守治疗无反应。由一名外科医生进行统一的手术操作，包括从前髂嵴提取骨髓，随后将其处理成8 - 10 mL的BMAC浓缩物。然后将BMAC注入减压后的股骨头。术后方案包括负重活动、物理治疗和为期4周的无非甾体抗炎药方案。结果指标包括疼痛评分、髋关节功能、膝关节症状、体育活动、患者满意度以及对该手术的推荐度。
在20例ONFH患者中，主要为左侧，大多数处于2b期，在24个月内观察到疼痛显著减轻和功能改善。平均疼痛评分从9.00降至3.55，而髋关节功能评分从46.12升至88.60。然而，一些患者出现了并发症，如症状复发（5%）、疾病进展（10%）和持续性疼痛（5%）。
BMAC植入的髓芯减压术是一种有前景、有效且安全的ONFH治疗方法，具有更好的成本效益和最小的副作用，使其成为一种可行的治疗选择。
