Abstract

BENEFICIAL EFFECTS OF PERCUTANEOUS CORE DECOMPRESSION WITH BONE MARROW ASPIRATE CONCENTRATE IN THE CLINICAL MANAGEMENT OF AVASCULAR NECROSIS FROM STAGE III TO II: A 28 MONTHS FOLLOW-UP STUDY

Venkatesh Movva1*, Anand Alluru, Syed Khaleel1, Sunitha Manne Mudhu, Vijayalakshmi Venkatesan

Abstract

Background and Clinical Significance: Avascular necrosis (AVN) of the femoral head is a progressive and debilitating condition resulting from compromised blood supply, leading to bone ischemia, structural collapse, and eventual joint degeneration. Delayed intervention frequently necessitates total hip arthroplasty (THA). Early-stage management using minimally invasive and regenerative approaches aims to preserve the native joint, alleviate symptoms, and prevent disease progression. Case Presentation: A 40-year-old male presented with left hip pain and was diagnosed with AVN of the femoral head, classified as Ficat–Arlet Stage III. Magnetic resonance imaging (MRI) revealed STIR hyperintensity involving the left femoral head, neck, and intertrochanteric region, with additional acetabular involvement and minimal joint effusion. The patient underwent a minimally invasive intervention consisting of percutaneous core decompression (PCD) augmented with autologous Bone Marrow Aspirate Concentrate (BMAC) and Platelet-Rich Plasma (PRP), delivered into the necrotic zone under fluoroscopic guidance. At 28-month follow-up, the patient demonstrated marked clinical and functional improvement. Pain, assessed using the Numeric Pain Rating Scale (NPRS), decreased from 6/10 preoperatively to 1–2/10. Functional outcomes showed significant gains in range of motion (ROM): hip flexion improved from 80° (painful) to 130° on the affected side, while extension increased from 10° to 15°. Internal rotation improved from 10° to 30°, and abduction from 15° to 35°. Muscle strength improved across all groups, with most reaching 5/5 on the Oxford MMT scale. Follow-up MRI demonstrated radiological regression from Stage III to Stage II AVN. Conclusion: This case highlights the potential of orthobiologic augmentation using BMAC and PRP in conjunction with core decompression as an effective joint-preserving strategy in AVN. The observed clinical, functional, and radiological improvements suggest that this combined approach may promote osteogenesis and angiogenesis, potentially reversing disease progression and delaying or avoiding the need for total hip arthroplasty in younger patients.

Keywords: Avascular necrosis, Bone Marrow Aspirate Concentrate, Platelet Rich Plasma, Regenerative Orthopaedics, Femoral Head.