Hip survival after plain core decompression alone versus bone morphogenetic protein and/or bone marrow reinjection with
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ORIGINAL PAPER
Hip survival after plain core decompression alone versus bone morphogenetic protein and/or bone marrow reinjection with core decompression for avascular osteonecrosis of the femoral head: a retrospective case control study in ninety two patients Pierre Martinot 1,2
&
J. Dartus 1,2 & J. T. Leclerc 1,2,3 & S. Putman 1,2 & J. Girard 1,2 & H. Migaud 1,2
Received: 3 June 2020 / Accepted: 29 June 2020 # SICOT aisbl 2020
Abstract Introduction Injecting bone marrow or bone morphogenetic protein 7 (BMP) during core decompression for avascular osteonecrosis (AVN) may improve survival. We hypothesized that adding a complementary technique (injection of BMP and/ or non-concentrated bone marrow) to core decompression would reduce the number of patients requiring a subsequent total hip arthroplasty (THA). Methods We retrospectively reviewed 92 cases from 2003 to 2018 with a minimum of 2 years of follow-up and an average follow-up of 64 months (24–204). Twenty-four patients had a core decompression (CD) (26.1% (24/92)), 25 had a CD associated with reinjection of bone marrow and BMP (rhBMP7) (27.2% (25/92)), and 43 patients had a CD with bone marrow reinjection (46.7% (43/92)). Results Hip survival after CD was 66.3% (61/92) at two years and 59.8% (55/92) at 10 years. CD with bone marrow and BMP reinjection had a better hip survival at ten years (HR: 0.492 (CI95%: 0.254–0.952) p = 0.035). A volume of necrosis greater than 30% (HR = 12.97 (CI95 [3.88–43.3] (p < 0.001))) and a Kerboul angle greater than 60° (HR: 12.5 (CI95 [2.84–54.6] (p < 0.001))) were risk factors for a subsequent THA. Conclusions CD is an interesting non-invasive technique to preserve the native hip after AVN of the femoral head. Reinjection of bone marrow and/or BMP improved CD hip survival. Keywords Core decompression . BMP . Autologous bone marrow . Osteonecrosis
Introduction Subchondral fracture is an expected and painful stage of avascular osteonecrosis (AVN) of the femoral head [1]. In order to reduce patient pain and delay implantation of a total hip arthroplasty (THA) [2], surgical core decompression (CD) Level of evidence: III, case control retrospective study * Pierre Martinot [email protected] 1
CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000 Lille, France
2
Service d’Orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000 Lille, France
3
Department of Orthopedic Surgery, CHU de Québec–Université Laval, Quebec, QC, Canada
has been suggested in early stages to promote revascularization of the femoral head [3]. The results of this minimally invasive surgery are mixed [4], while poor results have been observed at advanced stage or with a high volume of necrosis on magnetic resonance imaging (MRI). Some authors have suggested the addition of osteoinductive products to potentiate bone remodeling via osteoinduction and cell regeneration [5]. Hernigou et al. [6] suggested adding of stem cells (concentrated marrow) to improve outcomes of CD. Since then, other adjuvant solutions have been
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