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June 25Bone Marrow Aspirate in the treatment of Osteonecrosis

Articles, Hip Pain

At our institution, hip decompression with the introduction of concentrated bone marrow and platelet rich plasma was performed on 73 hips. Patients were followed for an average of 17 months. Twenty-five patients underwent unilateral decompression and 24 underwent bilateral decompression. Preoperative x-rays and MRI was obtained on all patients. Thirty-six left hips and 37 right hips underwent decompression. The average age of patients was 43 years. Fifty-seven patients had Stage I and 16 patients had stage II. Four hips were re-injected due to continued symptoms without radiographic evidence of progression. Sixteen hips progressed to further stages of osteonecrosis, ultimately requiring total hip replacement. There were no significant complications in any patient undergoing this procedure. Two patients were noted to have post-operative trochanteric bursitis at immediate follow-up, however this was managed non-operatively. The top three underlying etiologies included steroids, alcohol, and idiopathic osteonecrosis of the femoral head. Significant pain relief was reported in 86% of patients, while the rest of patients reported little or no pain relief.

In conclusion, the combination of hip decompression and injection of mesenchymal stem cells into the necrotic lesion provides satisfactory results in patients with early stage osteonecrosis of the femoral head and can lead to complete resolution of the necrotic lesion. The procedure is simple, with a low complication rate and the patients are allowed to weight bear as tolerated allowing them an early return to function and activities of daily living.

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