Comparative study of core decompression with allograft and autologous bone marrow therapy plus alendronate versus classical bone graft alone in Ficat grade II-III avascular necrosis of the hip.

BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a progressive, debilitating condition caused by compromised blood supply, leading to bone cell death and femoral head collapse. Effective early-stage treatments remain limited. AIM: This study compared core decompression (CD) with allograft and autologous bone marrow therapy plus alendronate against classical bone grafting alone in patients with Ficat Grade II-III ONFH, aiming to assess functional outcomes and delay the need for total hip arthroplasty. METHODOLOGY: This randomised, prospective study involved 48 patients with Ficat Grade II-III avascular necrosis of the hip. Group A received CD combined with autologous bone marrow stem cells and allograft plus alendronate, while Group B underwent CD with a classical iliac bone graft and alendronate. Clinical outcomes were assessed at 6, 12, and 24 months using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Oxford Hip Score (OHS), and magnetic resonance imaging-based necrotic area evaluation. RESULTS: Over a 24-month follow-up, Group A demonstrated superior outcomes across all clinical indices. WOMAC scores improved from 36.9 to 12.2 in Group A, versus 34.7 to 22.4 in Group B. HHS rose from 45.8% to 82.0% in Group A and from 42.6% to 60% in Group B. OHS increased from 12 to 44 in Group A and from 14 to 28 in Group B. Significant (p < 0.0001) reductions in necrotic segment size and fewer poor outcomes were observed in Group A. CONCLUSIONS: Group A's approach yielded greater functional recovery, pain relief, and mobility restoration than classical grafting alone.