Proof of concept to portray management of early and mid-stage avascular necrosis with bone marrow aspirate concentrate and high concentrate plasma augmentation, post percutaneous core decompression-an ortho biologics approach

Background: Avascular necrosis (AVN) or osteonecrosis of the femoral head portray as a progressive disease affecting hip joints particularly in younger and middle-aged individuals and if left untreated precipitate to secondary complications. Percutaneous core decompression (PCD) has been the first line treatment for AVN in view of its beneficial effects to remove necrotic lesion, non-invasive, compression lessened with revascularization. Ortho biologics explore the application of autologous bone marrow aspirate concentrate (BMAC) and high concentrate platelet rich plasma (HCP) found naturally in body to improve healing, reduce inflammation with very good safety profile and require minimal post-procedural time for recovery. Present study explores the synergistic effect of autologous BMAC and HCP post PCD, as an interventional therapy to treat AVN patients. Methods: We recruited (prospective study) 45 AVN patients (mean age: 37.8 years, range, 15-52 years, 38 males and 7 females). Treatment included, PCD followed by augmentation with autologous BMAC and HCP injection via fluoroscopy in femoral head guided. The patient’s follow-up was for two years by telephonic survey post therapy (2023-2025) and were assessed using standard Ficat and Arlet scoring. Results: Patients in stage I (3.8%), stage II (55.7%) and stage III (16.45%) showed greater improvement(s) as very good/good/satisfactory compared to stage IV (12.65%) which required total hip replacement (THR). Conclusions: We advocate promising line of treatment for management of stage I-III of AVN patients (Ficat and Arlet scoring) using combination of BMAC and HCP augmentation post PCD.