Core Decompression With Adinizer-Processed Minimally Manipulated Adipose Tissue for Osteonecrosis of the Femoral Head: A Case Report

Osteonecrosis of the femoral head (ONFH) is a progressive disorder that may lead to femoral head collapse and eventual total hip arthroplasty, particularly in relatively younger patients. Joint-preserving strategies remain of interest, and biologic augmentation has recently been explored as an adjunct to core decompression. We report a case of right ONFH treated with core decompression combined with minimally manipulated adipose tissue (microfragmented adipose tissue, MFAT) processed using an Adinizer system. A woman in her 50s presented with a five-month history of right hip pain. Baseline imaging, including coronal and axial MRI sequences, was consistent with Ficat-Arlet stage III ONFH with subchondral collapse. Given the patient's preference for a joint-preserving approach, core decompression with intraosseous MFAT injection was performed. Adipose tissue was harvested from the lower abdomen, mechanically processed using an Adinizer system, and delivered through the decompression tract into the femoral head. Clinically, the patient demonstrated improvement over time. The visual analog scale (VAS) pain score decreased from 10 to 1, and the modified Harris Hip Score (mHHS) improved from 61 to 96 during follow-up. No procedure-related complications were reported. This case suggests that Adinizer-processed MFAT combined with core decompression may be a feasible joint-preserving approach in selected patients with ONFH, even in post-collapse disease. However, given the single-case design, these findings should be interpreted cautiously. Further studies are required to determine reproducibility, optimal indications, and long-term structural outcomes.