Management of Early Avascular necrosis of femoral head with Core Decompression and Platelet Rich Plasma infiltration

Abstract

Various modalities available for the treatment of AVN range from conservative modalities like observation and non-weight-bearing mobilization, various pharmacological agents like Bisphosphonates, Enoxaparin are shown to be useful in some studies, Hyperbaric oxygen therapy to Surgical modalities like femoral head preserving procedures (core decompression with or without additional procedure, i.e. bone grafting, biologic adjuvants – Platelet Rich Plasma, Stem cells etc. and rotational osteotomies) and replacement surgeries. 20 patients of Early AVN who met inclusion criteria and operated with core decompression and PRP infiltration were included in this study. Out of 20 patients, 2 patients (10%) had superficial infections which healed on its own without any intervention, 5 patients (25%) had restriction of movements and 3 patients (15%) required replacement surgery. The mean pre-operative Harris Hip Score of our study was 64.3, and the mean post-operative Harris hip score of our study was 80.2. Out of 20 cases, 6 patients (30%) showed limitation of the progression of the disease, 3 (15%) patients progressed to the further stages of the disease and 11 patients (55%) had remission of the disease. The final outcome, on the basis of Harris Hip Score in 5 patients (25%), was excellent, 7 patients (35%) was good, 5 patients (25%) was fair, and in 3 patients (15%) was poor. Our study concludes that Core decompression along with PRP infiltration can be used as a good alternative for or in addition with traditionally performed core decompression and bone grafting.