Abstract

Background:
Avascular necrosis of the femoral head (ANFH) is a progressive orthopedic condition that often affects young individuals and may ultimately require total hip arthroplasty (THA). Core decompression (CD) is a widely used joint-preserving surgical technique, and bone marrow aspirate concentrate (BMAC) injection has been proposed as an adjunct to enhance outcomes by promoting vascularization and cartilage repair.
Objectives:
To compare the clinical and radiological outcomes of patients treated with CD alone versus CD combined with BMAC injection for ANFH.
Methods:
This retrospective study included patients diagnosed with ANFH who underwent CD with or without BMAC injection. Demographic characteristics, preoperative and 1-year Harris Hip Score (HHS), Visual Analog Scale (VAS) score, Steinberg stage, and the need for THA during follow-up were recorded. All diagnoses were confirmed by MRI and radiography.
Results:
A total of 42 hips (30 males, 12 females, mean age 41.8 years, range 14–66) were analyzed. BMAC injection was performed in 28 hips (66.7%) and not performed in 14 hips (33.3%). At 1-year follow-up, Steinberg stage progression was observed in 73.8% of hips, while 26.2% showed regression. THA was required in 14.3% of patients overall—7% in the BMAC group versus 28% in the CD-only group (p = 0.1). VAS scores decreased in 32% of BMAC-treated hips versus 21% in CD-only hips (p > 0.05). Improvement in HHS was seen in 60% of the BMAC group versus 50% of the CD-only group (p > 0.05).
Conclusion:
Although statistical significance was not reached, the addition of BMAC to core decompression showed a trend toward reduced THA conversion and improved hip function. These findings suggest a potential benefit that warrants further investigation in larger, prospective studies before routine use can be recommended.

Key words: Avascular necrosis, femoral head, core decompression, bone marrow aspirate concentrate, total hip arthroplasty, hip preservation