A Combination Therapy for Osteonecrosis of the Femoral Head and Short-Term Results

Objective: The purpose of this study is to report the clinical and radiological outcomes of patients who underwent core decompres- sion in combination with bone marrow aspiration concentrate injection at the decompressed site and medical treatment and to compare these outcomes with a matched cohort of patients who underwent isolated core decompression. Methods: Patients were divided into 2 groups according to their health insurance’s coverage. Patients were treated with core decom- pression in combination with bone marrow aspiration concentrate injection and medical therapy (group A) or with core decompres- sion alone (group B) for patients whose insurance did not cover bone marrow aspiration concentrate treatment. The extent of osteonecrosis was estimated by a modification of the combined necrosis-angle method of Kerboul. Results: A total of 29 hips in group A and 27 hips in group B were evaluated. The groups showed similar demographic data and follow-up time. A total of 3 patients from group A and 10 from group B underwent revision. Revisions were significantly more com- mon in group B (P = .018) and time to revision was also significantly shorter (P = .005). There was a significant difference in survival between the groups. Patients had better scores on average in the first postoperative year. There was no difference in clinical scores between the groups. Type of surgery was found to be a risk factor for revision. Conclusion: Core decompression combined with bone marrow aspirate concentration and mixed medical treatment consisting of alendronate, lovastatin, and enoxaparin resulted in better clinical outcomes, lower pain scores, and significantly lower revision rates compared with core decompression alone. Core decompression alone was a risk factor for revision.