Autologous Bone Marrow Cells with Core Decompression for Treating Avascular Necrosis of the Femoral Head

Background: Avascular necrosis of the femoral head (AVN) is a progressive pathological process resulting from disruption of blood supply to the femoral head and elevation of intraosseous pressure. Early stage AVN can be managed by various techniques, the results have been disappointing, total hip arthroplasty is frequently the only durable option for pain relief and restoration of function. The newer treatment modalities include using high stem cell concentration in the vicinity of the necrosed tissue with core decompression to prevent disease progression. Patients and methods: A single armed study done from May to November 2023, the total number of patients was 6, (2 Female 4 male). total joints treated 10, Etiology include corticosteroids use, systemic lupus erythematosus mostly related to steroid use in covid 19 epidemic. The age of the patients ranges from 25 - 55 years. The procedure includes core decompression with autologous bone marrow derived mononuclear cell injection inside the femoral head using local anesthesia ultrasound and fluoroscopy guided without drilling. Results: The procedure was safe results showed improvement in the Harris hip score from 48.7?6.6 to 88.00?4.6 (p?0.001) in all 6 patients. With radiological proof by x ray and magnetic resonance imaging in 3 cases according to The Mitchell's grade regressed from C to B in three patients. Conclusions: This single arm short term study showed that core decompression with autologous bone marrow derived cell therapy under local anesthesia with ultrasound and fluoroscopy guidance is safe simple and effective new method and it is a form of minimal manipulative treatment and merits such treatment in larger and longer-term study.