Results of minimally invasive core decompression and autologous bone grafting in combination with autologous bone marrow aspirate concentrate in the treatment of patients with aseptic osteonecrosis of the femoral head

Introduction Currently, limb salvage methods have been used for the treatment of aseptic osteonecrosis of the femoral head (ANFH), but their use does not always avoid joint replacement in the later stages of the disease. The combination of core decompression and autologous bone grafting with autologous bone marrow aspirate concentrate (BMAC) in the treatment of patients with ANFH could improve their quality of life, delay joint replacement, or, in some cases, avoid it completely. Purpose To evaluate the results of surgical treatment of patients with ANFH using minimally invasive core decompression and autologous bone grafting in combination with BMAC, develop an algorithm for choosing a method of surgical treatment based on the extent of damage to the femoral head and the stage of the disease. Material and methods A pilot multicenter study included 86 patients diagnosed with ANFH. All patients underwent minimally invasive core decompression in combination with autologous bone grafting and BMAC. Results were analyzed 3, 6, 12 months after surgery. Discussion Due to the fact that the presented study included mainly patients with post-Covid and steroidinduced osteonecrosis, and did not include patients with the first stage of the disease, the percentage of positive treatment results was slightly lower compared to other similar studies. Results Within 3 to 6 months after surgery, 21 patients (24 %) required joint replacement; among the remaining 65 patients (76 %), there was a significant improvement in the condition and quality of life that was confirmed by instrumental studies and functional assessment. Conclusion The technique of minimally invasive core decompression and autologous bone grafting in combination with BMAC is an effective method of treatment patients with pre-collapse ANFH stages, might improve their quality of life but does not allow regression of structural changes in the bone.