Treatment of aseptic osteonecrosis of the femoral head by core decompression coupled with injection of Platelet Rich Plasma

Introduction : Osteonecrosis of femoral head (ONFH) is a pathology leading to progressive collapse and deformity of the femoral head. Its conservative surgical treatment relies on core decompression with or without the addition of a biological stimulus such as PRP. Hypothesis : Does core decompression coupled with PRP injection lead to better functional results in the conservative treatment of ONFH and delay the age of total hip replacement (THR)? Patients and method : We conducted a prospective monocentric study over a 4-year period from August 1, 2020 to April 30, 2024, involving seven (7) cases of ONTF classified as Arlet and modified Ficat stages I, IIa, IIb and III, who had undergone core decompression and PRP injection in our department. The efficacy of the treatment was assessed by functional results according to the Postel-Merl d'Aubigné (PMA) score, preoperatively and postoperatively, and the need or otherwise for THR. Results : A total of six (6) patients presented with seven (7) cases of ONFH. ONFH classified as stage IIb were the most common in 3 cases (42.8%). The mean follow-up in our study was 29 months (extremes: 13 months and 48 months). The mean preoperative PMA score was 11.8/18, compared with a mean postoperative score of 15.4/18. Early-stage patients (group A: types I and IIa) had better functional results than late-stage patients (group B: types IIb and III). No patient required THR. Conclusion : Our results show that core decompression coupled with plasma injection is a simple, minimally invasive technique with better results for patients in the early stages of the disease (stage I and stage IIa).