PRP-incorporated autologous bone grafting safe, effective for osteonecrosis of the femoral head
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Patients in the pre-collapse stages of post-traumatic osteonecrosis of the femoral head may receive safe and effective treatment with platelet-rich plasma-incorporated autologous granular bone grafting, according to published results.
Researchers randomly assigned 46 patients in the pre-collapse stages of post-traumatic osteonecrosis of the femoral head to be treated with either core decompression and PRP-incorporated autologous granular bone grafting (n=24; treatment group) or core decompression and autologous granular bone grafting alone (n=22; control group). Researchers evaluated radiological results with X-ray and CT scans. They also assessed clinical results with Harris hip score and VAS preoperatively and at 3, 6, 12, 24 and 36 months postoperatively.
Results showed significant improvements in Harris hip scores in both treatment and control groups. However, researchers found 91.7% of patients in the treatment group reached the minimum clinically important difference for the Harris hip score compared with 68.2% of patients in the control group. At the last follow-up, patients in the treatment group also had significantly improved Harris hip and VAS scores compared with the control group, according to results.
Researchers noted 87.5% of patients in the treatment group achieved successful clinical results vs. 59.1% of patients in the control group. Results also showed 79.2% and 50% of patients in the treatment and control groups, respectively, achieved successful radiological results. The treatment group had higher survival rates based on the requirement for further hip surgery as an endpoint vs. the control group, according to results.
“Combining fresh autologous granular bone and PRP may provide the void filler and structural support after necrotic bone removal, which offers a chance for the PRP and fresh bone graft to combine their advantages together during the core decompression procedure,” the authors wrote. “The present study has demonstrated encouraging effects of this method and provides another choice for treatment in [Association of Research Circulation Osseous] ARCO stages II to III of post-traumatic [osteonecrosis of the femoral head] ONFH.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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W. Kelton Vasileff, MD
This paper by Hang Xian, MD, and colleagues is a well written, well planned, partially blinded, randomized controlled trial evaluating core decompression including bone grafting for post-traumatic avascular necrosis of the femoral head. Their treatment groups differed in the addition of platelet-rich plasma to the autologous bone graft material. Although the study had small patient sample size, they did show statistically significant differences in several patient-reported outcome measures, as well as radiographic outcomes and survival rates.
There are several studies that have shown good success with core decompression for avascular necrosis with the use of biological augments including platelet-rich plasma, bone marrow aspirate concentrate and adipose-derived products. Most studies also have small patient sample sizes, and reproducing these results is important in different settings. Additionally, if clinical success can be achieved with less invasive harvesting methods for the biological augments, patients may benefit as well.
Fresh iliac crest autologous bone was harvested and used in this study, which may bring some of the benefits of bone marrow aspirate concentrate along, as most of those harvests are from iliac crest sites. This study further supports the use of core decompression and bone grafting for avascular necrosis and suggests that platelet-rich plasma may be a useful augment to aid healing and clinical success.
Jameson Crane Sports Medicine Institute
Columbus, Ohio
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