Role of Orth Biologics in Core Decompression for Femoral Head Preservation in Early Avascular Necrosis of Hip

Abstract

Head preserving procedures for Early Avasculathe Necrosis of hip are invariably effective in early stage. Core decompression (CD) is mostly performed modality for early stages of AVN having different success rates. Current review aims at determining efficiency of Bone marrow aspirate concentrate, Platelet rich Plasma, Bone morphogenic proteins and combining it with Core Decompression for early AVN stage, before femoral head collapse. To preserve a femur head damaged by osteonecrosis, treatment options should be applied early in the disease process for best results. When the articular cartilage becomes deficient to nutrients, it become more difficult to save a particular femur head, and eventually bone destruction occur, affecting hip biomechanics; articular changes eventually develop, necessitating arthroplasty or arthrodesis. Other early treatment techniques has been identified & improved to improve femur head survival & delay replacement.  Analysis of 20 studies published between 2011 and 2020 was done of which 6 were retrospective & 14 were prospective. PRP showed better survival and functional outcome, however 3 studies showed inconclusive evidence for its regular usage. BMAC enhanced efficiency of CD & cell increment or combination of PRP for growth stimulation. Concluding, CD and BMAC worked effectively that CD only before femoral head collapse. But, PRP need more evidences for extensive utilization. Adding PRP to BMAC or culturing it would increase potency of CD with BMAC. Less data is available to assess efficiency of BMP-7 & role of Intraosseous bisphosphonate therapy could be studied for inexpensive & better alternate.