Pierre Martinot1,2, J Dartus3,4, J T Leclerc3,4,5, S Putman3,4, J Girard3,4, H Migaud3,4. 1. CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France. pierre.martinot@hotmail.fr. 2. Service d'Orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France. pierre.martinot@hotmail.fr. 3. CHU Lille, Hôpital Salengro, University of Lille, Hauts de France, F-59000, Lille, France. 4. Service d'Orthopédie, Hôpital Salengro, CHU Lille, Place de Verdun, F-59000, Lille, France. 5. Department of Orthopedic Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada.
Abstract
INTRODUCTION: Injecting bone marrow or bone morphogenetic protein 7 (BMP) during core decompression for avascular osteonecrosis (AVN) may improve survival. We hypothesized that adding a complementary technique (injection of BMP and/or non-concentrated bone marrow) to core decompression would reduce the number of patients requiring a subsequent total hip arthroplasty (THA). METHODS: We retrospectively reviewed 92 cases from 2003 to 2018 with a minimum of 2 years of follow-up and an average follow-up of 64 months (24-204). Twenty-four patients had a core decompression (CD) (26.1% (24/92)), 25 had a CD associated with reinjection of bone marrow and BMP (rhBMP7) (27.2% (25/92)), and 43 patients had a CD with bone marrow reinjection (46.7% (43/92)). RESULTS: Hip survival after CD was 66.3% (61/92) at two years and 59.8% (55/92) at 10 years. CD with bone marrow and BMP reinjection had a better hip survival at ten years (HR: 0.492 (CI95%: 0.254-0.952) p = 0.035). A volume of necrosis greater than 30% (HR = 12.97 (CI95 [3.88-43.3] (p < 0.001))) and a Kerboul angle greater than 60° (HR: 12.5 (CI95 [2.84-54.6] (p < 0.001))) were risk factors for a subsequent THA. CONCLUSIONS: CD is an interesting non-invasive technique to preserve the native hip after AVN of the femoral head. Reinjection of bone marrow and/or BMP improved CD hip survival.
INTRODUCTION: Injecting bone marrow or bone morphogenetic protein 7 (BMP) during core decompression for avascular osteonecrosis (AVN) may improve survival. We hypothesized that adding a complementary technique (injection of BMP and/or non-concentrated bone marrow) to core decompression would reduce the number of patients requiring a subsequent total hip arthroplasty (THA). METHODS: We retrospectively reviewed 92 cases from 2003 to 2018 with a minimum of 2 years of follow-up and an average follow-up of 64 months (24-204). Twenty-four patients had a core decompression (CD) (26.1% (24/92)), 25 had a CD associated with reinjection of bone marrow and BMP (rhBMP7) (27.2% (25/92)), and 43 patients had a CD with bone marrow reinjection (46.7% (43/92)). RESULTS: Hip survival after CD was 66.3% (61/92) at two years and 59.8% (55/92) at 10 years. CD with bone marrow and BMP reinjection had a better hip survival at ten years (HR: 0.492 (CI95%: 0.254-0.952) p = 0.035). A volume of necrosis greater than 30% (HR = 12.97 (CI95 [3.88-43.3] (p < 0.001))) and a Kerboul angle greater than 60° (HR: 12.5 (CI95 [2.84-54.6] (p < 0.001))) were risk factors for a subsequent THA. CONCLUSIONS:CD is an interesting non-invasive technique to preserve the native hip after AVN of the femoral head. Reinjection of bone marrow and/or BMP improved CD hip survival.
Entities:
Keywords:
Autologous bone marrow; BMP; Core decompression; Osteonecrosis
Authors: Michael A Mont; Jeffrey J Cherian; Rafael J Sierra; Lynne C Jones; Jay R Lieberman Journal: J Bone Joint Surg Am Date: 2015-10-07 Impact factor: 5.284
Authors: Michael A Mont; Michael G Zywiel; David R Marker; Mike S McGrath; Ronald E Delanois Journal: J Bone Joint Surg Am Date: 2010-09-15 Impact factor: 5.284