Effects of PRP injection combined with intersecting femoral head decompression versus combined with multiple core decompression in the treatment of avascular necrosis of femoral head-a single-center retrospective cohort study.

BACKGROUND

Avascular necrosis of femoral head (ANFH) is a localized destruction of the femoral head caused by a variety of complex reasons, which eventually progresses to collapse of the femoral head and loss of joint function. Platelet-rich plasma(PRP), an autologous platelet concentrate rich in growth factors, has been widely used in the treatment of ANFH because of its ability to promote osteogenesis. PRP injection is often combined with multiple surgical approaches to treat ANFH. The objective of this study is to evaluate the effect of PRP injection combined with intersecting femoral head decompression versus combined with multiple core decompression (MCD) in the treatment of ANFH.

METHODS

A retrospective cohort analysis comparing two surgical interventions was conducted between January 2020 and December 2020. Specifically, 25 patients with ARCO stage II non-traumatic ANFH received PRP injection combined with intersecting femoral head decompression, while another 25 patients underwent PRP injection plus MCD. Postoperative functional outcomes were assessed using the Harris Hip Score (HHS) and Visual Analogue Scale (VAS), while radiographic progression was evaluated through standardized X-ray and computed tomography (CT) imaging protocols. Functional and radiographic results were compared between the two groups.

RESULTS

All patients were followed up without occurrence of complications such as infection and thrombosis. The mean follow-up time was 29.7 ± 3.4 months. HHS of patients treated by intersecting femoral head decompression at 12 months and 24 months postoperatively (78.7 ± 4.1 and 79.8 ± 5.0) were significantly higher than those of patients treated by MCD (75.9 ± 5.4 and 76.6 ± 5.1) (P < 0.05). VAS of patients treated by intersecting femoral head decompression at 12 months and 24 months postoperatively (2.7 ± 0.8 and 2.6 ± 0.8) were significantly lower than those of patients treated by MCD (3.3 ± 0.8 and 3.1 ± 0.8) (P < 0.05).. HHS and VAS were improved postoperatively in both groups (P < 0.05). According to radiographic changes, the proportion of patients with aggravation of necrosis in patients treated by intersecting femoral head decompression (12%) was lower than that (24%) in patients treated by MCD at 24 months postoperatively (P > 0.05), but the difference is not significant.

CONCLUSION

Unlike conventional core decompression, PRP can penetrate slowly into the cancellous bone of the femoral head through drilled pores in patients treated by intersecting femoral head decompression, thus extending duration of action of PRP. Compared with PRP injection combined with MCD, PRP injection combined with intersecting femoral head decompression had better functional and radiographic outcomes in our study.