Anjali Aggarwal
Improved understanding of healing logistics and orthobiologics has provided a ray of hope for treating osteonecrosis (ON) of femoral head. Purpose was to evaluate efficacy of autologous bone marrow derived mononuclear cells (MNCs) augmentation during core decompression vis–a–vis core decompression in early stages of osteonecrosis. 38 (50 hips) were randomized into Group A (MNCs with core decompression; 18/26 hips) and group B (core decompression; 20/24 hips). Bone marrow aspirated from the posterior superior iliac spine was centrifuged and the resultant MNC harvest was counted and instilled in the core decompression tracts of patients in group A. Mean number of MNC injected was 153.91 million cells (SD= 91.30). Outcome was evaluated by VAS, Harris Hip score (HHS) and modified Kerboul angle for quantification of necrotic area. Follow up ranged from 4-14 (mean: 8.8) months. VAS scores improved from pre-operative levels of 5.45±1.46 to 1.33±.97 in group A. VAS scores in group B increased from 5.45±0.51 to 2.88±.69. The HHS in group A had a final mean value of 80.9±14.5 from a baseline score of 61.3±16.9. In group B the HHS changed from a baseline score of 67.6±9.3 to 72.4±7.4. Statistically significant improvement in VAS, HHS and modified Kerboul angle was observed in group A as compared to group B. Modified Kerboul angle changed by a mean of 4.1±15.4 in group A and 21.0±23.8 in group B. There was statistically significant change and progression of disease in group B. There was progression of disease in 3 hips of group A and 5 hips of group B. Autologous bone marrow derived MNCs are a safe and effective treatment for early stages of osteonecrosis hip. There is marked clinical improvement in the group treated by MNCs than those who received core decompression alone
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