A case of avascular necrosis of femoral head managed with bone marrow aspirate concentrate and platelet rich plasma as combination therapy: an orthobiologics approach

Abstract

Avascular necrosis (AVN) of the femoral head is a debilitating condition and a delay in the intervention(s) invariably results in the necrosis of the femoral head with secondary changes leading to its collapse. Early intervention by regenerative therapy/minimally invasive approach aim to delay or prevent joint replacement. 42-year-old male patient diagnosed for Bilateral AVN of the femoral head, Ficat–Arlet Stage II with key imaging findings of edema in both femoral heads. a cystic lesion (1.4 x 1.0 cm) in the left femoral neck, and Kerboul angles indicating moderate risk for collapse (Right: 180º; Left: 164º). The patient underwent intervention using minimally invasive percutaneous core decompression (PCD) augmented with autologous Bone Marrow Aspirate Concentrate (BMAC) and Platelet-Rich Plasma (PRP) into the necrotic zone monitored by fluoroscopy. The clinical outcomes show that combination of PCD, BMAC and PRP demonstrated beneficial effects post therapy at 12 months, evidenced by reduction in Numeric Pain Rating Scale (NPRS) dropped from 6/10 (pre-op) to 1-2/10 at 12 months and functional improvement measured by Oxford Hip Score (OHS) from 23 (severe/moderate) to 42 (Satisfactory joint function). Further MRI at 6 months reveal revascularization and restoration of marrow signal intensity in necrotic area. This case supports the use of Orthobiologics (BMAC + PRP) as an effective "joint-preserving" strategy for early-stage AVN. By leveraging osteogenic potential of stem cells and angiogenic properties of growth factors to delay or prevent the need for total hip arthroplasty (THA) in younger patients.