An integrative orthobiologic approach to femoral head osteonecrosis: a case report

Abstract

Avascular necrosis (AVN), is a progressive disorder resulting from impaired blood supply to the femoral head leading to subchondral collapse and secondary osteoarthritis. Augmentation with percutaneous core decompression (PCD) with Hyperbaric oxygen therapy (HBOT) and curcumin/95 supplementation with structured rehabilitation would demonstrate benefits in AVN. 37-year-old man presented with eight-month history of right hip pain with difficulties (walking, squatting, stair and gait). MRI imaging confirmed AVN of right femoral head stage II B (Ficat-Arlet) and baseline patient presented Visual Analog Scale (VAS) 6/10, Oxford Hip Score (OHS)/33 with reduced muscle strength. The patient underwent PCD with bone marrow aspirate concentrate (BMAC) and high platelet-rich-plasma (PRP) followed by 15 sessions of HBOT, with strengthening of hip core and gait, with curcumin/95, 1000 mg daily for 60 days. At six months, the patient showed decrease in VAS score from 6/10 to 1/10, Oxford Hip Score increased from 33 to 43, Right hip flexion improved from 100° to 125° with mild pain, internal rotation from 10° to 30°, and extension from 15° to 20°. Hip muscle strength improved from grades 3-4/5 at baseline to 5/5 across assessed muscle groups. The antalgic gait and localized tenderness resolved, and functional mobility improved. This study advocates multimodal treatment strategy to arrive at functional status noted at six months with improvement in pain, hip mobility, muscle strength and gait. However, the contribution of individual treatment components cannot be determined from a single case, and longer-term controlled studies are required.