Clinical and radiological outcomes of core decompression for early osteonecrosis of the femoral head: a retrospective comparative study

Vollständiger Abstract

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Background: Osteonecrosis of the femoral head (ONFH) is a progressive disorder characterized by compromised blood supply, leading to femoral head collapse and secondary osteoarthritis. As the disease predominantly affects young adults, hip-preserving procedures remain the preferred treatment in pre-collapse stages. Core decompression (CD) with bone grafting is widely performed, while platelet-rich plasma (PRP) has emerged as a biological adjunct that may enhance angiogenesis and osteogenesis. This study compared the clinical and radiological outcomes of core decompression with bone grafting alone versus core decompression with bone grafting augmented with PRP. Methods: This retrospective comparative study included 75 patients (78 hips) with ONFH treated between January 2015 and December 2024. Group A comprised 35 patients treated with core decompression and cancellous bone grafting, while Group B included 40 patients treated with core decompression, cancellous bone grafting and PRP. Clinical outcomes were assessed using the Harris hip score (HHS) and radiographic progression and conversion to total hip arthroplasty (THA) were recorded. Results: Good-to-excellent outcomes were achieved in 77.5% of the PRP group compared with 57.1% of the conventional group. Poor functional outcomes were observed in 17.5% of the PRP group compared to 37.1% of the conventional group. THA conversion was lower in the PRP group (17.1%) as compared to the conventional group (35.1%), representing an 18.0% absolute risk reduction. Conclusions: PRP augmentation demonstrated improved functional outcomes and reduced conversion to THA compared with bone grafting alone, suggesting a promising biological adjunct for hip preservation in early-stage ONFH.