PMID- 35389906
OWN - NLM
STAT- MEDLINE
DCOM- 20220411
LR  - 20230410
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 104
IP  - Suppl 2
DP  - 2022 Apr 6
TI  - Core Decompression and Bone Marrow Aspiration Concentrate Grafting for 
      Osteonecrosis of the Femoral Head.
PG  - 54-60
LID - 10.2106/JBJS.20.00527 [doi]
AB  - BACKGROUND: Core decompression (CD) with bone marrow aspiration concentrate 
      (BMAC) is a technique that may improve outcomes in osteonecrosis of the femoral 
      head (ONFH). The primary aim of this study was to evaluate the radiographic 
      progression free survival (PFS) of CD augmented with BMAC. Secondary aims were to 
      determine the survivorship with conversion (CFS) to total hip arthroplasty (THA) 
      as an endpoint, determine prognostic factors, and characterize the cellular 
      quality of the BMAC. METHODS: A retrospective cohort study of 61 femoral heads 
      (40 patients) was performed. Patient demographics, comorbidities, BMI, smoking 
      status, etiology, location and extent of ONFH were recorded. The primary endpoint 
      was radiographic progression of ONFH and secondarily, conversion to THA. 
      Additional aims were to determine predictive factors for progression and report 
      the cellular characteristics of the BMAC. Data obtained were compared to the 
      results of a prior randomized controlled trial comparing CD alone versus CD with 
      polymethylmethacrylate cement (PMMA) augmentation. RESULTS: Radiographic PFS of 
      CD with BMAC at 2 and 5 years was 78.3% and 53.3%, respectively. The risk of 
      progression was lower in the CD with BMAC group compared to CD alone (HR0.45, p = 
      0.03), however this difference no longer remained statistically significant on 
      multivariate analysis. Conversion to total hip arthroplasty free survival (CFS) 
      of CD with BMAC at both 2 and 5 years was 72.1% and 54.6%, respectively with no 
      differences compared to the control groups (CD alone, CD and PMMA). The 
      predictive factors for progression were obesity (BMI >/= 30) and the extent of the 
      disease as quantified by either percentage involvement, necrotic index or 
      modified necrotic index. CONCLUSIONS: No differences in PFS or CFS between CD 
      with BMAC compared to CD alone or CD with PMMA were identified. Independent 
      statistically significant predictors of progression-free survival or conversion 
      to THA are BMI >/= 30 and the extent of ONFH. Further research with an adequately 
      powered randomized controlled trial is needed. LEVEL OF EVIDENCE: 3.
CI  - Copyright (c) 2022 by The Journal of Bone and Joint Surgery, Incorporated.
FAU - Hoogervorst, Paul
AU  - Hoogervorst P
AUID- ORCID: 0000-0002-2265-4289
AD  - Department of Orthopedic Surgery, University of Minnesota, Minneapolis, 
      Minnesota.
FAU - Campbell, Joshua C
AU  - Campbell JC
AD  - Department of Orthopaedic Surgery, George Washington University, Washington, 
      District of Columbia.
FAU - Scholz, Natalie
AU  - Scholz N
AUID- ORCID: 0000-0002-7159-1210
AD  - Department of Orthopedic Surgery, University of Minnesota, Minneapolis, 
      Minnesota.
FAU - Cheng, Edward Y
AU  - Cheng EY
AD  - Department of Orthopedic Surgery, University of Minnesota, Minneapolis, 
      Minnesota.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
RN  - 9011-14-7 (Polymethyl Methacrylate)
SB  - IM
MH  - *Arthroplasty, Replacement, Hip
MH  - Bone Marrow/surgery
MH  - Decompression, Surgical/methods
MH  - Femur Head/surgery
MH  - *Femur Head Necrosis/diagnostic imaging/surgery
MH  - Humans
MH  - Polymethyl Methacrylate
MH  - Retrospective Studies
MH  - Treatment Outcome
COIS- Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided 
      with the online version of the article (http://links.lww.com/JBJS/G630).
EDAT- 2022/04/08 06:00
MHDA- 2022/04/12 06:00
CRDT- 2022/04/07 17:13
PHST- 2022/04/07 17:13 [entrez]
PHST- 2022/04/08 06:00 [pubmed]
PHST- 2022/04/12 06:00 [medline]
AID - 00004623-202204061-00009 [pii]
AID - 10.2106/JBJS.20.00527 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2022 Apr 6;104(Suppl 2):54-60. doi: 10.2106/JBJS.20.00527.