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. 2016 Jun 13;5(3):e615-20.
doi: 10.1016/j.eats.2016.02.009. eCollection 2016 Jun.

Core Decompression Augmented With Autologous Bone Marrow Aspiration Concentrate for Early Avascular Necrosis of the Femoral Head

Lucas Arbeloa-Gutierrez  1 , Chase S Dean  2 , Jorge Chahla  2 , Cecilia Pascual-Garrido  3
Affiliations

Core Decompression Augmented With Autologous Bone Marrow Aspiration Concentrate for Early Avascular Necrosis of the Femoral Head

Lucas Arbeloa-Gutierrez et al. Arthrosc Tech. .

Abstract

Lack of necessary perfusion to the femoral head can lead to necrosis of the underlying bone (avascular necrosis) and result in femoral and acetabular surface changes in advanced stages. Numerous treatments have been reported in the literature, including nonoperative and surgical procedures. In addition to the standard core decompression, we describe the use of bone marrow aspirate to stimulate a healing response and bone grafting, allowing for immediate weight bearing postoperatively. The purpose of this article was to describe our method of core decompression augmented with bone marrow aspirate concentrate and bone grafting for the treatment of early avascular necrosis of the femoral head.

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Figures

Fig 1
Fig 1
The patient is positioned supine on a fracture table with both feet secured in traction boots and internally rotated. A right hip setup is shown.
Fig 2
Fig 2
Iliac bone marrow is obtained percutaneously through the use of bone marrow aspiration needles bilaterally. (ASIS, anterosuperior iliac spine.)
Fig 3
Fig 3
The PerFuse rod is placed over the skin to determine the anteroposterior skin markings on a right hip. (ASIS, anterosuperior iliac spine.)
Fig 4
Fig 4
Fluoroscopy of a right hip: anteroposterior (A) and lateral (B) views. The trocar is advanced, making sure the location matches the area of avascular necrosis.
Fig 5
Fig 5
Delivery of bone marrow aspiration concentrate (BMAC) through a disposable cannula in a right hip. Injection is performed directly into the necrotic zone.
Fig 6
Fig 6
Bone graft is introduced using a syringe through the cannula. The bone graft is pushed into the canal with the use of a trocar rod in a right hip.
Fig 7
Fig 7
(A, B) Fluoroscopic images showing sequential filling of the tunnel with bone graft in a right hip.
See this image and copyright information in PMC

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