Platelet-rich Plasma-Incorporated Autologous Granular Bone Grafts Improve Outcomes of Post-traumatic Osteonecrosis of the Femoral Head

Background

Post-traumatic osteonecrosis of the femoral head (ONFH) is a major complication of femoral neck fractures that requires numerous solutions. The purpose of the current study was to investigate the effects of platelet-rich plasma (PRP)-incorporated autologous granular bone grafts for treatment in the pre-collapse stages (Association of Research Circulation Osseous (ARCO) stage II–III) of post-traumatic ONFH.

Methods

A total of 46 patients were eligible and enrolled in the study. Twenty-four patients were treated with core decompression and PRP-incorporated autologous granular bone grafting (treatment group: 9 female and 15 male; age range, 16–39 years), and 22 patients were treated with core decompression and autologous granular bone grafting (control group: 6 female and 16 male; age range, 18–42 years). During a minimum follow-up duration of 36 months, X-ray and computed tomography (CT) were used to evaluate the radiological results, and the Harris hip score (HHS) and visual analog scale (VAS) were chosen to assess the clinical results.

Results

Both the treatment and control groups had a significantly improved HHS (P < 0.001). The minimum clinically important difference for the HHS was reached in 91.7% of the treatment group and 68.2% of the control group (P = 0.0449). The HHS in the treatment group was significantly higher than that in the control group at the last follow-up (P = 0.0254). The VAS score significantly declined in the treatment group when compared with that in the control group (P = 0.0125). Successful clinical results were achieved in 21 of 24 patients (87.5%) in the treatment group compared with 13 of 22 patients (59.1%) in the control group (P = 0.0284). Successful radiological results were achieved in 19 of 24 patients (79.2%) in the treatment group compared with 11 of 22 patients (50.0%) in the control group (P = 0.0380). The survival rates based on the requirement for further hip surgery as an endpoint were higher in the treatment group in comparison to those in the control group (P = 0.0260).

Conclusions

PRP-incorporated autologous granular bone grafting is a safe and effective procedure for treatment in the pre-collapse stages (ARCO stage II–III) of post-traumatic ONFH.