Treatment Of Osteonecrosis Of The Femoral Head With Thorough Debridement, Bone Grafting And Bone Marrow Mononuclear Cells Implantation

objective: The purpose of this study is to describe the rationale, the surgical techniqueand the early clinical and radiographic results of thorough debridement, bone graftingand bone marrow mononuclear cells implantation to the treatment of ONFH.Methods: We use drills, curettes, broaches under image intensifier to perform athorough debridement of all necrotic lesion, pack autogenous cortical and cancellousbone which was harvested from the ipsilateral iliac crest tightly into the femoral head,implant bone marrow mononuclear cells containing mesenchymal stem cells into thenecrotic lesion. The study included15patients (20hips,10males,5females, mean age35years, range23-58years) with stage â…¡-â…¢ osteonecrosis of the femoral headaccording to the Association Research Circulation Osseous (ARCO) classification. Theoutcome was determined by changes in the Harris hip score, by progression inradiographic stages, and by the need for hip arthroplasty.Results: The mean follow-up was24months (range9-36months). The mean Harriship score (HHS) increased from64to85points, there was definite significance betweenpre-operative and post-operative.. The overall clinical success rate is80%, excellentplus good rate is75%.4hips progressed radiologically, the failure rate is20%, one hipof stage â…¡B progressed to â…¢B, two hips of stage â…¡C progressed to â…¢B, one hip ofstage â…¡C progressed to â…¢A, none of the patients got total hip replacement. Conclusions: Thorough debridement, autogenous bone grafting and bone marrowmononuclear cells implantation is an effective procedure in patient with small lesion,early stage osteonecrosis of the femoral head.