Bone Marrow-Augmented Core Decompression vs Iliac Crest Bone Graft in Femoral Head Osteonecrosis: which is better?

Osteonecrosis of the femoral head (ONFH) is a disorder defined by the aseptic ischemic necrosis of osseous tissue in the femoral head. This degenerative ailment results from impaired microcirculation beneath the cartilage, resulting in bone necrosis.Manish Kumar Yadav et al conducted a study to determine the difference in outcome of core decompression with autologous iliac crest bone graft versus bone marrow infiltration in avascular necrosis (AVN) of femoral head.
Stage II, III of Ficat and Arlet of AVN of femoral head evaluated clinically and radiologically before getting included into the study. A minimum of 20 cases were studied after clearance from the Ethics committee. The study has been published in ‘Journal of Clinical Orthopaedics.’The key findings of the study were:
• The mean HHS were statistically significant differences between the groups at 3 months and 6 months (P <0.05).
• At 3 months, the mean Visual Analog Scale (VAS) was 5.7 in Group A and 4.3 in Group B. At the end of the study (6 months), the mean VAS was 4.9 in group A and 2.7 in Group B. However, there were statistically significant differences between the groups at 3 months and 6 months (P < 0.05).
• Stage III X-ray finding was most common in Group a (63.6%) at pre-operative, and Stage II was most common in Group B (63.6%) at pre-operative. A similar finding was found at 6 months post-operative.
• Stage III magnetic resonance imaging (MRI) finding was most common in Group a (63.6%) at pre-operative and Stage II was most common in Group B (63.6%) at pre-operative.
• There was no significant difference (P > 0.05) in MRI and X-ray findings at pre-operative and 6 months between the groups.
The authors concluded – “Core decompression utilizing iliac crest bone graft increases the likelihood of head sphericity loss due to the application of a broad-bore drill, which compromises head support by excising subchondral bone. Core decompression with bone marrow infiltration yields a statistically significant enhancement in clinical outcomes, as evidenced by mean HHS and VAS scores. We also infer that multiple core decompressions with bone marrow infiltration would positively impact the patient’s radiological and clinical outcomes.”Further reading:
Comparative Study of Core Decompression with Autologous Iliac Crest Bone Graft Versus Bone Marrow Infiltration in Osteonecrosis of Femoral HeadManish Kumar Yadav et al
Journal of Clinical Orthopaedics | 2025 July-December; 10(2):85-89