Outcomes of Core Decompression with injectable CaSO4/CaPO4 versus quadratus femoris muscle pedicle bone grafting for treating avascular necrosis of femoral head : A comparative study

This study compares clinical and functional outcomes in patients with avascular necrosis of femoral head (AVNFH), treated with either autologous quadratus femoris muscle pedicle bone grafting (QF-MPBG) or core decompression combined with injectable composite graft of calcium sulfate and calcium phosphate ( PRO-DENSE™). Methods: In First Affiliated Hospital of Zhengzhou University, a retrospective study from January 2015 to December 2019 included 81 patients (64 males and 17 females) diagnosed with AVNFH (IIA-IIIB), affected sides either ipsilaterally or bilaterally making a total of 100 necrotized hips. Further undergoing hip preserving surgeries, 52 patients (62 hips) underwent QF-MPBG (Control group) and 29 patients (38 hips) underwent core decompression with injectable composite graft of calcium sulfate and calcium phosphate PRO-DENSE™ (Observation group). Results: At final follow up, majority of patients in both groups showed radiological and functional improvement in hip joints. Mean Harris hip score from 68 and 72 preoperatively increased to 73 and 79 postoperatively in control and observation group respectively (P < 0.001). Length of incision, blood loss, operation time, hospital stays in observation group showed better results than control group (P < 0.001). Clinical failure includes repeated lower Harris hip score (7/38) and (9/62), collapsed joints (1/38) and (9/38), and total hip arthroplasty (1/38) and (6/62) and intertrochanteric fracture (1/38) and (0/62) in observation and control group respectively. Clinical success rate in observation group 73.6% is better than control group of 61.2%.Conclusion: This study encourages with benefits of using core decompression with injectable composite graft of calcium sulfate and calcium phosphate (PRO-DENSE™) is more suitable and preferable technique compared to autologous quadratus femoris muscle pedicle bone grafting (QF-MPBG) for immediate treatment of AVNFH and delaying its progression and need for total hip arthroplasty in early to moderate stages