Clinical effectiveness of platelet rich fibrin combined with core decompression and grafting in early stage femoral head avascular necrosis

Abstract

Objectives: This study aims to evaluate the clinical effectiveness of platelet-rich fibrin (PRF) therapy in combination with core decompression (CD) and grafting in patients with femoral head avascular necrosis (AVNFH).

Patients and methods: Between February 2015 and February 2020, a total of 63 patients (45 males, 18 females; mean age: 45.8±11.7 years; range, 21 to 65 years) with early-stage AVNFH (Ficat-Arlet Stages I-II) who underwent treatment were retrospectively analyzed. The patients were divided into two groups: those treated with CD and grafting (CD+grafting; n=32) and those receiving additional PRF augmentation (CD+grafting+PRF; n=31). Demographic characteristics, including age, sex, and affected side, were comparable between the groups. Clinical assessments included pre- and postoperative Visual Analog Scale (VAS) for pain, Harris Hip Score (HHS), and Merle d’Aubigné Hip Score.

Results: No significant differences were observed between the groups preoperatively regarding HHS, Merle d’Aubigné scores, and VAS scores (p>0.05). Postoperatively, the PRF group demonstrated significantly improved outcomes in HHS (83.70±14.30 vs. 65.90±16.72, p=0.001), Merle d’Aubigné Hip Score (15.29±2.78 vs. 11.94±4.31, p=0.001), and VAS (2.06±1.50 vs. 4.69±2.08, p=0.001). Both groups showed significant clinical improvement, but PRF augmentation was associated with superior functional recovery and pain reduction.

Conclusion: Compared to CD+grafting alone, adding PRF to CD+grafting resulted in more favorable clinical outcomes with minimal complications. These findings suggest that PRF is a promising, minimally invasive adjunct therapy for joint preservation in early-stage AVNFH.