{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:50:58Z","timestamp":1787755858151,"version":"build-2784847793"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n \n Hip decompression effectively treats early-stage osteonecrosis of the femoral head (ONFH) by slowing disease progression and potentially delaying joint replacement. Biological adjuvants like bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) support bone regeneration and improve outcomes\n 1\u20137<\/jats:sup>\n . The present video article demonstrates a simple, coreless hip decompression technique with BMAC and PRP injection for early-stage ONFH.\n <\/jats:p>\n <\/jats:sec>\n \n Description:<\/jats:title>\n The procedure is performed in the same operating room setting as traditional core decompression, with the patient supine on a radiolucent table for fluoroscopic guidance. One or both legs are draped free for access to the iliac crests. Bone marrow is harvested percutaneously from the anterior superior iliac crest with a trocar needle kit, centrifuged, and prepared for injection. We recommend precoating needles and syringes with 1:1,000 heparin to prevent clotting. The BioCUE System (Zimmer Biomet) is typically utilized for centrifugation. Hip decompression is performed with use of a trocar and cannula (PerFuse System; Zimmer Biomet), with subsequent injection through the cannula into the femoral head. A 0.5-cm skin incision is made. The trocar is placed lateral to the femur and advanced percutaneously through the lateral femoral cortex, with a starting point proximal to the lesser trochanter. The trocar is then advanced along the femoral neck into the necrotic region by performing mallet strikes on the instrument\u2019s strike cap. Anteroposterior and frog-leg lateral views assist in positioning the trocar within the necrotic area. Internal leg rotation, which aligns the patella upward, helps position the trocar horizontally parallel to the floor. Positioning is adjusted using repeated imaging as needed. Once the patient is positioned, the trocar is removed, leaving the cannula in place. With the cannula retracted 1 cm, a 30-mL syringe is utilized to inject BMAC and PRP into the necrotic lesion. Because of sclerotic resistance, substantial pressure is needed, but retraction of the cannula helps. Following injection, the cannula is withdrawn another 1 cm, and demineralized bone matrix is injected to prevent escape of the BMAC.<\/jats:p>\n <\/jats:sec>\n \n Alternatives:<\/jats:title>\n Alternative treatments for ONFH include traditional core decompression with a sliding hip screw drill or an X-REAM device (Stryker), both of which carry a higher risk of fracture because of the larger diameter of the tract and require limited weightbearing postoperatively. Bone-cement injection can stabilize the femoral head but lacks regenerative properties. Core decompression with either BMAC or PRP alone, rather than in combination, also serves as an alternative treatment strategy. Open approaches, like osteotomy, are more invasive, have longer recovery times, and may complicate future hip arthroplasty if unsuccessful.<\/jats:p>\n <\/jats:sec>\n \n Rationale:<\/jats:title>\n This technique enables minimally invasive hip decompression and delivery of adjuvant cell therapy or grafting, typically without the use of power instruments. This approach avoids the risk of injuring the bone due to the heat from power tools, protecting the BMAC injection site. Patients are generally discharged the same day and permitted full weight-bearing immediately, even in bilateral surgeries.<\/jats:p>\n <\/jats:sec>\n \n Expected Outcomes:<\/jats:title>\n \n Hip decompression for ONFH has shown variable rates of success\n 8,9<\/jats:sup>\n , but adding BMAC or PRP may improve outcomes\n 1\u20133<\/jats:sup>\n . Houdek et al. reported that among 35 hips treated with decompression plus BMAC and PRP for corticosteroid-induced ONFH, 88% avoided THA at 3 years\n 2<\/jats:sup>\n and 70%, at 7 years\n 3<\/jats:sup>\n . Patients with grade-1 or 2 Kerboul angles had a 90% survivorship rate, underscoring the benefits of BMAC and PRP.\n <\/jats:p>\n <\/jats:sec>\n \n Important Tips:<\/jats:title>\n \n \n \n Insert the trocar into the lateral cortex, positioned distal to the vastus ridge and proximal to the lesser trochanter, to reduce iatrogenic subtrochanteric fracture risk.<\/jats:p>\n <\/jats:list-item>\n \n Avoid advancing closer than 5 mm to the subchondral cortex to prevent joint-surface disruption or collapse, especially with eccentric lesions.<\/jats:p>\n <\/jats:list-item>\n \n If resistance occurs during injection, retract the cannula a few millimeters laterally to increase delivery space and reduce pressure.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Acronyms and Abbreviations:<\/jats:title>\n \n \n \n BMAC = bone marrow aspirate concentrate<\/jats:p>\n <\/jats:list-item>\n \n ONFH = osteonecrosis of the femoral head<\/jats:p>\n <\/jats:list-item>\n \n PRP = platelet-rich plasma<\/jats:p>\n <\/jats:list-item>\n \n AP = anteroposterior<\/jats:p>\n <\/jats:list-item>\n \n THA = total hip arthroplasty<\/jats:p>\n <\/jats:list-item>\n \n ARCO = Association Research Circulation Osseous classification<\/jats:p>\n <\/jats:list-item>\n \n MRI = magnetic resonance imaging<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.st.24.00036","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T19:00:26Z","timestamp":1762369226000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Hip Decompression with Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Injection for Osteonecrosis of the Femoral Head"],"prefix":"10.2106","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6735-4861","authenticated-orcid":false,"given":"Ta-Wei","family":"Tai","sequence":"first","affiliation":[{"name":"Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan"},{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio F.","family":"Guarin Perez","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8195-4189","authenticated-orcid":false,"given":"Diego J.","family":"Restrepo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8513-1477","authenticated-orcid":false,"given":"Rafael J.","family":"Sierra","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10]]},"reference":[{"issue":"3","key":"bib1-20251105","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3325\/cmj.2013.54.219","article-title":"Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis","volume":"54","author":"Martin","year":"2013","journal-title":"Croat Med J."},{"issue":"2","key":"bib2-20251105","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s11999.0000000000000033","article-title":"Stem Cells Combined With Platelet-rich Plasma Effectively 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prospective, double-blinded, randomized, controlled study on autologous bone marrow buffy coat grafting combined with core decompression in patients with avascular necrosis of the femoral head","volume":"11","author":"Li","year":"2020","journal-title":"Stem Cell Res Ther."},{"issue":"3","key":"bib8-20251105","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1007\/s00264-020-04790-9","article-title":"What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?","volume":"45","author":"Andronic","year":"2021","journal-title":"Int Orthop."},{"issue":"7","key":"bib9-20251105","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1007\/s00264-018-3892-0","article-title":"Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced","volume":"42","author":"Sionek","year":"2018","journal-title":"Int Orthop."}],"container-title":["JBJS Essential Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.ST.24.00036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:54:19Z","timestamp":1787752459000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.ST.24.00036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.st.24.00036","relation":{},"ISSN":["2160-2204"],"issn-type":[{"value":"2160-2204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}