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

Burak Çakar; Rashad Aliyev; Anıl Aydın; Mehmet Fatih Uzun

doi:10.52312/jdrs.2025.2276

Burak Çakar¹, Rashad Aliyev¹, Anıl Aydın², Mehmet Fatih Uzun³

¹Department of Orthopedics and Traumatology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
²Department of Orthopedics and Traumatology, Kayseri State Hospital, Kayseri, Türkiye
³Department of Orthopedics and Traumatology, Ceylanpınar State Hospital, Şanlıurfa, Türkiye

Keywords: Avascular necrosis, core decompression, functional outcomes, platelet-rich fibrin.

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.

Citation: Çakar B, Aliyev R, Aydın A, Uzun MF. Clinical effectiveness of platelet rich fibrin combined with core decompression and grafting in early stage femoral head avascular necrosis?. Jt Dis Relat Surg 2025;36(3):659-665. doi: 10.52312/jdrs.2025.2276.