Efficacy of Selective Arterial Perfusion Combined With Core Decompression in Managing Osteonecrosis of the Femoral Head

AIM: To compare the effectiveness and safety of selective arterial perfusion (SAP) combined with core decompression (CD) versus CD alone for treating osteonecrosis of the femoral head (ONFH) at association research circulation osseous (ARCO) stages 1–2. METHODS: Overall, 102 individuals (involving 130 hips) diagnosed with nontraumatic ONFH at ARCO stages 1–2 and admitted into Beijing Jishuitan Hospital Guizhou Hospital (Guizhou Orthopedic Hospital) between January 2021 and December 2023 were enrolled in this retrospective study. They were assigned to two groups based on the treatment protocol: the experimental group (56 patients, 72 hips) treated with SAP combined with CD, and the control group (46 patients, 58 hips) receiving CD only. Both groups were supplemented with conventional treatment: oral aescuven forte (1 tablet/time, 2 times/day for 12 weeks), extracorporeal shock wave therapy (once per week for 4 weeks), nerve block (lateral femoral cutaneous nerve block for visual analogue scale (VAS) >5 points), and rehabilitation training (30 minutes/day, 5 days/week for 12 weeks). All participants were followed up for 12 months, with key outcomes such as effective rate, femoral head collapse rate, lesion size, bone marrow edema grading, VAS score, harris hip score (HHS) score, and complication rate recorded. RESULTS: No statistically significant differences in baseline data (age, gender, disease duration, ARCO staging, etiology, etc.) were identified between the two groups (p > 0.05), indicating their comparability. Twelve months after treatment, the effective rate of the experimental group (91.7%) proved higher than that of the control group (63.8%), whereas the femoral head collapse rate in the experimental group (5.6%) was lower in comparison to that of the control group (19.0%). After treatment, the experimental group also showed more significant improvements in lesion size, bone marrow edema (BME) grading improvement rate, VAS score, and HHS score. The complication rates of the two groups were similar (7.1% vs. 6.5%, p > 0.05). CONCLUSIONS: At 12 months of follow-up, compared with CD alone, SAP combined with CD demonstrated better clinical performance in nontraumatic ONFH patients at ARCO stages 1–2, accompanied by a higher effective rate, lower femoral head collapse rate, more significant reductions in lesion size and improved hip joint function, while maintaining a comparable safety profile. This combined regimen provides a valuable option for hip-preservation treatment in early-stage ONFH, with potential clinical implications for optimizing minimally invasive intervention strategies.