title: The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head.
abstract: OBJECTIVE
  The purpose of our study is to describe the rationale, the surgical technique and the early clinical and radiographic results of the treatment of patients with early stage osteonecrosis of the femoral head (ONFH) by performing: core decompression, injection of autologous bone marrow concentrate and the use of a new composite injectable bone substitute (PRO-DENSE(®)), as a mechanical supplementation associated with decompression.
  
  
  METHODS
  The study included 37 hips (31 patients, 14 females, 17 males; mean age 43.9 years, range 24-56 years) with stages IC-IIIA ONFH. The outcome was determined by the changes in the Harris hip score (HHS), by progression in radiographic stages and by the need for hip replacement. The mean follow-up was 20.6 months (range 12-32 months).
  
  
  RESULTS
  At final follow-up the mean HHS increased from 68 points pre-operatively to 86 points post-operatively. The radiological results showed that 29 hips (78.4 %) improved or had no further collapse. The overall clinical success rate of the procedure was 86.5 %, with three conversions to THA, and a failure rate of only 3.3 % in the pre-collapse group.
  
  
  CONCLUSIONS
  We are encouraged by these early results using core decompression, injection of the autologous bone marrow concentrate and backfilling the defect with an injectable bioceramic for the treatment of early stages of ONFH; as far as a conclusion can be drawn from the current data, this treatment seems to relieve hip pain and prevent the progression of ONFH in the majority of the cases.
authors.affiliation: Department of Special Surgical Science, University of Florence, C.T.O. Largo P. Palagi 1, 50139, Firenze, Italy. civi@mclink.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Civinini
authors.forename: Pietro
authors.initials: P
authors.lastname: De Biase
authors.forename: Christian
authors.initials: C
authors.lastname: Carulli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Matassi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Nistri
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Capanna
authors.forename: Massimo
authors.initials: M
authors.lastname: Innocenti
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002130:Calcium Phosphates / Q000008:administration & dosage / Q000627:therapeutic use*; D002133:Calcium Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D002516:Ceramics / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D002130:Calcium Phosphates; C020243:calcium phosphate; D002133:Calcium Sulfate