Core Decompression Combined with Intraosseous Ibandronate for Pre-collapse Osteonecrosis of the Femoral Head: Report of a Novel Technique, its Safety and Early Outcomes in Five Cases.

Background: Core decompression (CD) is an effective method in the management of pre-collapse stage of osteonecrosis of the femoral head (ONFH). It has been combined with various adjuvants to increase the efficacy including bone marrow aspirate concentration and platelet rich plasma. We evaluated a cheaper alternative in the form of ibandronate as an adjuvant to CD and to highlight the technique, safety, and early outcomes. Methods: The patients in the age group of 18-60 presenting with atraumatic ONFH in the pre-collapse stage were included in the study. The patients were followed up to a period of 1 year and evaluated in terms of radiologic progression and functional outcome (Modified Harris Hip Score [MHHS] and Visual Analog Scale [1]). Results: The study included six hips in five patients (three females and two males) ranging from 18 to 57 years. There was no sign of stage progression or collapse on radiography. The average post-operative MHHS was 87.4 (73.7-96.7) while VAS score improved from 2.8 to 1.3 postoperatively (p=0.00395). Conclusion: The use of ibandronate as an adjuvant with CD shows promise. It is safe and provides good clinical improvement and is a cheaper alternative. However, the interpretation is limited due to the small number of patients and short duration of follow-up.