Analysis of the Efficacy of Drilling Decompression Autologous Bone Marrow
and Allogeneic Bone Grafting in the Treatment of HIV-positive Patients
with Early Osteonecrosis of the Femoral Head
Authors: Shengtao Li , Jie Wang , Rui Ma , Changsong Zhao , Yu Pu , Min He , Zhengrong Gao , Xuemin Quan , Qiang Zhang 
Published: November 2023

Objective::
To investigate the efficacy of treating patients with HIV-positive osteonecrosis of the femoral head using drilled decompression autologous bone marrow and allogeneic bone grafting.To investigate the efficacy of treating patients with HIV-positive osteonecrosis
of the femoral head using drilled decompression autologous bone marrow and allogeneic bone
grafting.

Methods::
40 patients (44 hips) with early osteonecrosis of the femoral head treated by drilling decompression
autologous bone marrow and allogeneic bone grafting since October 2015 were retrospectively
analyzed, among which 20 patients (24 hips) were HIV-positive patients with early osteonecrosis
of the femoral head, 16 males and 4 females, age 22-43 years, average 39.6±10.18
years, and 20 patients (20 hips) in the same period HIV-negative early osteonecrosis of the femoral
head patients, 13 males and 7 females, aged 48-78 years, mean 63.50±7.94 years were negative
controls. General information including ARCO stage, Harris score, VAS score, hematological
indexes including CD4+ T lymphocyte count, and HIV viral load was recorded for all patients before
surgery. All patients were operated on by drilling and decompression of the necrotic area, harvesting
autologous iliac bone marrow with allogeneic bone, and bone grafting through the decompression
channel. The patients were followed up regularly at 6, 12, and 24 months after surgery
and annually thereafter, and the repair of the necrotic femoral head was observed by reviewing the
frontal and lateral X-ray, CT or MRI of the hip joint, and the complications and functional recovery
of the hip joint was counted and compared between the two groups.

Results::
All patients were followed up, and the ARCO stages in the HIV-positive group were
stage I 2 hips, stage IIA 6 hips, stage IIB 8 hips, stage IIC 6 hips, and stage III 2 hips, with a follow-
up time of 12 to 60 months and a mean of 24.6 months. In the negative control group, there
were 3 hips in ARCO stage I, 7 hips in stage IIA, 5 hips in stage IIB, 3 hips in stage IIC, and 2
hips in stage III, and the follow-up time ranged from 13 to 62 months, with an average of 24.8
months. The Harris score and VAS score of the hip in both groups improved significantly at 6
months after surgery compared with those before surgery (P < 0.05). The difference between the
Harris score of the hip in the positive group at 2-year after surgery compared with that at 6
months after surgery was statistically significant, but the VAS score at 2-year after surgery compared
with that at 6 months after surgery was not statistically significant. In the negative group,
there was no statistically significant difference in the Harris score and VAS score of the hip at 2
years after surgery compared with those at 6 months after surgery. In the positive group, there was
a trend of continuous increase in hip BMD from the beginning of the postoperative period (P <
0.05). There was no statistically significant difference between the negative group and the positive
group at the 2-year postoperative follow-up except for the Harris score, which was statistically
significant (P < 0.05), and the VAS score, which was statistically insignificant (P > 0.05). At
the 2-year postoperative follow-up, patients in both groups had good recovery of hip function, and
no complications such as vascular and nerve injury and fracture occurred during the perioperative
period and follow-up period, and no complications related to incisional infection and pulmonary
infection occurred during hospitalization.

Conclusion::
Drilling and decompression to remove the necrotic area of the femoral head and performing
autologous bone marrow and allogeneic bone grafting for patients with early-stage HIV--
positive osteonecrosis of the femoral head can effectively stop the progression of femoral head necrosis
in HIV-positive patients, delay the arthroplasty of joint replacement, and promote the repair
of the femoral head, which is a safe and effective method of treatment for early-stage HIV-positive
femoral head necrosis patients.