A Randomized Control Trial between Reverse Bone Grafting and Core Decompression in Avascular Necrosis of the Femoral Head

Background Avascular necrosis (AVN) of the femoral head is a debilitating condition that often leads to progressive joint dysfunction and collapse. Core decompression, with or without reverse bone grafting, is a commonly employed treatment modality. However, there is limited evidence comparing their effectiveness in improving functional and radiological outcomes. Objective This study aimed to compare the functional and radiological outcomes of core decompression with reverse bone grafting versus core decompression without reverse bone grafting in patients with Grade I, II, or III AVN of the femoral head. Methods A randomized controlled trial will be conducted at the Department of Orthopedics, AVBRH, from September 2023 to April 2026. Forty patients were randomly assigned to two groups: Group A (core decompression with reverse bone grafting) and Group B (core decompression without reverse bone grafting). Functional outcomes will be assessed via the Harris Hip Score and Hip Disability and Osteoarthritis Outcome (HOOS) score, whereas radiological parameters will include femoral head density, contour, and revascularization. Pain will be evaluated via the visual analog scale. Follow-up assessments will be conducted at 6 weeks, 12 weeks, and 6 months postoperatively. Expected Outcomes: This study provides insights into the comparative effectiveness of reverse bone grafting in enhancing functional and radiological outcomes in patients with AVN. It is anticipated that, compared with core decompression alone, reverse bone grafting enriched with biologics will result in superior results. Conclusion This study contributes to evidence-based recommendations for optimizing the surgical management of AVN of the femoral head.