Surgical Robot-Assisted Core Decompression with Bone Grafting Combined with Platelet-Rich Plasma Gel for the Treatment of Early-Stage Osteonecrosis of the Femoral Head

Lu Yafei; Gu Qiang; Qiao Weixin; Wang Yunqing; Zhu Ziqiang; Wang Jianqiang; Duan Gang

Abstract：Objective To compare the clinical efficacy of core decompression with bone grafting combined with platelet-rich plasma gel(PRG)treatment for early-stage osteonecrosis of the femoral head under orthopedic surgical robot guidance versus conventional C-arm guidance.Methods A retrospective analysis was conducted on the data of 42 patients(48 hips)with osteonecrosis of the femoral head who underwent core decompression with bone grafting combined with PRG at The Second Affiliated Hospital of Xuzhou Medical University from June 2022 to May 2024.All cases were classified as ARCO(Association Research Circulation Osseous)stages Ⅰ～Ⅱ.Twenty-two cases were assisted by orthopedic surgical robot(Robotic Group):15 males and 7 females;aged 23～59 years,with a mean age of(38.1±9.5)years.Twenty cases were assisted by C-arm fluoroscopy(C-arm Group):17 males and 3 females;aged 21～55 years,with a mean age of(37.6±9.7)years.The surgical condition were compared between the two groups.The preoperative and postoperative Harris scores and hip pain visual analog scale(VAS)scores of patients in the two groups were also compared.Results Patients were followed up for 9～12 months postoperatively,with a mean follow-up of(10.38±1.18)months.The Robotic Group was superior to the C-arm Group incision length,intraoperative blood loss,surgical operation time,total radiation exposure time,total number of fluoroscopic views,total number of punctures,and single-channel puncture success rate(P＜0.05).Both groups showed significant improvements in VAS scores and Harris scores at 1,3,and 9 months postoperatively compared with preoperative levels(P＜0.05).At all postoperative time points,the V AS scores of the Robotic Group were superior to those of the C-arm Group(P＜0.05);however,there was no statistically significant difference in Harris scores between the two groups(P＞0.05).Conclusion For the treatment of patients with early-stage osteonecrosis of the femoral head,compared with C-arm-assisted surgery,orthopedic robot-assisted surgery achieves better clinical outcomes,with smaller incision length,less intraoperative blood loss,shorter surgical operation time,lower total radiation exposure time,fewer total fluoroscopic views,fewer total punctures,and higher single-channel puncture success rate.