Abstract
Several preservative treatment options are available for the early stages of avascular necrosis of the femoral head (ANFH) but are not as effective as in the advanced-stages. The management of Ficat stage III-IV AFNH is limited to the high rate of patients being converted to total hip replacement (THR). Four female patients with Ficat stage III-IV ANFH were included in this study, with a median age of 32.5 (20-40 years) and different risk factors. All four patients underwent open reduction and internal fixation with dynamic hip screw, transtrochanteric rotational osteotomy (TRO), and 7.5 mL secretome implantation from the allogeneic umbilical cord. With a median follow-up of 24.25 months (8-45 months), the patients showed an increment in Harris hip score and a decrement in visual analog scale during the follow-up period, except for one patient. Only the fourth patient with high disease activity of systemic lupus erythematosus and a long period of corticosteroid consumption progressed into collapsed, infected, and converted to THR. Combining TRO with secretome implantation is an effective alternative for advanced Ficat stages of ANFH patients. However, uncontrolled autoimmune conditions might interfere with the efficacy of the combination treatment and worsen the prognosis.