EP6.1 Histological Findings After Intraosseous Bone Marrow Aspirate Concentrate (BMAC) in a Pediatric Avascular Necrosis of the Femoral Head

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ID: 331355
2026
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Abstract
Abstract Introduction Osteonecrosis of the femoral head (ONFH) is a progressive condition that can result in structural collapse and eventual need for arthroplasty, particularly in cases with underlying infectious or inflammatory etiology. Biological adjuncts such as Bone Marrow Aspirate Concentrate (BMAC) have been increasingly used with the aim of promoting tissue repair and regeneration. However, direct histological evidence of the biological effects of BMAC in human femoral heads remains limited. Methods We report the case of a 13-year-old patient with a history of septic arthritis of the hip, which evolved unfavorably to femoral head osteonecrosis. The patient underwent a hip preservation approach that included intraosseous administration of BMAC. Despite this intervention, the disease progressed clinically and structurally, ultimately requiring total hip arthroplasty. The resected femoral head was submitted for histopathological analysis to evaluate tissue-level changes following biological treatment. Results Histological examination revealed extensive areas of bone remodeling characterized by immature osteoid formation and disorganized trabecular architecture. The normal marrow space was partially replaced by fibrovascular reparative tissue, with evidence of a mixed inflammatory infiltrate composed of lymphocytes, plasma cells, and polymorphonuclear cells. Foci of hemorrhage, both recent and chronic, were identified, along with areas of fibrosis and reactive bone formation. Additionally, regions of osteocartilaginous transition with chondrocyte clustering were observed, suggesting ongoing tissue differentiation and possible chondrogenic activity. In some areas, decreased hematopoietic elements were noted, while others preserved residual marrow activity. Conclusion Although hip preservation was not achieved and progression to arthroplasty occurred, histological findings demonstrated a biologically active reparative environment within the femoral head following combined intra-articular and intraosseous BMAC administration. These findings suggest that BMAC may stimulate local tissue remodeling, even in avascular osteonecrosis.
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Authors Diego Arriola Espinosa, MD Antonio Porthos Salas, MD Hector Velasco, MD Jacek Mazek, MD Daniel Fernando López, MD Carlos Alonso Miranda, MD David Santiago Taffinder, MD Cesar Adriel Flores, MD Luis Mariano Renteria, MD Carlos Oliverio Aguilar
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.358
URL
https://doi.org/10.1093/jhps/hnag043.358
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