We conducted a single-center prospective analytical study in a private hospital in Iraq on 31 patients with early-stage (stages I to III) non-traumatic ANFH. Baseline demographic data included age, gender, etiological factors, and ANFH stage according to the Ficat and Arlet classification based on plain radiograph, MRI, and the location of the necrotic lesion in each hip. A prospective, randomized, open-label was conducted involving patients who were developing ANFH at Iraqi private hospital, Iraq, from January 31, 2021, to November 2022. The intervention group received decompression and autologous bone marrow concentration (n=31).
The stage of ANFH was determined based on the Association Research Circulation Osseous (ARCO) classification 1994 for early-stage osteonecrosis, as follows:

Stage 0: Normal plain radiograph, normal computed tomography (CT), normal magnetic resonance imaging (MRI) or scintigraphy;

Stage I: Normal plain radiograph with abnormal CT or MRI;

Stage II: Plain radiograph: trabecular bone changes without variations in subchondral bone; MRI: unusual and diagnostic appearance;

Stage III: Plain radiograph: a highlight on the signs of a subchondral fracture displaying the "crescent sign";

Stage IV: Radiographic manifestation of femoral head flattening;

Stage V: Plain radiograph reveals a sign of femoral head flattening in addition to osteoarthritic variations, including decreased joint space and acetabula alteration;

Stage VI: It appears that the entire joint is destroyed.

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