Advertisement

Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with Early-Stage Osteonecrosis of the Femoral Head: A Comparative Study

      Abstract

      The management of early-stage osteonecrosis of the femoral head (ONFH) remains challenging. This study aimed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH. The study recruited 28 hips with early ONFH randomly assigned into two groups of core decompression with (group A) and without (group B) bone marrow injection. Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Visual Analogue Scale (VAS) pain index, and MRI. The mean WOMAC and VAS scores in all patients improved significantly (P < 0.001). MRI showed a significant improvement in group A (P = 0.046) and significant worsening in group B (P < 0.001). Bone marrow stem cell injection with core decompression can be effective in early ONFH.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mont M.A.
        • Jones L.C.
        • Hungerford D.S.
        Non-traumatic osteonecrosis of the femoral head: ten years later—current concepts review.
        J Bone Joint Surg (Am Vol). 2006; 88: 1107
        • Gao You-Shui
        • Zhang Chang-Qing
        Cytotherapy of osteonecrosis of the femoral head: a mini review.
        Int Orthop. 2010; 34: 779
        • Ohzono K.
        • Saito M.
        • Sugano N.
        • et al.
        The fate of nontraumatic avascular necrosis of the femoral head: a radiologic classification to formulate prognosis.
        Clin Orthop Relat Res. 1992; 277: 73
        • Sen Ramesh Kumar
        Management of avascular necrosis of femoral head at pre-collapse stage.
        Indian Journal Orthop. 2009; 43: 6
        • Khanuja H.S.
        • Mont M.A.
        • Etienne G.
        • et al.
        Treatment algorithm for osteonecrosis of the hip.
        Tech Orthop. 2001; 16: 80
        • Liberman J.R.
        Core decompression for osteonecrosis of hip.
        Clin Orthop. 2004; : 418
        • Koo K.H.
        • Kim R.
        • Ko G.H.
        • et al.
        Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression.
        J Bone Joint Surg (Br). 1995; 776: 870
        • Xiao Z.
        • Jiang H.
        • Zhan X.-L.
        • et al.
        Treatment of osteonecrosis of femoral head with BMSC seeded bio-derived bone materials combined with rhBMP-2 in rabbits.
        Chin J Traumatol. 2008; 11–3: 165
        • Lieberman J.R.
        • Conduah A.
        • Urist M.R.
        Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein.
        Clin Orthop Relat Res. 2004; 429: 139
        • Lee K.
        • Goodman S.B.
        Cell therapy for secondary osteonecrosis of the femoral condyles using the Cellect DBM System: a preliminary report.
        J Arthroplasty. 2009; 24–1: 43
        • Hernigou P.
        • Poignard A.
        • Manicom O.
        • et al.
        The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone.
        J Bone Joint Surg Br Vol. 2005; 87: 896
        • Gangji V.
        • Hauzeur J.P.
        Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells.
        J Bone Joint Surg (Am Vol). 2005; 87: 106
        • Yan Z.Q.
        • Chen Y.S.
        • Li W.J.
        • et al.
        Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion.
        Chin J Traumatol. 2006; 9: 3
        • Daltro G.C.
        • Fortuna V.A.
        • Salvino de Araújo S.A.
        • et al.
        Femoral head necrosis treatment with autologous stem cells in sickle cell disease.
        Acta Ortop Bras. 2008; 16: 44
        • Hernigou P.
        • Poignard A.
        • Zilber S.
        • et al.
        Cell therapy of hip osteonecrosis with autologous bone marrow grafting.
        Indian Journal Orthop. 2008; 43: 40
        • Hernigou P.
        • Habibi A.
        • Bachir D.
        • et al.
        The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease.
        J Bone Joint Surg Am. 2006; 88–12: 2565
        • Mitchell D.G.
        • Steinberg M.E.
        • Dalinka M.K.
        • et al.
        Magnetic resonance imaging of the ischemic hip: alterations within the osteonecrotic, viable and reactive zones.
        Clin Orthop Relat Res. 1989; 244: 60
        • Koo K.K.
        • Dussayult R.G.
        • Kaplan P.A.
        • et al.
        Fatty marrow conversion of the proximal femoral metaphysis in the osteonecrotic hips.
        Clin Orthop Relat Res. 1995; 361: 159
        • Hernigou P.
        • Beaujean F.
        • Lambotte J.C.
        Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis.
        J Bone Joint Surg Br Vol. 1999; 81: 349
        • Tzaribachev N.
        • Vaegler M.
        • Schaefer J.
        • et al.
        Mesenchymal stromal cells: a novel treatment option for steroid-induced avascular osteonecrosis.
        IMAJ. 2008; 10: 232
        • Song S.
        • Zhu S.
        • Sun C.
        Treatment of avascular necrosis of femoral head by periosteal cell transplantation: an experimental study.
        Zhonghua Yi Xue Za Zhi. 1998; 52: 8
        • Sen R.K.
        • Tripathy S.K.
        • Aggarwal S.
        • et al.
        Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: a randomized control study.
        J Arthroplasty. 2012; 27: 679
        • Lim Young Wook
        • Kim Yong Sik
        • Lee Jong Wook
        • et al.
        Stem cell implantation for osteonecrosis of the femoral head.
        Exp Mol Med. 2013; 45: e61