Bone marrow aspirate concentrate (Stem cells) therapy for pre-collapse stage of AVN of femoral head: An interventional comparative study (original) (raw)
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Journal of Clinical Orthopaedics and Trauma, 2021
Background: Various joint preserving treatments are available for use in Avascular Necrosis of the femoral head. Most of these are effective in the pre-collapse stage of the disease. This review aimed to evaluate the effectiveness of core decompression and Bone Marrow Aspirate Concentrate in various stages of AVN, in modifying the progression of the disease and the need for hip replacement. Material and methods: The Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews reporting guidelines were followed. The literature search was conducted from inception till 2 nd May 2021, on the PUBMED, SCOPUS, and Google Scholar search engines, using "bone marrow aspirate concentrate osteonecrosis femur" and "bmac osteonecrosis femur" as the keywords. In all these studies, Core Decompression with Bone marrow Aspirate concentrate was performed. The evaluation was done based on the progression of osteonecrosis, improvement in functional outcomes and the conversion to total hip arthroplasty. Results: We have analyzed 612 hips from11 studies, based on our inclusion and exclusion criteria. The mean age of the patients was 38.27 years. There was a predominance of males. The grade of AVN ranged from grade 1 to 4. The average follow-up period of the cases ranged from 2 to 12 years (average: 4.38 years). The functional scores were improved in the majority of cases. Radiographic progression occurred in 23.5% of hips, and the Total Hip Arthroplasty was performed in 14.9% of hips. Conclusions: Core decompression with Bone Marrow Aspirate Concentrate in pre-collapse stages of the disease is beneficial in improving the functions scores and for reducing the radiological progression of the disease and need for total hip arthroplasty, in the majority of cases.
Management of avascular necrosis of femoral head at pre-collapse stage
Indian Journal of Orthopaedics, 2009
In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efÞ cacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufÞ cient, to support their routine use in the treatment or prevention of osteonecrosis of the hip. Core decompression with modiÞ cation of technique is still one of the safest and most commonly employed procedures with evidence based success in the pre-collapse stage of AVN of femoral head. The additional use of bone morphogenic protein, and bone marrow stem cells may provide the opportunity to enhance the results of core decompression. At present, the use of large vascularised cortical grafts, the other surgical procedure with high success rate is still not common due to technical difÞ culty in surgery. Likewise osteotomies are also not getting common as arthroplasty is getting more acceptable, so is awaited without any intermediate big surgical interventions.
Journal of Clinical Orthopaedics and Trauma, 2015
Background: Femoral head is the most common bone affected by avascular necrosis. Core decompression procedure, when done in the initial stages, before collapse, may arrest or reverse the progress of avascular necrosis and thereby may preserve the normal femoral head. Hence, we have analysed the clinical, functional and radiological outcome of core decompression and bone grafting in patients with Osteonecrosis of the femoral head (ONFH) upto stage IIB (Ficat & Arlet). Materials and method: A study was undertaken at our institute from June 2010 to June 2013 wherein 20 patients (28 hips) of ONFH upto grade II B (Ficat & Arlet) were treated with core decompression and the outcomes were studied. Patients were subjected to core decompression of the affected hip. All the patients were operated in lateral position. In 26/28 hips, cancellous grafting was done after harvesting graft from the posterior iliac crest. In 2 patients cortical non-vascularised fibular graft was used. Results: Functional outcome was assessed by Harris hip score, wherein 19 hips (67.85%) had good or excellent outcome; 1 hip (3.57%) had fair out come. However, 8 hips (28.57%) showed poor result. For stage I, 12/13 hips (92.3%) improved, whereas for Stage IIA, 6/11 hips (54.54%) showed improvement and for stage IIB, only 2/4 hips (50%) showed improvement. Less than 25% of the hips required a replacement or salvage procedure. Strict non weight bearing was complied by 23 hips (82.14%), whereas 5 hips (17.85%) were not compliant. If we exclude non compliant patients, our success rate was 92.3% for grade I, 100% for grade IIA and 50% for grade IIB. Conclusion: Core decompression and bone grafting provide satisfactory outcome when patients are carefully selected in early stages of the disease, before the stage of collapse.
Annals of Medicine and Surgery, 2021
Background: Core decompression (CD) has been used in the treatment of pre-collapse stages avascular necrosis (AVN) with good results. Hyperbaric oygen therapy (HBO) was used as a non-invasive treatment for pre-collapse stages osteonecrosis with favorable results. This study aimed to compare the outcomes of HBO versus CD in stage II of non-traumatic AVN of the femoral head. Methods: Data were collected retrospectively for patients with non-traumatic AVN of the femoral head that was confirmed by MRI and underwent HBO or CD between January 2010 and December 2018, with a minimum follow-up of 12 months. Oxford Hip Score (OHS), radiographic progression, and Short-Form 12(SF12) were used to assess the outcomes. Results: Nineteen patients with 23 stage II AVN of the femoral head were included, 12 (52.2%) in CD, and 11 (47.8%) in the HBO group with an average follow-up of 34.2 ± 18.4 months. 66.7% of patients in CD and 81.8% in the HBO group achieved satisfactory hip function outcome with statistically significant mean Oxford Hip Score (35.8 ± 6.7 and 35.5 ± 5.1) (P 0.009 & .003) respectively. No statistical difference of OHS and SF12 (PCS &MCS) was found between the two groups (P 0.202, 0.128 & .670 respectively). Eight (34.7%) cases progressed to a higher radiological stage at one year follow-up. The rate of progression was not statistically significant between both groups (P 0.469) with no statistical difference of OHS and SF12 (PCS & MCS) in the progressed group (P 0.747, 0.648 & 0.416) respectively. Conclusion: This study showed that the HBO is promising and as effective as CD in the treatment of non-traumatic pre-collapsed AVN of the femoral head. Hence, HBO could be used as an alternative non-invasive treatment option.
International Journal of Research in Orthopaedics
Background: Avascular necrosis of the femoral head is a disorder that can lead to the collapse of the femoral head and can progress to secondary osteoarthritis, which would ultimately require a total hip replacement. It can be avoided if the disease is diagnosed at an early stage. Intra-osseous pressures can be reduced, thereby aiding in halting the disease progression by core decompression along with bone marrow aspirate concentrate with morselized bone allograft. Aim was to evaluate the role of core decompression with BMAC with bone grafting for the treatment of early stage AVN of the hip by clinical and functional outcomes of the patient. Methods: A prospective observational study done to evaluate the clinical and functional outcomes by using the Harris hip score with domains for pain, functional activity, range of motion, and gait. Pre-operative and 18-months post-operative HHS was calculated in 30 samples between 30-50 years undergoing core decompression with BMAC and bone graf...
Core decompression and biotechnologies in the treatment of avascular necrosis of the femoral head
EFORT Open Reviews, 2017
Avascular necrosis (AVN) of the femoral head (FH) causes 5% to 12% of total hip arthroplasties (THA). It especially affects active male adults between the third and fifth decades of life. The exact worldwide incidence is unknown. There are only few data related to each country, but most of it relates to the United States. Non-surgical management has a very limited role in the treatment of AVN of the FH and only in its earliest stages. Core decompression (CD) of the hip is the most common procedure used to treat the early stages of AVN of the FH. Recently, surgeons have considered combining CD with autologous bone-marrow cells, demineralised bone matrix or bone morphogenetic proteins or methods of angiogenic potential to enhance bone repair in the FH. Manuscripts were deemed eligible for our review if they evaluated treatment of early stage AVN of the FH with biotechnology implanted via CD. After application of eligibility criteria, we selected 19 reports for final analysis. The prin...
Orthopedic reviews, 2016
The aim of this study was to investigate the safety of injection of bone marrow aspirate concentrate during core decompression and to study its clinical (visual analogue scale; Harris-Hip-score) and radiological outcomes (magnetic resonance imaging). In this prospective and randomized clinical trial we evaluated 24 consecutive patients with non-traumatic femoral head necrosis (FHN) during a period of two years after intervention. In vitro analysis of mesenchymal stem cells was performed by evaluating the fibroblast colony forming units (CFU-Fs). Postoperatively, significant decrease in pain associated with a functional benefit lasting was observed. However, there was no difference in the clinical outcome between the two study groups. Over the period of two years there was no significant difference between the head survival rate between both groups. In contrast to that, we could not perceive any significant change in the volume of FHN in both treatment groups related to the longitudi...
The Results Of Core Decompression Treatment In Femoral Head Avascular Necrosis
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2018
The Results of Core Decompression Treatment in Avascular Necrosis of the Femoral Head Objective: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significant disability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who had been operated in our clinic. Methods: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merle d'Aubigné-Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arlet with hip anterior-posterior and lateral graphs and magnetic resonance imaging. Results: The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Of these patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patients developed AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According to the Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From the etiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinical improvement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users. The Merle d'Aubigné-Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroid users. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1, 70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hip prosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hip replacement was 27 months. Conclusion: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient's quality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, although it has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still do not have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. It is a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.
Core Decompression with Bone Marrow Stem Cells for Osteonecrosis of Femoral Head
2020
The authors conducted a systematic review and meta-analysis to determine if Core Decompression (CD) with Bone Marrow Stem Cells (BMSC) is more effective in treating Osteonecrosis of the Femoral Head (ONFH) compared to CD. Authors used Cochrane Library, EMBASE, PubMed, Web of Science, and hand-searched references through January 2020, identifying relevant randomized controlled trials (RCTs). Risk of bias was assessed with Cochrane's handbook. Fifty-four abstracts were screened, and eight RCTs (five at high and three at unclear risk of bias) with 432 patients were included. Meta-analyses found statistically significant improvement in Harris Hip Score (HHS) at 12 months (Difference in Means [DM]=10.065;95% Confidence Interval [CI]=4.509 to 15.622; p<0.001) and pain intensity at 24 months (DM=-7.364;95% CI=-12.113 to-2.615;p=0.002) in CD+BMSC group compared to CD alone although these results may not be clinically significant. Risk of Total Hip Replacement (THR) in patients receiving CD+BMSC was 33.4% lower than in CD group though not significant (RR=0.666; 95% CI=0.355 to 1.250;p=0.206). Though meta-analyses found the addition of BMSC to CD significantly improves clinical outcomes (HHS and pain intensity) compared to CD only, evidence was of moderate/low quality due to high risk of bias, imprecision, and small sample sizes. Further research is needed to confirm the results.
Journal of Hip Preservation Surgery, 2020
Head preserving modalities in avascular necrosis (AVN) hip are variably effective in early stages, and further options that could prevent head distortion and osteoarthritis are needed. Core decompression (CD) is the most commonly used surgery in the early stages of osteonecrosis with variable rates of success. The present review aimed to determine the effectiveness of bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), bone morphogenetic proteins (BMP) or their combination with CD in early stages of AVN hip, prior to collapse of femoral head. Additionally, any newer unexplored modalities were also searched for and ascertained. PubMed and SCOPUS databases were searched for relevant articles in English language describing CD with aforementioned orthobiologics. We analysed a total of 20 studies published between 2011 and 2020. There were 6 retrospective and 14 prospective studies. PRP showed improved survival and functional outcomes; however, with only three studies, t...