Purpose Osteonecrosis of the femoral head is a progressive and debilitating disease that causes pain, osteoarthritis and hip joint collapse, eventually necessitating hip replacement. This study evaluated the long-term outcomes of autologous adult live-cultured osteoblasts (AALCO) implantation in patients with osteonecrosis of femoral head. Patients and Methods In this retrospective multicenter study, we collated and analyzed data of patients ≥12 years of age who underwent AALCO (OSSGROW ® ) between 2010 and 2015 for the treatment of osteonecrosis of the femoral head. Results Data from 64 patients (101 hip joints) were assessed in this study. The mean ±SD duration of disease since diagnosis of osteonecrosis was 7.4±1.6 years. The mean follow-up duration was 6.3±1.4 years. The mean VAS score (n=98 hips) reduced significantly from 58.8 ± 13.8 to 32.2 ± 32.1 post-operatively (mean difference: −26.5±35.2, p=0.001) and Harris hip score (n=97 hips) also significantly improved from 47.1±12.3 to 63.7±27.7 post-operatively (mean difference:16.7±28.7, p=0.0001). Following the AALCO treatment, 29 hips in 13 patients (28.7%) underwent total hip replacement (THA), indicating that AALCO treatment could delay THA for 71.3% of hips. A total of 39.1% of hips diagnosed in early stage versus 60.8% in the late stage of osteonecrosis required THA. Overall, 60.4% of hips improved, 2% remained stable, and 37.6% progressed following the AALCO implantation. The condition of disease was found to have improved in 71.1% of patients in early stage (Grades I and II) versus 58% in the late stage (Grades III and IV) of osteonecrosis. Conclusion Patients with osteonecrosis who received implantation of autologous-cultured osteoblasts using AALCO showed improvement in joint function and decrease in pain. Treatment with AALCO halted progression of osteonecrosis, preserved the natural hip, and eliminated the need for hip replacement surgeries in 7 out of 10 patients.

Four patients from a Muslim family with an inherited skeletal dysplasia are presented. It is more crippling than usual form of spondylo-epiphysial dysplasia tarda and the onset is very early in the life i.e. at 4 years. The disorder is progressive, crippling and has striking clinical resemblance to juvenile rheumatoid arthritis. The striking X-ray appearance is of platyspondyly and irregularities of capital femoral epiphysis. There is absence of any synovitis. Two of these patients are females aged 8 years and 18 years. The third patient is their cousin brother aged 6 years and their uncle who is of 50 years old and crippled.

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