Autologous mesenchymal stem cell implantation in the management of osteonecrosis of the femoral head

Yan, Denglu; Chen, Liming; Li, Zirong; Guo, Wanshou; Sun, Wei

doi:10.1097/bco.0000000000000218

Cited by 12 publications

(17 citation statements)

References 27 publications

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“…Among comparative studies, seven were retrospective comparative studies [13,15,17,25,34,54]: six missed to find any significant difference between treatment and control groups, analyzing clinical scores, radiologic outcomes and failures, and only one [27] reported significantly increased clinical and radiological scores, with fewer failures. Two level II prospective comparative studies [11,39] were found in the literature.…”

Section: Resultsmentioning

confidence: 99%

Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

Andriolo

Merli²,

Tobar³

et al. 2018

International Orthopaedics (SICOT)

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Section: Resultsmentioning

confidence: 99%

Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

Andriolo

Merli²,

Tobar³

et al. 2018

International Orthopaedics (SICOT)

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“…Majority of the studies, 20 (40%), used the original “Ficat” classification [ 24 , 27 , 29 , 32 , 34 , 36 , 41 , 46 , 48 – 52 , 56 – 59 , 61 , 62 , 67 ]. Ten studies (20%) followed the “Modified Ficat” classification [ 12 , 25 , 31 , 44 , 47 , 54 , 55 , 63 , 65 , 70 ] and other eleven (22%) [ 26 , 28 , 30 , 37 – 39 , 45 , 60 , 66 , 68 , 69 ] used the ARCO system. Finally, nine studies (18%) [ 12 , 13 , 33 , 35 , 40 , 42 , 43 , 53 , 64 ] applied the “Steinberg/University of Pennsylvania” classification.…”

Section: Resultsmentioning

confidence: 99%

What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?

Andronic

Weiss

Shoman

et al. 2020

International Orthopaedics (SICOT)

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Purpose Core decompression (CD) of the femoral head is performed to preserve the hip in avascular necrosis (AVN). The outcome following this procedure differs based on the medical centre and the technique. Also, the time to total hip replacement (THR) and the percentage of patients subsequently undergoing a THR are controversial. Methods A systematic review was performed following PRISMA guidelines. The search included CENTRAL, MEDLINE, EMBASE, Scopus, AMED and Web of Science Core Collection databases. Studies reporting the outcome of CD for AVN were assessed. Studies using additional implants, vascularized grafts or any type of augmentation were excluded. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC) tool. Trial registration International prospective register of systematic reviews (PROSPERO) - CRD42018100596. Results A total of 49 studies describing 2540 hips were included. The mean weighted follow-up time was 75.1 months and the mean age at surgery was 39 years. Twenty-four of 37 studies reported improvement in all outcome scores, whilst 9/37 studies report only partial improvement post-operatively. Four studies (4/37) described poor clinical outcomes following intervention. Data was pooled from 20 studies, including 1134 hips with a weighted mean follow-up of 56 months. The percentage of hips undergoing THR averaged 38%. The time to THR had a weighted mean of 26 months after CD. Conclusion Pooled results from 1134 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 38% of patients underwent a total hip replacement at an average of 26 months following core decompression without augmentation.

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“…The included studies were published from 1996 to 2019. Eight of the studies were RCTs, 30 - 36 , 49 seven were retrospective case-control studies, 37 , 39 - 43 , 47 and five were prospective control studies. 38 , 44 - 48 , 48 In each of the included studies, the baseline difference between the intervention group and the control group revealed no statistical significance.…”

Section: Resultsmentioning

confidence: 99%

“…Harris Hip Score: A total of 11 trials 29 , 31 , 32 , 35 - 39 , 41 , 42 , 44 , 48 , 48 reported HHS postoperatively during follow-up. Due to the lack of standard deviation (SD) data for four studies, 30 , 38 , 40 , 42 we only analyzed seven studies 32 , 33 , 36 , 37 , 43 , 45 , 49 involving 474 hips (Intervention = 256, Control = 218). According to the different intervention measures, we divided the studies into four subgroups (cell therapy = 3, 33 , 36 , 43 bone grafting = 2, 32 , 37 porous tantalum rod = 1, 49 and biological materials = 1 45 ).…”

Section: Primary Outcome Measuresmentioning

confidence: 99%

“…Due to the lack of standard deviation (SD) data for four studies, 30 , 38 , 40 , 42 we only analyzed seven studies 32 , 33 , 36 , 37 , 43 , 45 , 49 involving 474 hips (Intervention = 256, Control = 218). According to the different intervention measures, we divided the studies into four subgroups (cell therapy = 3, 33 , 36 , 43 bone grafting = 2, 32 , 37 porous tantalum rod = 1, 49 and biological materials = 1 45 ). Heterogeneity existed between studies of bone grafting (I 2 = 96%, p < 0.001, chi-squared test) ( Figure 2 ), and a random effects model was used.…”

Section: Primary Outcome Measuresmentioning

confidence: 99%

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Comparison of cell therapy and other novel adjunctive therapies combined with core decompression for the treatment of osteonecrosis of the femoral head

Zhu

Zhang

Chen

et al. 2021

Bone & Joint Research

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Aims The value of core decompression (CD) in the treatment of osteonecrosis of the femoral head (ONFH) remains controversial. We conducted a systematic review and meta-analysis to evaluate whether CD combined with other treatments could improve the clinical and radiological outcomes of ONFH patients compared with CD alone. Methods We searched the PubMed, Embase, Web of Science, and Cochrane Library databases until June 2020. All randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing CD alone and CD combined with other measures (CD + cell therapy, CD + bone grafting, CD + porous tantalum rod, etc.) for the treatment of ONFH were considered eligible for inclusion. The primary outcomes of interest were Harris Hip Score (HHS), ONFH stage progression, structural failure (collapse) of the femoral head, and conversion to total hip arthroplasty (THA). The pooled data were analyzed using Review Manager 5.3 software. Results A total of 20 studies with 2,123 hips were included (CD alone = 768, CD combined with other treatments = 1,355). The combination of CD with other therapeutic interventions resulted in a higher HHS (mean difference (MD) = 6.46, 95% confidence interval (CI) = 2.10 to 10.83, p = 0.004) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (MD = −10.92, 95% CI = -21.41 to -4.03, p = 0.040) and a lower visual analogue scale (VAS) score (MD = −0.99, 95% CI = -1.56 to -0.42, p < 0.001) than CD alone. For the rates of disease stage progression, 91 (20%) progressed in the intervention group compared to 146 (36%) in the control group (odds ratio (OR) = 0.32, 95% CI = 0.16 to 0.64, p = 0.001). In addition, the intervention group had a more significant advantage in delaying femoral head progression to the collapsed stage (OR = 0.32, 95% CI = 0.17 to 0.61, p < 0.001) and reducing the odds of conversion to THA (OR = 0.35, 95% CI = 0.23 to 0.55, p < 0.001) compared to the control group. There were no serious adverse events in either group. Subgroup analysis showed that the addition of cell therapy significantly improved clinical and radiological outcomes compared to CD alone, and this approach appeared to be more effective than other therapies, particularly in precollapse (stage I to II) ONFH patients. Conclusion There was marked heterogeneity in the studies. There is a trend towards improved clinical outcomes with the addition of stem cell therapy to CD. Cite this article: Bone Joint Res 2021;10(7):445–458.

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Autologous mesenchymal stem cell implantation in the management of osteonecrosis of the femoral head

Abstract: Background:The aim of this study was to evaluate the results of implantation of mesenchymal stem cells (MSCs) as treatment for early-stage osteonecrosis of the femoral head (ONFH).

Cited by 12 publications

References 27 publications

Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?

Comparison of cell therapy and other novel adjunctive therapies combined with core decompression for the treatment of osteonecrosis of the femoral head

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