Cell-Based and Scaffold-Based Therapies for Joint Preservation in Early-Stage Osteonecrosis of the Femoral Head

Abstract

Numerous basic-science and translational studies of cell-based and scaffold-based therapies are currently being performed. » The advantages and limitations of cell-based therapy for osteonecrosis of the femoral head, including bone marrow-derived mononuclear cells (BM-MNCs), mesenchymal stem cells (MSCs), and MSC-derived exosomes, are being examined preclinically. » A range of ceramic-based, polymer-based, hydrogel-based, and composite scaffolds have been used for the treatment of osteonecrosis of the femoral head in order to physically or functionally support bone repair and remodeling. » Modulation of the pro-inflammatory response at an appropriate time point has enhanced bone formation in experimental models. The therapeutic potential of these strategies in translational models of osteonecrosis of the femoral head has not been fully clarified.

Difference in Therapeutic Strategies for Joint‐Preserving Surgery for Non‐Traumatic Osteonecrosis of the Femoral Head between the United States and Japan: A Review of the Literature

“…At first, single 10 mm core diameters were used, but since 2000, multiple CDs, which are 3 mm or less in diameter, have been preferred. More recently, due to advances in regenerative medicine, cell therapy combined with the CD procedure has become popular 1–4, 13–16 . For cell therapy, bone marrow mononuclear cells are mostly used.…”

“…For cell therapy, bone marrow mononuclear cells are mostly used. Cultured bone marrow stem cells or platelet‐rich plasmas have also been tried 1–4, 13 . In contrast, in Japan, CD has not been performed at all except for biopsy purposes.…”

“…Recently, regenerative therapies with CD, including cell therapy 13, 14 , alternative bone therapy 15 , and growth factor therapy 16 , have been developed and are gaining in popularity as the next generation of treatments. With the advent of regenerative medicine, joint‐preserving treatment for ONFH is now facing a major crossroads.…”

Recombinant Human FGF-2 for the Treatment of Early-Stage Osteonecrosis of the Femoral Head: TRION, a Single-Arm, Multicenter, Phase II Trial

“…Thanks to the widespread use of MRI and the cautious use of corticosteroids, the early diagnosis of ONFH is increasing. Several studies have examined the efficacy of combining CD with cell or growth factors [12][13][14][15][16]. The biological augmentation of CD has shown promising results; however, the clinical results varied and no consensus exists on the strategy for joint-preserving surgery in the current ONFH guidelines published in several countries [2,4,5,11].…”

“…However, these trials had several limitations regarding efficacy, including patients with good prognosis who do not require surgery, a small sample size due to the rarity of the condition, and inadequate organization of the control data. Further high-quality studies with validated organized control data are needed for the regenerative procedure to be applied to the general clinical setting [2][3][4]13,17,18].…”