Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma

Abstract

We report a case of a 43-year-old man with early stage (stage 1) avascular necrosis (AVN) of the femoral head treated with adipose tissue-derived stem cells (ASCs) and platelet-rich plasma (PRP). ASC-containing stromal vascular fraction was mixed with PRP and hyaluronic acid. This mixture was then injected into the diseased hip under ultrasound guidance. The affected hip was reinjected weekly with additional PRP for 4 weeks. The patient was followed-up with sequential magnetic resonance imaging (MRI) scans at 3, 18, and 21 months after treatment, together with Visual Analogue Scale (VAS) Walking Index, Functional Rating Index, Harris Hip Score, and Range of Motion (ROM) assessments. The patient's severe hip pain was considerably improved at 3 months after treatment, with pain scores, ROM and MRI showing near complete resolution of AVN. Pain scores, ROM and MRI at 18 and 21 months after treatment indicated complete resolution of AVN. This case represents the first evidence of complete resolution of early stage AVN of the hip following treatment with ASCs/PRP.

Adipose Tissue-Derived Mesenchymal Stem Cells: A Novel Therapy in Orthopedics

“…The patient's severe hip pain was considerably improved at 3 months after treatment. Pain scores, range of motion and MRI at 18 and 21 months post treatment indicated complete resolution of a vascular necrosis of the femoral head [84][85][86][87].…”

“…Thirteen articles were included in the review, they consisted of 1 RCT, 4 nRCTs, 1 prospective comparative study, 1 longitudinal cohort study, 2 case control studies, 3 case series and one case report [68,[73][74][75][76][77][78][79][80][81][82][83][84]. The number of patients injected with stem cells ranged between 12 and 1128.…”

The management of platelet-rich plasma in ONFH treatment: A systematic review

“…BmMSCs/PRP treatment. The concentration of AdMSCs(around 200 000/g) is higher than that of bmMSCs(around 6000-60 000/g) [53], and the source of BmMSCs is restricted by certain disease like osteoporosis and leucocythemia [54]. And the study from Wyles et al also supported the AdMSCs, suggesting that AdMSCs show greater potency for proliferation and osteogenic differentiation superior to BmMSCs in the setting of osteonecrosis [53].…”

“…When months at least [51,52]. In another case report from Pak et al [53], one patient with I stage ONFH received PRP/AdMSCs mixture treatment once and PRP treatment every week for 4 weeks in subsequent treatment. Eventually, the patient reported the complete resolution of hip pain and motion function abnormalities after 21 months followed-up, and the MRI presented a significant signal changes in both the T1 and T2 views of the femoral head before and after PRP/AdMSCs treatment.…”

Effect of Photobiomodulation Therapy on the Increase of Viability and Proliferation of Human Mesenchymal Stem Cells

“…Pak's team demonstrated regeneration of the hyaline cartilage of patellofemoral joints, pain relief, and an improved range of motion and function in patients with chondromalacia patellae after injection of autologous MSCs [29,30]. MSCs can also regenerate bone in osteonecrosis of the femoral head; 3-7 months after MSC injection symptoms had completely subsided and MRI confirmed the reversal of necrosis [31]. De Girolamo proved the efficacy of MSCs injection for treating Achilles tendinopathy; he achieved a reduction in pain and improved functional capacity and quality of life of patients [32].…”