Correlation between the efficacy of stem cell therapy to osteonecrosis of the femoral head and cell viability

Abstract

Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of necrotic area is the key to treatment.At present, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas through the characteristics of stem cells. However, a considerable number of patients cannot achieve a satisfactory outcome in repairing the femoral head necrotic area. It is very important to find out the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression to early-stage of ONFH. Methods: A total of 30 patients with idiopathic ONFH were performed core decompression combined with autologous stem cell transplantation. The Harris score (HHS) and necrosis area change of patients before and after operation were observed. The mean value of repair ratio was set as a threshold dividing the patients into group A (ratios greater than the mean value) and group B (ratios less than the mean value). The ultrastructure, proliferative capacity and multidirectional differentiation ability were compared between the groups. Results: At 9 months after surgery, HHS and magnetic resonance imaging (MRI) findings had improved by varying degrees. Based on the repair ratio, i.e., (62.2 ± 27.0) %, 62.2% was set as a threshold dividing the patients into group A and group B. Better repair(Group A) showed faster proliferation efficiency and healthier ultrastructure. The cells of Group A also showed stronger specific staining after osteogenesis and chondrogenesis induced differentiation. The activity of alkaline phosphatase (ALP) was also higher in group A (OD 2.39 ± 0.44 vs 1.85 ± 0.52; P <0.05) after osteogenic differentiation. Conclusions: The quality of implanted stem cells is closely related to the efficacy of this procedure and determines whether the defects of self-repair in the necrotic areas can be corrected to enhance the repair capacity of necrotic tissue and to promote the repair of necrotic areas to achieve the desired therapeutic outcome.

Role of Orth Biologics in Core Decompression for Femoral Head Preservation in Early Avascular Necrosis of Hip

“…46 studies were chosen after a review of titles and abstracts, and complete texts were examined. Finally, 20 studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] were included (all published between 2011 and 2020).…”

“…This review comprised a total of 20 studies, which were tabulated [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. There were 14 prospective studies [33,39,21,22,23,24,27,28,29,30,31,35,36,37] and six retrospective studies [25,26,32,34,38,40]. Three investigations on the use of PRP with CD were published, one of which was a randomised study [21].…”

“…Three investigations on the use of PRP with CD were published, one of which was a randomised study [21]. 14 studies looked at effectiveness of BMAC as a CD adjuvant [24][25][26][27][28][29][30][31][32][33][34][35][36][37], while one looked at the use of recombinant BMP-7 [40]. The results of employing both BMAC & PRP with CD were assessed in the remaining two investigations [38,39].…”

Connexin43 Overexpression Promotes Bone Regeneration by Osteogenesis and Angiogenesis in Rat Glucocorticoid-Induced Osteonecrosis of the Femoral Head

“…Many studies have suggested that combining stem cells transplantation with genetic modification can improve the treatment efficiency of stem cell transplantation(3, 14, 26). BMSCs transplantation has been proved as a promising treatment method for the early stages of ONFH(10, 38, 52, 58). Previous studies demonstrated that SDF-1α overexpression could significantly promote bone regeneration through osteogenesis and angiogenesis(54), and the overexpression of P-glycoprotein or VEGF165 could also significantly decrease the incidence of GIONFH by promoting osteogenesis and blood vessel regeneration(16–17).…”

Impact of Femoral Neck Cortical Bone Defect Induced by Core Decompression on Postoperative Stability: A Finite Element Analysis

“…Therefore, hip preservation treatment prior to the collapse of the femoral head (in early ONFH) is very important [3]. Currently, ONFH is mainly treated with core decompression combined with other therapies, such as stem cell transplantation [4], platelet-rich plasma instillation [5], porous tantalum rod implantation [6], and quadratus femoris muscle pedicle bone grafting [7]. These procedures promote the gradual replacement of the dead bone in the necrotic area, tissue repair, and mechanical strength; prevent further collapse of the femoral head; alleviate hip pain; and improve hip joint function.…”