Lack of Conclusive Evidence of the Benefit of Biologic Augmentation in Core Decompression for Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review

Andronic, Octavian; Hincapié, Cesar A.; Burkhard, Marco D.; Loucas, Rafael; Loucas, Marios; Ried, Emanuel; Rahm, Stefan; Zingg, Patrick O.

doi:10.1016/j.arthro.2021.04.062

Cited by 12 publications

(4 citation statements)

References 51 publications

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“…There is an increasing number of elderly patients undergoing hip arthroplasty for the treatment of osteoarthritis and/or osteonecrosis of the femoral head (ONFH) with unbearable persistent pain. 1 It was reported that the annual incident rate of total hip arthroplasty increased from 15.2/100,000 in 2010 to 22.3/100,000 in 2018 in Korea, showing the same increased tendency as reports from Western countries. 2 Previous studies have reported that approximately 27% of patients developed chronic postsurgical pain (CPSP) after hip arthroplasty.…”

Section: Introductionmentioning

confidence: 69%

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

Lü¹,

Hu²,

Dai³

et al. 2021

IJGM

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Section: Introductionmentioning

confidence: 69%

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

Lü¹,

Hu²,

Dai³

et al. 2021

IJGM

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“…Till date, however, no statistically signi cant differences in the radiological progression of necrosis and the rate of conversion to arthroplasty, as well as PROM between surgical procedures regarding CD, have been reported 12,13,17,19,21,22 . Only cell therapy combined with CD has shown relatively superior outcomes regarding the radiological progression of ON 11,12,23−27 .…”

Section: Discussionmentioning

confidence: 99%

Implantation of core tract autologous bone into decompressed lesion in the core decompression for osteonecrosis of the femoral head

Yoon

2022

Preprint

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Introduction Core decompression (CD) is a treatment modality used to prevent progression of subchondral collapse and arthritic change in osteonecrosis of the femoral head (ONFH). This study aimed to evaluate the outcomes of CD with autologous bone graft to promote rapid bone formation and early postoperative ambulation. Methods This study included 13 patients who received CD for ONFH (≤ 2mm head collapse) with a minimum follow-up of two years. We implanted autologous bone blocks obtained from the decompression tract into the decompressed necrotic area, and the remaining space was filled with 5–10 cc of allograft bone chips or left empty. We then evaluated patients’ clinical and radiographical outcomes. Results The mean visual analog scale improved from 4.7 at admission to 3.1 at the latest follow-up (P = 0.039). The mean modified Harris hip score also improved from 59.8 to 73.2 ( P = 0.027). Mild osteoarthritic changes were noted in most patients (11/13, 84.6%), and the hip survival rate (no further surgeries required) was 76.9%. Three patients underwent total hip arthroplasty due to residual hip pain (mean time to reoperation, 12.7 months). Conclusion Core decompression showed favorable clinical outcomes without any surgery-related complications. This technique may be recommended for the treatment of ONFH.

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“…The femoral head usually develops into secondary arthritis when it collapses [ 4 ]. Core decompression (CD) is a commonly used procedure for treating femoral head necrosis despite some controversy; it is a simple procedure that treats ONFH by drilling into the necrotic area of the femoral head [ 5 – 8 ]. The theoretical advantage of CD is in relieving the pain by reducing venous congestion and bone marrow pressure.…”

Section: Introductionmentioning

confidence: 99%

Regenerative therapies for femoral head necrosis in the past two decades: a systematic review and network meta-analysis

Wang,

Hu,

Wei

et al. 2024

Stem Cell Res Ther

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Background Regenerative techniques combined with core decompression (CD) are commonly used to treat osteonecrosis of the femoral head (ONFH). However, no consensus exists on regeneration therapy combined with CD that performs optimally. Therefore, we evaluated six regenerative therapies combined with CD treatment using a Bayesian network meta-analysis (NMA). Methods We searched PubMed, Embase, Cochrane Library, and Web of Science databases. Six common regeneration techniques were categorized into the following groups with CD as the control group: (1) autologous bone graft (ABG), (2) autologous bone graft combined with bone marrow aspirate concentrate (ABG + BMAC), (3) bone marrow aspirate concentrate (BMAC), (4) free vascular autologous bone graft (FVBG), (5) expanded mesenchymal stem cells (MSCs), and (6) platelet-rich plasma (PRP). The conversion rate to total hip arthroplasty (THA) and progression rate to femoral head necrosis were compared among the six treatments. Result A total of 17 literature were included in this study. In the NMA, two of the six treatment strategies demonstrated higher response in preventing the progression of ONFH than CD: MSCs (odds ratio [OR]: 0.098, 95% confidence interval [CI]: 0.0087–0.87) and BMAC (OR: 0.27, 95% CI: 0.073–0.73). Additionally, two of the six treatment strategies were effective techniques in preventing the conversion of ONFH to THA: MSCs (OR: 0.062, 95% CI: 0.0038–0.40) and BMAC (OR: 0.32, 95% CI: 0.1–0.074). No significant difference was found among FVBG, PRP, ABG + BMAC, ABG, and CD in preventing ONFH progression and conversion to THA (P > 0.05). Conclusions Our NMA found that MSCs and BMAC were effective in preventing ONFH progression and conversion to THA among the six regenerative therapies. According to the surface under the cumulative ranking value, MSCs ranked first, followed by BMAC. Additionally, based on our NMA results, MSCs and BMAC following CD may be necessary to prevent ONFH progression and conversion to THA. Therefore, these findings provide evidence for the use of regenerative therapy for ONFH.

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Lack of Conclusive Evidence of the Benefit of Biologic Augmentation in Core Decompression for Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review

Cited by 12 publications

References 51 publications

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

Implantation of core tract autologous bone into decompressed lesion in the core decompression for osteonecrosis of the femoral head

Regenerative therapies for femoral head necrosis in the past two decades: a systematic review and network meta-analysis

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