Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

Abstract

Purpose: This study evaluated mid-term clinical and radiological results of autologous bone marrow transplantation (BMT) for early stage osteonecrosis of the femoral head (ONFH) and analyzed prognostic factors. Materials and Methods: From November 2003 to April 2008, 101 hips of 93 patients with early stage ONFH who underwent autologous BMT were followed for at least five years. For clinical results, preoperative and postoperative Harris hip scores (HHS) were evaluated and survival rate was obtained at the point of performing total hip arthroplasty or femoral head collapse progression. Radiologic results were assessed by changes in necrosis size on magnetic resonance imaging performed preoperative and postoperatively. For evaluation of prognostic factors, survival rate was analyzed according to age, gender, etiology, stage, necrosis size, and location. Results: Averaged HHS at latest follow up showed no significant change in comparison with preoperative HHS. Of 101 hips, 35 hips required arthroplasty and six hips were running head collapse. Groups with use of steroid, lateral location of necrosis, large size of necrosis, or large necrotic angles showed lower survival rate. However, age, gender, and stage had no effect. Conclusion: In early days, autologous BMT for early ONFH can be considered as a treatment for improvement of clinical features and delay of radiologic progress. However, after some years, there was no effect compared with the natural course of ONFH.

ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

“…Grafting of concentrated bone marrow mononuclear cells (BMMC) has been combined to core decompression to treat the early stage of ONFH, and several studies showed promising results. 91 92 93 94 95 96 97 Given that size and location of the necrotic lesion are the major determinants of further collapse of the femoral head and collapse does not occur in small lesions even without any intervention, 19 98 99 there is limited evidence to confirm the effectiveness of BMMC therapy in well-designed studies. Thus, a large-scale randomized controlled trial to verify the efficacy of core decompression with/without BMMC is warranted.…”