THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis

Nally, Francisco; Zanotti, Gerardo; Buttaro, Martín; Dilernia, Fernando Díaz; Mansilla, Ignacio Garcia; Piccaluga, Francisco

doi:10.5301/hipint.5000552

Cited by 30 publications

(30 citation statements)

References 25 publications

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“…ONFHN is commonly diagnosed in patients aged 40 years or younger and may be linked to steroid or alcohol use, trauma [1,5,11e14]. There are a variety of hip-sparing management strategies for these patients including core decompression [15,16], nonvascularized bone grafts [17,18], free vascularized fibular grafts [1,5,11e13,19e21], stem cell injection [22], peritrochanteric osteotomies [23], electrical stimulation [24,25], and activity modification [14]. Regardless of the treatment, patients remain at a risk of further progression of disease and may ultimately require THA.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Ryan

Wooster

Jiranek

et al. 2019

The Journal of Arthroplasty

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Keywords:osteonecrosis avascular necrosis free vascularized fibular graft total hip arthroplasty conversion arthroplasty a b s t r a c t Background: Conversion total hip arthroplasties (THAs) from prior free vascularized fibular grafting (FVFG) are infrequently reported in the literature. We characterized the perioperative outcomes of patients undergoing conversion THA and compared them with those of a matched cohort of patients undergoing primary THA for osteonecrosis of the femoral head and neck (ONFHN). Methods: The institutional database was queried for patients with FVFG requiring conversion to THA. This cohort was then matched 1:1 for age, gender, and American Society of Anesthesiologists (ASA) score for patients with ONFHN undergoing primary THA. Medical records were reviewed for intraoperative and postoperative complications, which were then compared between conversion and primary THA patient cohorts. Results: Two hundred eighty-eight THA patients were included for analysis (144 patients with FVFG matched to 144 patients with ONFHN and no prior FVFG). Patients with prior FVFG who underwent THA had significantly greater operative time and blood loss (P < .001). Although not significant, there were more intraoperative fractures in the FVFG cohort (P ¼ .053). Postoperatively, patients with FVFG had significantly greater blood transfusions (P < .001) and hematoma formation (P ¼ .004) than the matched cohort. There was no difference in length of stay, discharge disposition, or venous thromboembolism; however, patients who underwent conversion THA showed increased deep infection (P ¼ .044) and rate of return to the operating room (P ¼ .010). Conclusion: Although there are numerous treatment strategies for patients with ONFHN, many patients will ultimately require THA. Patients undergoing conversion after FVFG are more likely to have complications including increased blood loss, hematoma formation, and intraoperative fractures. Consequently, surgeons should concentrate on preoperative optimization and prepare for specific technical challenges.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Ryan

Wooster

Jiranek

et al. 2019

The Journal of Arthroplasty

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“…1 Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China. 2 Yueyang Traditional Chinese Medicine Hospital, Hunan, China. 3 Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu, China.…”

Section: Ethics Approval and Consent To Participatementioning

confidence: 99%

“…of patients [1]. The course of this disease is progressive, and the arthritis severity gradually increases [2] until patients with late-stage ONFH require total hip arthroplasty (THA) [3]. In clinical practice, it is challenging to determine how to prevent the progression of early-stage ONFH or to completely repair the necrotic areas to avoid THA.…”

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confidence: 99%

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

Sun

Liu

et al. 2019

Preprint

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Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine 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 for early-stage ONFH. Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups. Results : At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05). Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

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“…Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients [1]. The course of this disease is progressive, and the arthritis severity gradually increases [2] until patients with late-stage ONFH require total hip arthroplasty (THA) [3]. In clinical practice, it is challenging to determine how to prevent the progression of early-stage ONFH or to completely repair the necrotic areas to avoid THA.…”

Section: Introductionmentioning

confidence: 99%

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

Sun

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine 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 for early-stage ONFH.Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups.Results: At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05).Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

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THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis

Abstract: In these series of cases including patients with pre-collapse osteonecrosis, we observed non-significant results regarding rate of conversion to THA with CD, CDBG or CDSC at an average of 5.5 years.

Cited by 30 publications

References 25 publications

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

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

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

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