The role of cell therapies and hip arthroscopy in the management of osteonecrosis: an update

Papavasiliou, Athanasios; Triantafyllopoulos, Ioannis Κ.; Paxinos, Odysseas; Tsoukas, Dimitrios; Kostantoulakis, Charalambos

doi:10.1093/jhps/hny021

Cited by 13 publications

(6 citation statements)

References 59 publications

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“…The addition of fibula and vascularized grafts to CD have shown promising results but are challenging surgeries to perform and have donor site co-morbidities. On the other hand, newer orthobiologics have been increasingly tested in the past decade; bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP) and bone morphogenetic protein-7 (BMP-7) have been supplemented with CD to increase the success rates in early AVN [ 14 − 17 ]. A few studies have even assessed these in post-femoral head collapse and distortion stages [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip

Kumar

Shetty²,

Dhillon

2020

Journal of Hip Preservation Surgery

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Head preserving modalities in avascular necrosis (AVN) hip are variably effective in early stages, and further options that could prevent head distortion and osteoarthritis are needed. Core decompression (CD) is the most commonly used surgery in the early stages of osteonecrosis with variable rates of success. The present review aimed to determine the effectiveness of bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), bone morphogenetic proteins (BMP) or their combination with CD in early stages of AVN hip, prior to collapse of femoral head. Additionally, any newer unexplored modalities were also searched for and ascertained. PubMed and SCOPUS databases were searched for relevant articles in English language describing CD with aforementioned orthobiologics. We analysed a total of 20 studies published between 2011 and 2020. There were 6 retrospective and 14 prospective studies. PRP showed improved survival and functional outcomes; however, with only three studies, there is inconclusive evidence for its routine utilization. BMAC enhances the efficacy of CD which can further be increased by culture and expansion of cells or combining it with PRP to stimulate growth. In conclusion, CD with BMAC works more efficiently than CD alone prior to collapse of femoral head in AVN. However, PRP needs more evidence for extensive application. Addition of PRP to BMAC or culturing the latter could further enhance the potency of CD + BMAC combination. Very limited data is available for the efficacy of BMP-7 and the role of intraosseous bisphosphonates should be evaluated for a cheaper and potential alternative.

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Section: Introductionmentioning

confidence: 99%

Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip

Kumar

Shetty²,

Dhillon

2020

Journal of Hip Preservation Surgery

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“…Mono-nuclear stem cells, which are building blocks of hip's skeletal anatomy, are found in bone marrow aspiration concentrate (BMAC). They develop into bone-forming cells replacing old, faulty cells, preserving structural balance & integrity [16][17][18][19]. Introducing fresh pool of lineage cells capable of differentiating into cells required for hip's normal physiology appears to be promising therapy option for pre collapse phases of AVN.…”

Section: Core Decompression + Bmacmentioning

confidence: 99%

“…Fibular & vascular grafts have been added with CD with better results, however they're difficult operations to execute. Newer orthobiologics, are progressively investigated in last 10-12 years; CD has been augmented with BMAC, PRP, & BMP-7 to boost the success rates [14][15][16][17]. Less studies [18,19] had looked at them in the later stages.…”

Section: Introductionmentioning

confidence: 99%

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

Dadlani

2021

JPRI

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Head preserving procedures for Early Avasculathe Necrosis of hip are invariably effective in early stage. Core decompression (CD) is mostly performed modality for early stages of AVN having different success rates. Current review aims at determining efficiency of Bone marrow aspirate concentrate, Platelet rich Plasma, Bone morphogenic proteins and combining it with Core Decompression for early AVN stage, before femoral head collapse. To preserve a femur head damaged by osteonecrosis, treatment options should be applied early in the disease process for best results. When the articular cartilage becomes deficient to nutrients, it become more difficult to save a particular femur head, and eventually bone destruction occur, affecting hip biomechanics; articular changes eventually develop, necessitating arthroplasty or arthrodesis. Other early treatment techniques has been identified & improved to improve femur head survival & delay replacement. Analysis of 20 studies published between 2011 and 2020 was done of which 6 were retrospective & 14 were prospective. PRP showed better survival and functional outcome, however 3 studies showed inconclusive evidence for its regular usage. BMAC enhanced efficiency of CD & cell increment or combination of PRP for growth stimulation. Concluding, CD and BMAC worked effectively that CD only before femoral head collapse. But, PRP need more evidences for extensive utilization. Adding PRP to BMAC or culturing it would increase potency of CD with BMAC. Less data is available to assess efficiency of BMP-7 & role of Intraosseous bisphosphonate therapy could be studied for inexpensive & better alternate.

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“…The results are inconclusive due to the vast difference in the time period for the two trials and further RCTs are needed. In 2016, the systematic review by Papakostidis et al 45 found the likelihood of the femoral head advancing to the collapse stage were decreased when compared to the CD group (OR=0.2; 95%CI:= 0.08 to 0.6; p=0.02). However, this systematic review included three retrospective case-control trials [46][47][48] , along with one prospective pilot trial 49 , which were all excluded from our systematic review due to our inclusion/exclusion criteria of including only prospective RCTs.…”

Section: Collapse Of the Femoral Headmentioning

confidence: 99%

Core Decompression with Bone Marrow Stem Cells for Osteonecrosis of Femoral Head

Farrokhi¹,

Honnabovi²,

Pavone³

et al. 2020

J Anesthesiol & Pain Therapy

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The authors conducted a systematic review and meta-analysis to determine if Core Decompression (CD) with Bone Marrow Stem Cells (BMSC) is more effective in treating Osteonecrosis of the Femoral Head (ONFH) compared to CD. Authors used Cochrane Library, EMBASE, PubMed, Web of Science, and hand-searched references through January 2020, identifying relevant randomized controlled trials (RCTs). Risk of bias was assessed with Cochrane's handbook. Fifty-four abstracts were screened, and eight RCTs (five at high and three at unclear risk of bias) with 432 patients were included. Meta-analyses found statistically significant improvement in Harris Hip Score (HHS) at 12 months (Difference in Means [DM]=10.065;95% Confidence Interval [CI]=4.509 to 15.622; p<0.001) and pain intensity at 24 months (DM=-7.364;95% CI=-12.113 to -2.615;p=0.002) in CD+BMSC group compared to CD alone although these results may not be clinically significant. Risk of Total Hip Replacement (THR) in patients receiving CD+BMSC was 33.4% lower than in CD group though not significant (RR=0.666; 95% CI=0.355 to 1.250;p=0.206). Though meta-analyses found the addition of BMSC to CD significantly improves clinical outcomes (HHS and pain intensity) compared to CD only, evidence was of moderate/low quality due to high risk of bias, imprecision, and small sample sizes. Further research is needed to confirm the results.

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The role of cell therapies and hip arthroscopy in the management of osteonecrosis: an update

Cited by 13 publications

References 59 publications

Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip

Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip

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

Core Decompression with Bone Marrow Stem Cells for Osteonecrosis of Femoral Head

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