Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells

The role of “cell therapy” in osteonecrosis of the femoral head

“…3 of the studies were randomized control trials (RCTs) (Sen et al 2012, Zhao et al 2012, Ma et al 2014), 1 was a prospective control study (Gangji et al 2011), and the remaining 3 were retrospective case-control studies (Yamasaki et al 2010, Lim et al 2013, Liu et al 2013). …”

“…6 studies (with 421 participants) provided relevant data (Yamasaki et al 2010, Gangji et al 2011, Zhao et al 2012, Lim et al 2013, Liu et al 2013, Ma et al 2014). The pooled estimate of effect size for structural failure of the FH favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were shown to be decreased by 5 times compared to the control (CD) group (OR = 0.2, 95% CI: 0.08–0.6; p = 0.02).…”

“…Relevant data were obtained from 5 studies (with 252 participants) (Yamasaki et al 2010, Gangji et al 2011, Zhao et al 2012, Liu et al 2013, Ma et al 2014). The pooled estimate of effect size for structural failure of FH indicated an 8-fold decrease in the odds of collapse of the FH in the cell therapy group compared to the CD group (OR = 0.12, 95% CI: 0.06–0.26; p < 0.001) in the absence of statistical heterogeneity (Q-test = 1.81, df = 4, p = 0.77, and I 2 = 0%) (Figure 6A, see Supplementary data).…”

“…4 studies (with 208 participants) provided relevant data (Yamasaki et al 2010, Gangji et al 2011, Zhao et al 2012, Liu et al 2013). The overall estimate of effect size for conversion to THR favored the cell therapy group, although it reached only borderline significance levels (OR = 0.30, 95% CI: 0.08–1.06; p = 0.06) in the presence of a moderate degree of statistical heterogeneity (Q-test = 4.39, df = 3, p = 0.22, and I 2 = 32%), (Figure 6B, see Supplementary data).…”

“…In 2 of them, CD and cell therapy were combined with autologous bone graft (Lim et al 2013, Ma et al 2014), while in 2 other studies they had been combined with hydroxyapatite (HA) fillers (Yamasaki et al 2010, Liu et al 2013). After exclusion of the above studies, we created another subgroup consisting of reports comparing CD alone with CD plus application of autologous bone marrow concentrate (cell therapy) (Gangji et al 2011, Sen et al 2012, Zhao et al 2012). Only 2 studies provided relevant data for the primary outcome measures (Gangji et al 2011, Zhao et al 2012) (Figure 7, see Supplementary data).…”