Abstract
Goal: This study evaluated 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 January 2006, 49 hips in 43 patients with early stage ONFH underwent autologous BMT were followed for at least 2 years. For clinical results, preoperative and postoperative Harris hip score (HSS) were evaluated and survival rate was obtained at the point of performing the total hip arthroplasty. Radiologic results were assessed by changes in necrosis size on MRI performed preoperatively and postoperatively. To evaluate prognostic factors, survival rate was analyzed according to age, gender, etiology, and duration of the symptom. Results: Postoperative average HHS was significantly increased and there were no significant changes in necrosis size on MRI. Eleven of the 79 hips were required the arthroplasty and the group with use of steroid and short duration of symptom less than 6 months showed lower survival rate. Conclusion: Autologous BMT for early ONFH can be one of the treatments to improve clinical feature and delay radiologic progress. However the steroid-induced ONFG and short duration of symptom seemed to be poor prognostic factors.
Highlights
Materials and MethodsFrom November 2003 to January 2006, 49 hips in 43 patients with early stage ONFH underwent autologous bone marrow transplantation (BMT) were followed for at least 2 years
ONFH is a disease that mainly occurs in younger patients, and it requires arthroplasty because it can cause pain and collapse in the femoral head after 73-92% of progress when untreated, even at early stages [7,9,21,24,27]
It is known that good results have been observed when core decompression or core decompression with bone graft are performed in early stages of the disease [1,8,15,26]
Summary
43 patients (49 cases) with early ONFH who underwent an autologous BMT from November 2003 to January 2006, in Ficat stages I, IIA, and IIB were selected. Autologous bone marrow transplantation is a treatment modality in the early stages that creates the regeneration of the femoral head It has a low morbidity rate on the donor site with the advantage that it is a relatively easy surgical procedure to perform. Gangji et al [3] showed that autologous bone marrow transplantation for early osteonecrosis of the femoral head can be an effective and safe treatment, reporting that it noticeably decreased pain and statistically significantly delayed the progress to stage III when compared to core decompression (10% vs 62.5%). The survival rate was 100%, 72.2%, and 80%, respectively, in observations over 29 months on average after operation at Ficat stages I, IIA, IIb, and it remains in doubt as to whether autologous bone marrow transplantation can be considered a treatment modality with superior results than core decompression and autologous iliac bone graft. It is necessary to conduct further studies with more population targets, since there was a limited population examined to produce this result
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