Abstract
Objective This study aims to systematically evaluate the efficacy and safety of core decompression combined transplantation of autologous bone marrow stem cells (CDBMSCs) for treatment of avascular necrosis of the femoral head (ANFH). Methods Randomized controlled trials (RCTs) regarding effectiveness of core decompression combined transplantation of autologous bone marrow stem cells for treating ANFH were searched in 8 comprehensive databases prior to September 2016. The data analysis was performed by using the RevMan version 5.3. Results A total of 11 studies with 507 participants were included. Results showed that CDBMSCs group was more effective than CD group in increasing Harris hip score, decreasing necrotic area of femoral head, collapse of femoral head, and conversion to total hip replacement incidence. In the subgroup analysis, the results did not change in different intervention measure substantially. In addition, the safety of CDBMSCs for ANFH is reliable. Conclusion Based on the systematic review, our findings suggest that core decompression combined transplantation of autologous bone marrow stem cells appeared to be more efficacious in the treatment at early stages of ANFH.
Highlights
Avascular necrosis of the femoral head (ANFH) is a progressive pathological process, usually caused by disruption of the blood supply to the femoral head and elevation of intraosseous pressure
After combining the data and analyzing them, the result showed that CDBMSCs were more effective than Core decompression (CD) alone in increasing Harris hip score (MD = 11.28, 95% confidence interval (CI) = 9.52 to 13.03, P < 0.00001)
As there was no homogeneity in the consistency of the trial results (P = 0.78, I2 = 0%), a fixed effects model was applied, while in the CDBMSCs plus ABG versus CD plus ABG subgroup, the result showed that experiment group almost reached borderline levels of statistical significance compared to the control group (OR = 0.27, 95% CI = 0.07 to 1.09, P = 0.07)
Summary
This study aims to systematically evaluate the efficacy and safety of core decompression combined transplantation of autologous bone marrow stem cells (CDBMSCs) for treatment of avascular necrosis of the femoral head (ANFH). Randomized controlled trials (RCTs) regarding effectiveness of core decompression combined transplantation of autologous bone marrow stem cells for treating ANFH were searched in 8 comprehensive databases prior to September 2016. Results showed that CDBMSCs group was more effective than CD group in increasing Harris hip score, decreasing necrotic area of femoral head, collapse of femoral head, and conversion to total hip replacement incidence. Based on the systematic review, our findings suggest that core decompression combined transplantation of autologous bone marrow stem cells appeared to be more efficacious in the treatment at early stages of ANFH
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