Abstract
BackgroundTo date, several trials have reported the use of mesenchymal stem cell (MSC) implantation for osteonecrosis of the femoral head (ONFH). However, the clinical outcomes have not been conclusive. This study compared the clinical and radiological results of bone marrow mesenchymal stem cell (BMMSC) implantation with traditional simple core decompression (CD) using a matched pair case–control design.MethodsWe retrospectively reviewed 100 patients with ONFH (106 hips) who had been treated by CD alone (50 patients, 53 hips) and CD + BMMSC implantation (50 patients, 53 hips) between February 2004 and October 2014. We assessed the total hip replacement arthroplasty (THA) conversion rate and ARCO (Association Research Circulation Osseous) stage progression. Survivor rate analysis was performed using the Kaplan–Meier method, and an additional THA was defined as the primary endpoints.ResultsThe mean follow-up period was 4.28 years. There was a difference in the THA conversion rate between the CD (49%) and CD + BMMSC groups (28.3%) (p = 0.028). ARCO stage progression was noted in 20 of 53 hips (37.7%) in the CD group and 19 of 53 hips (35.8%) in the CD + BMMSC group. Among collapsed cases (ARCO stages III and IV), there was no difference in clinical failure rate between the two groups. Conversely, in the pre-collapse cases (ARCO stages I and II), only 6 of 30 hips (20%) progressed to clinical failure in the CD + BMMSC group, whereas 15 of 30 hips (50%) progressed to clinical failure in the CD group (p = 0.014). Kaplan–Meier survival analysis showed a significant difference in the time to failure between the two groups up to 10-year follow-up (log-rank test p = 0.031). There was no significant difference in terms of age (p = 0.87) and gender (p = 0.51) when comparing THA conversion rates between groups. No complication was noted.ConclusionsThese results suggest that implantation of MSCs into the femoral head at an early stage of ONFH lowers the THA conversion rate. However, ARCO stage progression is not affected by this treatment.Trial registrationRetrospectively registered
Highlights
To date, several trials have reported the use of mesenchymal stem cell (MSC) implantation for osteonecrosis of the femoral head (ONFH)
Osteonecrosis of the femoral head (ONFH) progresses to osteoarthritis which can only be treated by a total hip replacement arthroplasty (THA)
The present study investigated the outcome of the two treatments, taking into consideration various factors which may affect the progression of avascular necrosis (AVN), such as age, gender, etiology, body mass index (BMI), and initial stage of ONFH
Summary
Several trials have reported the use of mesenchymal stem cell (MSC) implantation for osteonecrosis of the femoral head (ONFH). The rates of osteoblast and bone cell apoptosis were found to be increased in the necrotic region [4, 5] This finding showed that transplanting fresh mesenchymal stem cells into the necrotic lesion may be a useful treatment option. Hernigou et al [6] introduced intra osseous injection of a high concentration of bone marrow stem cells, and the clinical outcome was better than that of CD treatment previously performed alone. After this trial, transplanting autologous bone marrow mesenchymal stem cells (BMMSC) into the core decompression pathway has become effective treatment for ONFH [7,8,9]. The present study investigated the outcome of the two treatments, taking into consideration various factors which may affect the progression of avascular necrosis (AVN), such as age, gender, etiology, body mass index (BMI), and initial stage of ONFH
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