Combination use of core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis using Forest and Funnel Plots.

Linghanqing Wang,Keda Li,Xu Rong Tian ,Chunlei Liu

doi:10.1155/2021/1284149

Abstract

Objective This study evaluated the efficacy and safety of CD combined with bone marrow stem cells in the treatment of femoral head necrosis by systematic review and meta-analysis. Methodology. PubMed, The Cochrane Library, Embase, CNKI, Google Scholar and MEDLINE, etc. databases were searched for clinical randomized controlled trials (RCTs) comparing core decompression combined with autologous bone marrow mesenchymal stem cells versus core decompression alone in the treatment of femoral head necrosis. The retrieval period is from the establishment of each database to May 20, 2021. After literature was extracted and literature quality was evaluated, meta-analysis was conducted by using RevMan5.3 software. Results A total of 420 osteonecrosis of the femoral head 452 patients' data were collected from all studies. Compared with the core decompression alone group, the CD combined with bone marrow stem cell showed marked reduction in the Visual analog scale (VAS), enhanced Harris hip score (HHS) at 12 months and 24 months, slowed down the progression of the disease, decreased the number of hips conversed to total hip arthroplasty (THA) in the future. Conclusion Core decompression therapy is a very effective and safe treatment process used for ONFH. Moreover, CD combined autologous bone marrow stem cell transplantation can improve the survival rate of the necrotic head, reduce hip pain and delay the disease progression, the rate of THA postoperatively.

Highlights

The osteonecrosis of the femoral head (ONFH) is an obstruction or injury caused by the blood supply to the femoral head, resulting in bone tissue death
Core decompression can reduce the pressure in the femoral head medullary cavity, it can break the necrotic part, improve blood flow resistance and venous reflux, intensify the substitution of the fresh bone, avoids femoral necrosis aggravated hindering the process of bone necrosis [4, 5]
Keywords used for the search were "stromal cells", "bone marrow stromal stem cells," "Mesenchymal Stem Cells [Mesh], "core decompression", "ONFH", "osteonecrosis of the femoral head", "femur necrosis", "osteonecrosis", "bone marrow stem cells" etc

Summary

Introduction

The osteonecrosis of the femoral head (ONFH) is an obstruction or injury caused by the blood supply to the femoral head, resulting in bone tissue death. The restoration of osteocyte and bone marrow components leads to structural changes and disintegration of the femoral head, resulting in joint pain and disease which hard to heal for the patient [1,2,3]. Core depression (CD) is one of the most commonly used methods for treating early ONFH. A large number of studies revealed that core depression incorporated with cytotherapy is comparatively a superior treatment to turn down the rate of breakdown of early and mid-term osteonecrosis of the femoral head [6]

Methods

Results

Discussion

Conclusion