Abstract
Background The treatment results of core decompression (CD) and biomechanical support are not always satisfactory in osteonecrosis of the femoral head (ONFH). Stem cell therapy has been incorporated into traditional treatment in order to promote bone regeneration. The efficacy and safety of stem cell therapy combined with CD or biomechanical support on advanced and long-term patients with ONFH were unknown. The aim of this study was to assess whether stem cell combination therapy is superior to single CD or porous tantalum rod implantation treatment in ONFH. Methods A systematic search of the literature was performed to evaluate all included randomized controlled trials (RCTs) on stem cell combination therapy for patients with ONFH in PubMed, Cochrane Library, Web of Science, and Embase sites. We assessed the quality and risk of bias for the included studies. And the outcomes of Harris hip score (HHS), visual analogue scale (VAS), and adverse events were statistically analyzed. Results We included 10 randomized controlled trials, containing a total of 498 patients with 719 hips. Stem cell therapy combined with CD versus CD alone for HHS of ONFH was different (MD = 8.87, 95% CI = [5.53, 12.22], P < 0.00001). The combination of stem cell therapy and CD can effectively improve HHS. Similarly, the VAS of the stem cell combination therapy group also differed compared with the control group (MD = −14.07, 95% CI = [−18.32, −9.82], P < 0.00001). The result showed that stem cell combination therapy can relieve the pain of patients with ONFH. There was no significant difference in adverse response outcome events between the combination therapy group and the control group (RR = 1.57, 95% CI = [0.62, 3.97], P = 0.34). Conclusions Stem cell therapy combined with core decompression is an effective and feasible method with few complications in the clinical treatment of early-stage ONFH. Even in the combination of porous tantalum rod implantation and peripheral blood stem cells, stem cell combination therapy is superior to single biomechanical support treatment. But high-quality, large-sample, multicenter, and long-term follow-up RCTs are still needed to corroborate the efficacy and safety of stem cell combination therapy in ONFH treatment.
Highlights
Osteonecrosis of the femoral head (ONFH) is a prevalent disease in relatively young patients, usually caused by hip trauma, alcoholism and long-term administration of steroid, which may lead to significant hip pain, articular surface collapse, and eventual osteoarthritis [1]
To investigate the efficacy and safety of stem cell therapy combined with core decompression (CD) or porous tantalum rod implantation in ONFH patients, especially those with advanced stage and long-term follow-up [7], our research systematically retrieved the latest randomized controlled trials on stem cell combination therapy for ONFH according to the PRISMA guidelines [8]
Our findings demonstrate that in earlystage ONFH, stem cell therapy combined with core decompression is far more effective than core decompression alone
Summary
Osteonecrosis of the femoral head (ONFH) is a prevalent disease in relatively young patients, usually caused by hip trauma, alcoholism and long-term administration of steroid, which may lead to significant hip pain, articular surface collapse, and eventual osteoarthritis [1]. Erefore, in order to promote bone regeneration, stem cell therapy has been incorporated into traditional CD treatment. When compared with treating ONFH with CD alone, the combined application of stem cell therapy and CD, in early treatment, has superior analgesic and clinical effects, and can more effectively delay the Journal of Healthcare Engineering progress of femoral head collapse [4]. The efficacy and safety of these methods have been controversial and have yet to be proven in patients with advanced and longterm ONFH [5, 6]. To investigate the efficacy and safety of stem cell therapy combined with CD or porous tantalum rod implantation in ONFH patients, especially those with advanced stage and long-term follow-up [7], our research systematically retrieved the latest randomized controlled trials on stem cell combination therapy for ONFH according to the PRISMA guidelines [8]. The positive role and improvement of the new technologies in treatment were discussed, with a view of providing clinicians with scientific evidence for the treatment of ONFH patients
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