Il trattamento della necrosi avascolare della testa femorale con core decompression e utilizzo di cellule stami-nali e fattori di crescita: l’esperienza della Clinica Ortopedica

Abstract

Avascular necrosis of femoral head is a disorder that can lead to femoral head collapse and total hip replacement in young patients. One of the reasons for insufficient creeping substitution after the development of the necrotic lesion may be the small number of progenitor cells in the proximal femur and in the trochanteric region, thus the possibility has been raised that treatment modalities should stimulate and guide bone remodelling to preserve the integrity of the femoral head. For this reason, we studied the implantation of concentrated autologous mesenchymal stem cells and platelets growth factors in the necrotic lesion to determine the effect on clinical symptoms, stage and volume of osteonecrosis. Between 2005 and 2010 we studied 12 patients (14 hips) with avascular necrosis at early stages (one hip stage I, ten stage II, three stage III) according to Arlet and Ficat system. All patients were treated with core decompres-sion and autologous bone marrow grafting obtained from the iliac crest of patients. The aspirated marrow was reduced in volume by centrifugation from 30-60 ml to 6-7 ml in order to preserve only mesenchymal stem cells. A concentrate of platelet rich of growth factors obtained by the same technique was added to the graft. The mean age of patients at the time of surgery was 40 years (range: 20-54 years). The outcomes studied were clinical symptoms and disease progression. The mean follow-up was 2.6 years (range: 1-5 years). Total hip replacement was necessary in 2 hips (evolution to collapse) among the 14 hips operated, both in stage III at the time of surgery. Nine hips with stage I-II osteo-necrosis of femoral head at the time of surgery demonstrated complete resolution of clinical symptoms and no desease progression based on preoperative and post operative MRI studies. The remaining three hips (two pa-tients) with stage II-III demonstrated improvement in clinical symptoms in comparison to the time before sur-gery but these patients still referred functional limitation and pain. According to our experience, concentrated autologous mesenchymal stem cells and platlet growth factors im-plantation after core decompression relieves hip pain and functional limitation and prevents the progression of osteonecrosis in selected patients. Therefore, it is likely to be first choice treatment in stages I-II of osteonecrosis of the femoral head.