Abstract
ObjectivesAutologous peripheral blood stem cell (auto-PBSC) transplantation is an effective therapeutic for the osteonecrosis of the femoral head (ONFH) but without prognosis estimation. This study mainly aimed to (1) determine whether auto-PBSC transplantation is a promising option, (2) assess the risk of hip-preservation failure, (3) achieve a predictive model of femoral head survival after the intervention, and (4) eventually identify clinical indications for auto-PBSC transplantation in future.MethodsAfter reviewing the in-patient database of the First Affiliated Hospital of Zhejiang Chinese Medicine University from June 2012 to June 2014, 37 eligible patients with Association Research Circulation Osseous stage I or II ONFH who were receiving intra-arterial infusion of auto-PBSCs were recruited. A case form was designed to retrieve relevant data. Hip-preservation failure was defined as the endpoint. All participants were stratified by the categorical risk of collapse, which was statistically tested through log-rank analysis. All significant factors were evaluated using Cox proportional hazards regression model, and a predictive nomogram plot was generated.ResultsIn total, 47 hips were followed up for 53.96 ± 21.09 months; the median survival time was 60.18 months. Among the predictors, body mass index (BMI; P = 0.0015) and Harris hip score (HHS; P < 0.0001) independently affected femoral head survival. Patients with BMI ≥ 24 kg/m2 exhibited a 2.58 times higher risk of hip-preservation failure [95% confidence interval (CI), 1.32–5.45] than those with BMI < 24 kg/m2, whereas those with HHS ≥ 70 exhibited a 0.19 times lower risk (95% CI, 0.09–0.38) than those with HHS < 70. Hazard ratios associated with age (P = 0.042), BMI (P = 0.012), HHS (P = 0.022), and necrotic volume (P = 0.000) were 1.038 (95% CI, 1.001–1.075), 1.379 (95% CI, 1.072–1.773), 0.961 (95% CI, 0.928–0.994), and 1.258 (95% CI, 1.120–1.412), respectively. A nomogram plot (score test P = 0.000; C-index = 0.8863) was available for the orthopedic doctor to predict hip survival probability.ConclusionsThe results suggest that intra-arterial infusion of auto-PBSCs prolongs femoral head survival. Age, BMI, HHS, and necrotic volume can influence the efficacy of this intervention.This study was approved by ethics committee of the trial center, number 2019-KL-075-01.
Highlights
Osteonecrosis of the femoral head (ONFH) is a debilitating disease that progresses due to an inadequate blood supply and elevated intraosseous pressure, subsequently leading to bone marrow and osteocyte death [1]
Not yet universally accepted, percutaneous bone marrow-derived mesenchymal stromal stem cell (MSC) injection has emerged as an efficient strategy and has a widespread use before collapse; it simultaneously promotes osteogenesis and angiogenesis [5]
A review of the current literature shows that autologous peripheral blood stem cells likewise contain CD34+ cells (CD34 is an antigen expressed on stem and progenitor cells) [6], which have been proved to a feasible therapy as MSCs [7]
Summary
Osteonecrosis of the femoral head (ONFH) is a debilitating disease that progresses due to an inadequate blood supply and elevated intraosseous pressure, subsequently leading to bone marrow and osteocyte death [1]. Once the collapse of the femoral head occurs, secondary degeneration of the hip ensues. Due to the complications of THA and the limitation of prosthesis durability, optimizing efficient hippreservation therapy in the early stage is crucial [4]. Not yet universally accepted, percutaneous bone marrow-derived mesenchymal stromal stem cell (MSC) injection has emerged as an efficient strategy and has a widespread use before collapse; it simultaneously promotes osteogenesis and angiogenesis [5]. AutoPBSCs are easy to collect and safe to use with less complications and lead to an early patient discharge. The use of auto-PBSCs remains controversial with regard to the cost of auto-PBSC protocol and characterization of stem cells [8]
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