Abstract
BackgroundAvascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Eventually, the disease progresses and results in FH collapse. Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key. The use of stem cells (SC) for the treatment of AVN of the FH has been proposed. We undertook a systematic review of the medical literature examining the use of SC for the treatment of early stage (precollapse) AVN of the FH, in both pre-clinical and clinical studies.MethodsData collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, SC dosage and treatment protocol, incidence of disease progression, patient reported outcomes, volume of necrotic lesion and hip survivorship.ResultsIn pre-clinical studies, the use of SC uniformly demonstrated improvements in osteogenesis and angiogenesis, yet source of implanted SC was variable. In clinical studies, groups treated with SC showed significant improvements in patient reported outcomes; however hip survivorship was not affected. Discrepancies regarding dose of SC, AVN etiology and disease severity were present.ConclusionsRoutine use of this treatment method will first require further research into dose and quality optimization as well as confirmed improvements in hip survivorship.
Highlights
Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations
Eighteen studies were excluded: 3 were review articles [18,19,20], one was a surgical technique article [21], 3 articles were early/pilot results which were subsequently included in future articles [7,16,22], 6 articles examined stem cells (SC) treatment in conjunction with therapies other than Core decompression (CD) [23,24,25,26,27,28], two articles used SC transplanted intravenously instead of by CD [13,29], 1 article examined prevention of AVN not treatment [5], and two articles included patients with post collapse AVN of the FH [1,15] (Figure 1)
This review systematically examined the current literature on SC therapy for the treatment of early stage AVN of the FH including clinical and preclinical studies
Summary
Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Avascular necrosis (AVN) of the femoral head (FH) is a debilitating and painful disease with multiple etiologic risk factors [1,2,3,4]. These include, but are not limited to, corticosteroid use [1,3,4,5,6], alcohol abuse [1,2,3,4], previous trauma [1,3], hemoglobinopathy [7], Gaucher’s disease and coagulopathies [8].
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