Abstract
BackgroundIdiopathic osteonecrosis of the femoral head (ONFH) occurs at a relatively younger age. It is therefore important to prevent the resultant femoral head collapse and requirement of total hip arthroplasty in these patients. In 2003, we initiated concentrated autologous bone marrow aspirate transplantation (CABMAT), a joint-preserving treatment for ONFH, at our institution. Here, we report the long-term results of CABMAT treatment.MethodsWe retrospectively collated and analyzed the demographic and treatment data of 69 patients (109 hips) with idiopathic ONFH treated with CABMAT between April 2003 and April 2008.ResultsTotally, 44 patients (21 men, 23 women, 80 hips) completed the 10-year follow-up. The follow-up rate was 73.4%, and the mean follow-up period was 12.0 (range, 10.0–15.4) years. The mean age of the patients was 42.2 (range, 16.3–70.5) years. Using the Association Research Circulation Osseous (ARCO) classification system for preoperative analysis, 12, 31, 32, and 5 hips were classified as stages 1, 2, 3, and 4, respectively. The overall rate of conversion to total hip arthroplasty (THA) was 34% (27/80 hips). In a multivariate regression analysis, the preoperative stage of ONFH and the body mass index were found to correlate significantly with conversion to THA. Totally, 43 hips (of 80) were classified as belonging to the pre-collapse stage (i.e., stages 1 or 2). The overall collapse rate and the THA-conversion rate of these hips were estimated to be 49% (21/43) and 14% (6/43), respectively.ConclusionsOn the basis of our long-term findings, the minimally invasive and feasible CABMAT therapy can be utilized as one of a joint-preserving treatment for ONFH.
Highlights
Idiopathic osteonecrosis of the femoral head (ONFH) occurs at a relatively younger age
Idiopathic osteonecrosis of the femoral head (ONFH) is a refractory hip disorder, which leads to femoral head collapse and hip osteoarthritis
The preoperative stage of osteonecrosis and the patient’s body mass index (BMI) were found to be significantly correlated with conversion to total hip arthroplasty (THA) in the multivariable statistical analysis
Summary
Idiopathic osteonecrosis of the femoral head (ONFH) occurs at a relatively younger age. In 2003, we initiated concentrated autologous bone marrow aspirate transplantation (CABMAT), a joint-preserving treatment for ONFH, at our institution. Several previous studies have reported the efficacy of bone marrow transplantation in ONFH [5,6,7]. We initiated concentrated autologous bone marrow aspirate transplantation (CABMAT) for the treatment of ONFH in 2003 [8]. As a part of the transplant procedure, bone marrow is aspirated from the iliac crest of the affected patient and centrifuged twice to separate the buffy coat. In 2017, we reported the results of CABMAT after a mean follow-up period of 5 years in patients with asymptomatic ONFH [10, 11]. This study aimed to report the results of management of ONFH with CABMAT for > 10 years
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