Early Stage Of Osteonecrosis Of The Femoral Head Research Articles

Could BMMNCs therapy reduce the mid- and long-term rate of total hip arthroplasty of femoral head necrosis?: A systematic review and meta-analysis.

Osteonecrosis of the femoral head (ONFH) is a cause of hip pain and early joint lesion in patient. The hip-preserving treatments are especially important for patients in early stage of ONFH. However, it is controversial of the effectiveness and safety of bone marrow mononuclear cells (BMMNCs) in the treatment of ONFH. The aim of the study was to explore the mid- and long-term efficacy (particularly the rate of total hip arthroplasty [THA]) with BMMNCs in treatment of ONFH. PubMed, Web of Science, Embase, OVID, Cochrane Libriary, CNKI, and Google Scholar databases were searched for relevant randomized controlled trials or non-randomized controlled trials from inception to October 15, 2022. Methodological quality of the trials was assessed, relevant data were extracted, and RevMan 5.3 and Stata 15.0 software were used to perform the meta-analysis of parameters related to the consequences. A total of 22 articles were included, including 1923 patients. Meta-analysis results showed that the treatment of BMMNCs has a significantly lower incidence of THA (odds ratio [OR] = 0.33; 95% confidence interval [CI] = 0.27-0.41, P < .00001), radiographic progression rate (OR = 0.37; 95% CI = 0.21-0.63, P = .0003) and visual analog score at 24 months (mean difference [MD] = -11.84; 95% CI = -14.86 to -8.82, P < .00001), and has higher Harris hip score (MD = 6.90; 95% CI = 4.56-9.24, P < .00001), improvement of visual analog score at 24 months (MD = 6.87; 95% CI = 1.84-11.89, P = .007) and Merle D'Aubigne and Postel hip score (MD = 0.79; 95% CI = 0.14-1.44, P = .02). But there was no significant difference in the Western Ontario and McMaster University Osteoarthritis index (MD = -6.32; 95% CI = -16.76 to 4.12, P = .24) and incidence of complication (OR = 0.86; 95% CI = 0.52-1.42, P = .56). Current evidence supports that BMMNCs therapy could reduce the mid- and long-term rate of THA, improve hip function, alleviated the degree of hip pain, delay the progression of imaging staging and not increase the rate of complication, which maybe serve as a preferred option for treating ONFH.

Therapeutic effect of human umbilical cord mesenchymal stem cells in early traumatic osteonecrosis of the femoral head.

BackgroundOsteonecrosis of the femoral head (ONFH) is a refractory disease due to its unclear pathomechanism. Therapies during the early stage of ONFH have not achieved satisfactory results. Therefore, this study aims to explore the available evidence for the therapeutic effect of human umbilical cord mesenchymal stem cells (HUCMSCs) on early-stage traumatic ONFH.MethodsEarly-stage traumatic ONFH was established. The femoral heads of rats were then locally administered HUCMSCs. Four weeks and eight weeks after surgery, bone repair of the necrotic area in the femoral head was analyzed to evaluate the therapeutic effect of HUCMSCs using micro-CT, histopathological staining, immunofluorescence staining, Luminex.ResultsHUCMSCs were still present in the femoral head four weeks later, and the morphological, micro-CT and histopathological outcomes in the 4-week HUCMSC-treated group were better than those in the model, NS and 8-week HUCMSC-treated groups. Local transplantation of HUCMSCs promoted bone repair and prevented bone loss in the necrotic area of the femoral head.ConclusionsHUCMSCs can survive and positively affect the femoral head through local transplantation in early-stage traumatic ONFH. The conclusions of this study can provide a treatment option for patients who have ONFH and can serve as basic research on the advanced development of this disease.The Translational potential of this articleThe study indicated that the positive effect of exogenous HUCMSCs in the treatment of early-stage traumatic ONFH provides the solid basis and guidance for the clinical application of HUCMSCs.

Modified technique of advanced core decompression for treatment of femoral head osteonecrosis.

Osteonecrosis of the femoral head (ONFH) is a destructive condition most commonly affecting young and middle-aged patients. The leading consequence of ONFH is often a significant articular disability. Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease. To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique, which is a new way of joint-preserving surgical treatments. The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed; the follow-up ended in December 2019. There were 6 male patients with an average age of 43 years in our study. Gratifying results have been obtained from the comparison of Harris hip score, visual analogue scale, and imaging examination before and after operation. This new modified technique is simple, safe, and reliable. No serious perioperative complications were observed in our cases. Advantages of the single blade expandable reamer are obvious. The adjuvant substance is inexpensive and easy to obtain. Thus, this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.

Clinical efficiency of bone marrow mesenchymal stem cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression

BackgroundTo date, several trials have reported the use of mesenchymal stem cell (MSC) implantation for osteonecrosis of the femoral head (ONFH). However, the clinical outcomes have not been conclusive. This study compared the clinical and radiological results of bone marrow mesenchymal stem cell (BMMSC) implantation with traditional simple core decompression (CD) using a matched pair case–control design.MethodsWe retrospectively reviewed 100 patients with ONFH (106 hips) who had been treated by CD alone (50 patients, 53 hips) and CD + BMMSC implantation (50 patients, 53 hips) between February 2004 and October 2014. We assessed the total hip replacement arthroplasty (THA) conversion rate and ARCO (Association Research Circulation Osseous) stage progression. Survivor rate analysis was performed using the Kaplan–Meier method, and an additional THA was defined as the primary endpoints.ResultsThe mean follow-up period was 4.28 years. There was a difference in the THA conversion rate between the CD (49%) and CD + BMMSC groups (28.3%) (p = 0.028). ARCO stage progression was noted in 20 of 53 hips (37.7%) in the CD group and 19 of 53 hips (35.8%) in the CD + BMMSC group. Among collapsed cases (ARCO stages III and IV), there was no difference in clinical failure rate between the two groups. Conversely, in the pre-collapse cases (ARCO stages I and II), only 6 of 30 hips (20%) progressed to clinical failure in the CD + BMMSC group, whereas 15 of 30 hips (50%) progressed to clinical failure in the CD group (p = 0.014). Kaplan–Meier survival analysis showed a significant difference in the time to failure between the two groups up to 10-year follow-up (log-rank test p = 0.031). There was no significant difference in terms of age (p = 0.87) and gender (p = 0.51) when comparing THA conversion rates between groups. No complication was noted.ConclusionsThese results suggest that implantation of MSCs into the femoral head at an early stage of ONFH lowers the THA conversion rate. However, ARCO stage progression is not affected by this treatment.Trial registrationRetrospectively registered

Investigating clinical failure of core decompression with autologous bone marrow mononuclear cells grafting for the treatment of non-traumatic osteonecrosis of the femoral head.

This study aimed to analyze the clinical factors related to the failure of autologous bone marrow mononuclear cells grafting (BMMCG) following core decompression (CD) in early stage osteonecrosis of the femoral head (ONFH). In total, 148 patients (192 hips) underwent CD with autologous BMMCG for treatment of non-traumatic ONFH. The patients were classified by their ARCO staging and China-Japan Friendship Hospital (CJFH) typing system. All patients were clinically and radiographically followed up every threemonths during the first year and every six months in the following years. The clinical evaluation was conducted by pre- and post-operative Harris hip scores (HHS), while serial anteroposterior (AP) and frog lateral radiographs were used for post-operative radiographic evaluation. There were 56 hips as clinical failure cases, and 50 hips (89.29%) of failure cases developed between three and tenmonths after operation. Based on CJFH classification system, type L2 showed more failure rate with 60.0% (9 of15). The Cox risk model showed that disease type was an independent risk factor for post-operative clinical failure (P = 0.042). Multivariate analysis of the Cox proportional-hazards model showed that type L1 had a hazard ratio (HR) of 0.286 (95% CI 0.100-0.816), type L3 with HR of 0.245 (95% CI 0.079-0.759), respectively. Disease type is an important risk factor for autologous BMMCG combined with CD, and the degree of lateral pillar necrosis is a significant reference index for prognosis evaluation in early stage of ONFH.

Establishing rabbit model of osteonecrosis of the femoral head by intraosseous liquid nitrogen freezing method

Objective To establish the rabbit model of osteonecrosis of the femoral head (ONFH) by intraosseous liquid nitrogen freezing method. Methods One side femoral head of eighteen New Zealand rabbits was randomly selected for establishing the rabbit models of ONFH by intraosseous liquid nitrogen freezing method, and the another side as normal controls. After 2, 4, and 8 weeks after operation, gross, radiological and histopathological observations were observed. Results The normal side of the femoral head had no abnormal changes, and the number of empty bone lacunae accounted for (11.02±1.56)%. On the experimental side, X-ray showed that the femoral head density increased at the 2nd week. At 4th week, the cystic changes were seen and bone density increased. At 8th week, the bone density of the femoral head was uneven, and mild collapse of weight bearing area was found in 2 femoral heads. Histopathologically, at 2nd week, hematopoietic tissue decreased, bone trabecular necrosis and bone marrow focal necrosis, and empty bone lacunae increased significantly [(73.33±7.21)%] in the femoral heads. At 4th week, trabecular bone thinning and derangement were found, empty bone lacunae increased significantly [(81.52±7.35)%], and fibrous tissues were seen in the femoral heads. At 8th week, the necrotic area in the femoral head was significantly increased, trabecular bone became thinner, sparse and broken, and a large number of empty lacunae [(88.13±8.12)%] were seen. There were some hyperplastic connective tissue in the necrotic area, and repaired reaction in the peripheral of the necrotic area. There was no damage and stripping of the cartilage surface of the femoral head. On the experimental side, osteonecrosis appeared in the femoral heads. At 2nd, 4th, and 8th week, the lacunae count was significantly greater on the experimental side than that of the normal side (t2nd week=12.168, P2nd week=0.007; t4th week=13.048, P4th week=0.006; t8th week=13.048, P8th week=0.006). Conclusion Establishing the rabbit models of ONFH with intraosseous liquid nitrogen freezing method is simple and easy, which can simulate clinical early stage of ONFH and suitable for the standardizational treatment study. Key words: Liquid nitrogen freezing; Osteonecrosis of the femoral head; Models, animal; Rabbit

Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults.

The treatment of adult osteonecrosis of the femoral head (ONFH), with 8.12 million patients in China, remains a challenge to surgeons. To standardize and improve the efficacy of the treatment of ONFH, Chinese specialists updated the experts' suggestions in March 2015, and an experts' consensus was given to provide a current basis for the diagnosis, treatment and evaluation of ONFH. The current guideline provides recommendations for ONFH with respect to epidemiology, etiology, diagnostic criteria, differential diagnosis, staging, treatment, as well as rehabilitation. Risk factors of non-traumatic ONFH include corticosteroid use, alcohol abuse, dysbarism, sickle cell disease and autoimmune disease and others, but the etiology remains unclear. The Association Research Circulation Osseous (ARCO) staging system, including plain radiograph, magnetic resonance imaging, radionuclide examination, and histological findings, is frequently used in staging ONFH. A staging and classification system was proposed by Chinese scholars in recent years. The major differential diagnoses include mid-late term osteoarthritis, transient osteoporosis, and subchondral insufficiency fracture. Management alternatives for ONFH consist of non-operative treatment and operative treatment. Core decompression is currently the most common procedure used in the early stages of ONFH. Vascularized bone grafting is the recommended treatment for ARCO early stage III ONFH. This guideline gives a brief account of principles for selection of treatment for ONFH, and stage, classification, volume of necrosis, joint function, age of the patient, patient occupation, and other factors should be taken into consideration.

The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head

It has been suggested that transient osteoporosis or the bone marrow oedema syndrome (BMOS) may be the initial phase of osteonecrosis of the femoral head (ONFH) and that there may be a common pathophysiology. In this study, we have assessed the MR images of 200 consecutive patients with ONFH in respect of the BMO pattern in order to test this hypothesis. This pattern was not observed in the early stage of ONFH. The initial abnormal finding detected on the MR images was an abnormal band of intensity at the junction between the necrotic area and the normal bone. Structural damage of the head seems to result in the appearance of the BMO pattern and the development of pain in ONFH. There was no finding to support the existence of a continuum between BMOS and ONFH.