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

Abstract

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

Influence of inflammatory conditions provided by macrophages on osteogenic ability of mesenchymal stem cells

“…The early step of bone formation involves the migration of mesenchymal stem cells (MSC), which undergo proliferation and differentiation along the osteoblastic lineage. Indeed, MSC implantation has emerged as a promising strategy for promoting bone regeneration in several clinical conditions, including delayed unions and non-unions, critical-sized bone defects, periprosthetic osteolysis, osteonecrosis, and inflammatory bone disorders [6][7][8][9][10]. The benefits of MSC therapy are mainly attributed to paracrine effects via soluble factors, exerting both immunoregulatory and regenerative actions [11].…”

Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability

“…Sugaya's team confirmed the efficacy of local BMSC transplantation in the treatment of femoral head necrosis through animal experiments; they showed that BMSCs in the necrotic area can survive, proliferate, differentiate into bone, and promote repair [19,20]. However, stem cell therapy for osteonecrosis has not shown sufficient repair outcomes in clinical application [7]. Wojciech Pepke compared the individual efficacy of bone marrow cell implantation and core decompression in the treatment of early-stage ONFH and found no significant difference between treatments in the postoperative change in necrotic area [11].…”

“…Femoral head necrosis is a disease involving the activity of local stem cells in the femoral head [6]. In ONFH patients, the number and viability of mesenchymal stem cells (MSCs) in the femoral head were found to be decreased [7]. Therefore, stem cell implantation is a potential treatment strategy.…”

Letter to editor concerning the article “muscle pedicle bone grafting using the anterior one-third of the gluteus medius attached to the greater trochanter for treatment of Association Research Circulation Osseous stage II osteonecrosis of the femoral head” (Cho KJ et al. International Orthopaedics. doi: 10.1007/s00264-018-3839-5)

“…In the last two decades, the total number of procedures performed for ONFH is doubled [2]. Sadly, the longterm results of hip preserving procedures are not favourable, so the surgical techniques have to evolve in order to achieve better results [3]. The authors reported mid-term follow-up of a series of muscle pedicle graft treatment for ONFH.…”

“…The technique is encouraging and I would like to congratulate authors for their study, theoretically, procedures that provide a blood supply for necrotic area could be more effective than conventional CD or even structural allografts. Conversion to total hip arthroplasty (THA) and any progress or changes in staging were considered as outcome measurement in this study which are used repeatedly in same studies [3][4][5]. The authors reported success rate of 87.5% because at final followup, only three out of 24 hips have been converted to THA; I do not agree with this result.…”