Core decompression and biotechnologies in the treatment of avascular necrosis of the femoral head

Abstract

Avascular necrosis (AVN) of the femoral head (FH) causes 5% to 12% of total hip arthroplasties (THA). It especially affects active male adults between the third and fifth decades of life. The exact worldwide incidence is unknown. There are only few data related to each country, but most of it relates to the United States.Non-surgical management has a very limited role in the treatment of AVN of the FH and only in its earliest stages. Core decompression (CD) of the hip is the most common procedure used to treat the early stages of AVN of the FH. Recently, surgeons have considered combining CD with autologous bone-marrow cells, demineralised bone matrix or bone morphogenetic proteins or methods of angiogenic potential to enhance bone repair in the FH.Manuscripts were deemed eligible for our review if they evaluated treatment of early stage AVN of the FH with biotechnology implanted via CD. After application of eligibility criteria, we selected 19 reports for final analysis.The principal results showed that only by correctly mastering the therapeutic principles and adopting proper methods specifically oriented to different stages can the best therapeutic effect be achieved. Combining CD with biotechnology could result in a novel long-lasting hip- preserving treatment option.Furthermore, more refined clinical studies are needed to establish the effectiveness of biotechnology treatments in AVN of the FH.Cite this article: EFORT Open Rev 2017;2:41-50. DOI: 10.1302/2058-5241.2.150006

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

“…This decreased activity may affect local tissue and vascular regeneration, oxygen supply, and osteogenic function, eventually leading to ONFH [25]. Moreover, decreased stem cell activity can hinder the repair of necrotic areas, thus forming a vicious cycle [26]. Therefore, it is necessary to improve the growth and differentiation capacities of stem cells in the necrotic area of the femoral head [27,28].…”

Clinical and Radiographic Alterations in Bilateral Avascular Necrosis of the Femoral Head Following Laser Acupuncture: A Case Report

“…This case of FHAVN improved significantly after a prolonged course of laser acupuncture. However, in some orthopedic sources, noninvasive treatments like inhalation of hyperbaric oxygen, mesenchymal stromal cell therapy, gene therapy carrying growth factor, and vascular endothelial growth factor 20,21 have been mentioned, but to the best of our knowledge, it is the first report using low-level laser therapy as a treatment for AVN of the femoral head. It seems that this study has been able to show the effect of LLLT on AVN treatment, for the first time.…”

CORR Insights®: Free Vascularized Fibular Grafting Improves Vascularity Compared With Core Decompression in Femoral Head Osteonecrosis: A Randomized Clinical Trial

“…Recently, surgeons have considered combining core decompression with cultured or concentrated bone mesenchymal stem cells [15,22]-peripheral blood stem cells mobilized by granulocyte-colony stimulating factor [11] or bone morphogenetic proteins [8,9]-to enhance bone repair in AVN. But the clinical success in those studies was inconsistent (from 47% to 83%) [1]. Still, the use of autologous cell therapy in combination with core decompression appears to be superior to core decompression treatment alone [12].…”