Core decompression and implantation of bone marrow mononuclear cells with porous hydroxylapatite composite filler for the treatment of osteonecrosis of the femoral head

Liu, Yaosheng; Liu, Shubin; Su, Xiuyun

doi:10.1007/s00402-012-1623-3

Cited by 73 publications

(102 citation statements)

References 14 publications

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“…Liu et al (2013) found an improvement in both HHS and visual analog scale (VAS) in the cell therapy group compared to the controls at the end of follow-up (p < 0.0001 for both comparisons).…”

Section: Resultsmentioning

confidence: 95%

“…3 of the studies were randomized control trials (RCTs) (Sen et al 2012, Zhao et al 2012, Ma et al 2014), 1 was a prospective control study (Gangji et al 2011), and the remaining 3 were retrospective case-control studies (Yamasaki et al 2010, Lim et al 2013, Liu et al 2013). …”

Section: Resultsmentioning

confidence: 99%

“…However, almost half of the studies included were retrospective in nature (Yamasaki et al 2010, Lim et al 2013, Liu et al 2013) and most of them possibly suffered from selection bias (due to lack of random generation and concealment of the allocation sequence), performance bias and detection bias (due to poor blinding of participants, personnel, or outcome assessors), and attrition bias (i.e. in most studies, follow-up losses were not taken into account in an intention-to-treat analysis) (Figure 2, see Supplementary data).…”

Section: Resultsmentioning

confidence: 99%

“…6 studies (with 421 participants) provided relevant data (Yamasaki et al 2010, Gangji et al 2011, Zhao et al 2012, Lim et al 2013, Liu et al 2013, Ma et al 2014). The pooled estimate of effect size for structural failure of the FH favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were shown to be decreased by 5 times compared to the control (CD) group (OR = 0.2, 95% CI: 0.08–0.6; p = 0.02).…”

Section: Resultsmentioning

confidence: 99%

“…4 studies provided relevant data, but not in a consistent way to allow us to obtain a summarized estimate of effect size of any functional outcome (Gangji et al 2011, Sen et al 2012, Liu et al 2013, Ma et al 2014). …”

Section: Resultsmentioning

confidence: 99%

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The role of “cell therapy” in osteonecrosis of the femoral head

et al. 2015

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Background and purposeThe value of core decrompression for treatment of osteonecrosis of the femoral head (ONFH) is unclear. We investigated by a literature review whether implantation of autologous bone marrow aspirate, containing high concentrations of pluripotent mesenchymal stem cells, into the core decompression track would improve the clinical and radiological results compared with the classical method of core decompression alone. The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR).Patients and methodsAll randomized and non-randomized control trials comparing simple core decompression with autologous bone marrow cell implantation into the femoral head for the treatment of ONFH were considered eligible for inclusion. The methodological quality of the studies included was assessed independently by 2 reviewers using the Cochrane Collaboration tool for assessing risk of bias in randomized studies. Of 496 relevant citations identified, 7 studies formed the basis of this review.ResultsThe pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08–0.6; p = 0.02). The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3–1.02; p = 0.06).InterpretationOur findings suggest that implantation of autologous mesenchymal stem cells (MSCs) into the core decompression track, particularly when employed at early (pre-collapse) stages of ONFH, would improve the survivorship of femoral heads and reduce the need for hip arthroplasty.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The role of “cell therapy” in osteonecrosis of the femoral head

et al. 2015

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Bone tissue engineering for treating osteonecrosis of the femoral head

Bian

et al. 2023

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Osteonecrosis of the femoral head (ONFH) is a devastating and complicated disease with an unclear etiology. Femoral head-preserving surgeries have been devoted to delaying and hindering the collapse of the femoral head since their introduction in the last century. However, the isolated femoral head-preserving surgeries cannot prevent the natural progression of ONFH, and the combination of autogenous or allogeneic bone grafting often leads to many undesired complications. To tackle this dilemma, bone tissue engineering has been widely developed to compensate for the deficiencies of these surgeries. During the last decades, great progress has been made in ingenious bone tissue engineering for ONFH treatment. Herein, we comprehensively summarize the state-of-the-art progress made in bone tissue engineering for ONFH treatment. The definition, classification, etiology, diagnosis, and current treatments of ONFH are first described. Then, the recent progress in the development of various bone-repairing biomaterials, including bioceramics, natural polymers, synthetic polymers, and metals, for treating ONFH is presented. Thereafter, regenerative therapies for ONFH treatment are also discussed. Finally, we give some personal insights on the current challenges of these therapeutic strategies in the clinic and the future development of bone tissue engineering for ONFH treatment. K E Y WO R D S biomaterials, bone tissue engineering, osteonecrosis of the femoral head, regenerative therapy  Yixin Bian and Tingting Hu contributed equally to this work.

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