Early Results of Core Decompression and Autologous Bone Marrow Mononuclear Cells Instillation in Femoral Head Osteonecrosis

Sen, Ramesh Kumar; Trıpathy, Sujit Kumar; Aggarwal, Sameer; Marwaha, Neelam; Sharma, Ratti Ram; Khandelwal, Niranjan

doi:10.1016/j.arth.2011.08.008

Cited by 184 publications

(222 citation statements)

References 22 publications

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“…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%

“…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%

“…Sen et al (2012) found an improvement in Harris hip score (HHS) in the cell therapy group compared to the control group at 12 months postoperatively (p < 0.02). However, this difference became reduced to statistically insignificant levels at 24 months (p = 0.09).…”

Section: Resultsmentioning

confidence: 99%

“…In 2 of them, CD and cell therapy were combined with autologous bone graft (Lim et al 2013, Ma et al 2014), while in 2 other studies they had been combined with hydroxyapatite (HA) fillers (Yamasaki et al 2010, Liu et al 2013). After exclusion of the above studies, we created another subgroup consisting of reports comparing CD alone with CD plus application of autologous bone marrow concentrate (cell therapy) (Gangji et al 2011, Sen et al 2012, Zhao et al 2012). Only 2 studies provided relevant data for the primary outcome measures (Gangji et al 2011, Zhao et al 2012) (Figure 7, see Supplementary data).…”

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: 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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“…There have been attempts to use core decompression with the addition of bone marrow cells (BMC) [8,10,[47][48][49]50•]. Li et al [8] compared the use of BMC therapy to core decompression alone in a meta-analysis of 4 studies (n=219 hips) [47-49, 50•].…”

Section: Mesenchymal Stem Cellsmentioning

confidence: 99%

A current review of core decompression in the treatment of osteonecrosis of the femoral head

Pierce

Jauregui

Elmallah

et al. 2015

Curr Rev Musculoskelet Med

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The review describes the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling technique, and (4) the overall outcomes of these procedures. Core decompression has optimal outcomes when used in the earliest, precollapse disease stages. More recent studies have reported excellent outcomes with percutaneous drilling. Furthermore, adjunct treatment methods combining core decompression with growth factors, bone morphogenic proteins, stem cells, and bone grafting have demonstrated positive results; however, larger randomized trial is needed to evaluate their overall efficacy.

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Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia

Jones

Kaste

Karol

et al. 2020

Pediatric Blood & Cancer

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With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.

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Early Results of Core Decompression and Autologous Bone Marrow Mononuclear Cells Instillation in Femoral Head Osteonecrosis

Cited by 184 publications

References 22 publications

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

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

A current review of core decompression in the treatment of osteonecrosis of the femoral head

Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia

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