Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years postoperatively

Abstract

BackgroundWe had previously established concentrated autologous bone marrow aspirate transplantation (CABMAT), a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head (ONFH). The present study aimed to evaluate the effects of CABMAT as a hip preserving surgical approach, preventing femoral head collapse in asymptomatic ONFH.MethodsIn total, 222 patients (341 hips) with ONFH were treated with CABMAT between April 2003 and March 2013. Based on magnetic resonance imaging, we determined that 119 of these patients had bilateral asymptomatic ONFH (238 hips), and 38 further patients had unilateral asymptomatic ONFH (38 hips). In this series, we retrospectively examined 31 hips in 31 patients with unilateral asymptomatic ONFH treated surgically between 2003 and 2012 and followed up for more than 2 years. Clinical and radiological evaluation were performed immediately before the procedure and at the final follow-up. The two-year follow-up rate among patients with unilateral ONFH was 82% (31/38). Therefore, the present study included 31 patients (19 males and 12 females), with a mean age and follow-up period of 40 and 5.8 years, respectively. Of the 31 asymptomatic hips, 5, 6, 10, and 10 had osteonecrosis of types A, B, C1, and C2, respectively. The diagnosis, classification, and staging of ONFH were based on the 2001 Japanese Orthopaedic Association (JOA) classification.ResultsSecondary collapse of the femoral head was observed in 6/10 hips and 5/10 hips with osteonecrosis of types C1 and C2, respectively. Total hip arthroplasty was performed in 9.6% of patients (3/31 hips), at an average of 33 months after surgery. Clinical symptoms improved after surgery, and the secondary collapse rate at a mean of 5.8 years after CABMAT was lower than that reported in several previous studies on the natural course of asymptomatic ONFH.ConclusionsEarly diagnosis of ONFH (i.e., before femoral head collapse) and early intervention with CABMAT could improve the clinical outcome of corticosteroid and alcohol-induced ONFH.

Comparative Analysis of Cellular and Growth Factor Composition in Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma

“…BM was aspirated and concentrated according to a previously published method [ 9 – 14 ]. Briefly, patients were given general anesthesia and BM was aspirated from both anterior iliac crests using a BM harvest needle (Medical Device Technologies, Gainesville, FL, USA) with 20 ml syringes prefilled with 1.5 ml of the anticoagulant citrate dextrose.…”

“…We previously developed a treatment for osteonecrosis and nonunion using 30–40 ml of BMA concentrate (BMAC) produced without special instruments from 300–400 ml of BMAs harvested from the ilium and centrifuged [ 9 – 14 ]. To ensure that the buffy coat layer of the BMA was extracted without leakage, the areas immediately above and below this layer were also manually extracted.…”

Bone Regeneration, Reconstruction and Use of Osteogenic Cells; from Basic Knowledge, Animal Models to Clinical Trials

“…Intravenously injected BMC, combined with iloprost, improved fracture healing in patients with avascular necrosis of the femoral head compared to treatment with core decompression alone [168]. Six year post-operative outcomes of proceeding concentrated autologous bone marrow aspirate transplantation (CABMAT) resulted in the successful prevention of femoral head collapse [169]. Clinical evaluation of the spared joints in autologous concentrated bone marrow grafting conducted on four patients affected by advanced osteonecrosis resulted in recovery and improved motion [170].…”

Quantitative assessment of mesenchymal stem cells contained in concentrated autologous bone marrow aspirate transplantation for the treatment of osteonecrosis of the femoral head: predictive factors and differences by etiology

“…Bone marrow aspiration, concentration, and transplantation were performed using the method previously developed by Yoshioka et al and Tomaru et al [ 5 , 6 ]. Firstly, bone marrow was aspirated from both anterior iliac crests using a bone marrow harvesting needle.…”

“…Our method for concentrating bone marrow aspirate does not use a cell separator [ 1 ]. Previously, we reported positive outcomes gained by using this method in the treatment of ONFH [ 2 , 6 ]. It has also been applied in the treatment of nonunion [ 7 ].…”