Osteonecrosis repair with bone marrow cell therapies: State of the clinical art

Hernigou, Philippe; Flouzat-Lachaniette, Charles-Henri; Delambre, Jérôme; Poignard, Alexandre; Allain, J.; Chevallier, Nathalie; Rouard, Hélène

doi:10.1016/j.bone.2014.04.034

Cited by 109 publications

(78 citation statements)

References 40 publications

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“…Therapies using cells [4][5][6], proteins, and other bone growth-promoting substances [2,7,8] have been proposed, and various cell therapies using autologous marrow cells are already being attempted. Non-cellular therapeutic strategies using growth factors have been proposed; however, there has been little progress with regard to the verification of animal experiments, primarily because of the absence of an animal model for femoral head-specific necrosis [9,16] and secondarily because of the lack of a technique to locally deliver the growth factor [17].…”

Section: Discussionmentioning

confidence: 99%

“…Autologous bone marrow cell transplantation may be reliable for the treatment of the precollapse stage of ONFH [4][5][6]. Implantation of cylindrical metal (porous tantalum) rods into the femoral head can prevent collapse by providing structural support in the necrotic area, which has been approved as an early-stage therapy [21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Therapies using cells, proteins, and other bone growthpromoting substances have been proposed, and various types of autologous marrow cell therapy have been used [4][5][6]. Furthermore, non-cellular therapeutic strategies that use growth factors have also been proposed [2,3,7,8].…”

Section: Introductionmentioning

confidence: 99%

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A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

Kuroda

Asada

et al. 2015

International Orthopaedics (SICOT)

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Purpose We evaluated the safety and clinical outcomes of a single local administration of gelatin hydrogel impregnated with recombinant human fibroblast growth factor (rhFGF)-2 for the treatment of the precollapse stage of osteonecrosis of the femoral head (ONFH). Methods Patients with ONFH (precollapse stage ≤2) received a single local administration of 800 μg of rhFGF-2-impregnated gelatin hydrogel and were followed up for one year. The surgery was performed using a minimally invasive technique involving a 1-cm skin incision, and walking was allowed from day one postoperatively. The primary outcomes included occurrence of adverse events and complications. The secondary outcomes included changes in the Harris hip scores, visual analog scale for pain scores, University of California, Los Angeles (UCLA) activity scores, and radiological images. Results We included ten patients, of which five experienced 14 adverse events, including one complication from spinal anesthesia. However, patients completely recovered from all adverse events. The mean clinical scores significantly improved by one year postoperatively compared with the pre-operative scores (before vs. after: visual analog score for pain, 21.2 vs. 5.3 mm; UCLA activity score, 5.5 vs. 6.6; Harris hip score, 81.0 vs. 96.9 points). There was only one case of femoral head collapse; however, this occurred in a hip with extensive necrosis. Stage progression and collapse did not occur in the other nine cases. Computed tomography confirmed bone regeneration in the femoral heads. Conclusions Clinical application of rhFGF-2-impregnated gelatin hydrogel for patients with precollapse ONFH was feasible and safe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

Kuroda

Asada

et al. 2015

International Orthopaedics (SICOT)

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“…42 Core decompressions followed by injection of autologous bone marrow stem cells have been introduced for the treatment of osteonecrosis of the hip in order to increase the number of committed osteogenic cells in areas of osteonecrosis, 43 and also intravenous administration of autologous and allogenic stem cells has been tried. 44 Complications to these extensive procedures have been reported as minimal, but the results, however, vary. [45][46][47] Physical modalities Extracorporal shock wave therapy.…”

Section: Surgicalmentioning

confidence: 99%

Treatment of bone marrow lesions (bone marrow edema)

Eriksen

2015

BoneKEy Reports

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Bone marrow lesions (BMLs) or using older terminology 'Bone marrow edema' is characterised by excessive water signals in the marrow space on magnetic resonance imaging or ultrasound; BMLs constitute a central component of a wide variety of inflammatory and non-inflammatory rheumatologic conditions affecting the musculoskeletal system: BMLs are not only considered significant sources of pain but also linked to increased disease activity in many musculoskeletal conditions (for example, osteoarthritis, rheumatoid arthritis). The purpose of this review is to summarise current knowledge about the treatment of BMLs, with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.

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“…For example, it is clear that rhBMP-2 combined with a collagen scaffold has ample regenerative capacity for spinal fusion without the addition of any exogenous MSCs 51 . However, for complex diseases such as osteonecrosis, the pleiotropic and immunomodulatory capacities of MSCs may be required for treatment 52 .…”

Section: Cellsmentioning

confidence: 99%