Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

Andriolo, Luca; Merli, Giulia; Tobar, Carlos; Altamura, Sante Alessandro; Kon, Elizaveta; Filardo, Giuseppe

doi:10.1007/s00264-018-3787-0

Cited by 68 publications

(60 citation statements)

References 67 publications

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“…Since then, pre-clinical studies and human studies employing unselected BM-derived cells, circulating angiogenic cells, and mesenchymal stem cells have shown that injection of those cells to the femoral head was able to ameliorate hip performance. Andriolo et al [38] confirm with a systematic review and meta-analysis that regenerative therapies increase survivorship of avascular necrosis of the femoral head, which is confirmed by Hernigou et al [39] who report a prospective, randomized trial investigating long-term effects of bone marrow cell therapy in patients with bilateral osteonecrosis.…”

Section: Cell Therapy and Osteonecrosismentioning

confidence: 72%

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hernigou¹,

Daltro

Hernigou

2018

International Orthopaedics (SICOT)

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Section: Cell Therapy and Osteonecrosismentioning

confidence: 72%

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hernigou¹,

Daltro

Hernigou

2018

International Orthopaedics (SICOT)

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“…In this study, no complication occurred during auto-PBSC mobilization, collection, and infusion, proving that it is a safe intervention for patients with ONFH. As PBSCs, theoretically, have the potential to differentiate into vascular endothelial cells and secrete biologically active paracrine factors for regeneration [14,15], this study cohort, exhibiting a 50 ± 7% hip-preservation success rate at 5-year follow-up, supports the efficacy of auto-PBSC transplantation for ONFH compared with previous studies, which suggested that > 50% of patients with ONFH required THA within 3 years of diagnosis [16,17]. However, the outcomes were individually different; therefore, the factors that led to this difference were investigated.…”

Section: Discussionmentioning

confidence: 99%

Prognosis after autologous peripheral blood stem cell transplantation for osteonecrosis of the femoral head in the pre-collapse stage: a retrospective cohort study

Pan

Ding

et al. 2020

Stem Cell Res Ther

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Objectives: Autologous peripheral blood stem cell (auto-PBSC) transplantation is an effective therapeutic for the osteonecrosis of the femoral head (ONFH) but without prognosis estimation. This study mainly aimed to (1) determine whether auto-PBSC transplantation is a promising option, (2) assess the risk of hip-preservation failure, (3) achieve a predictive model of femoral head survival after the intervention, and (4) eventually identify clinical indications for auto-PBSC transplantation in future. Methods: After reviewing the in-patient database of the First Affiliated eligible patients with Association Research Circulation Osseous stage I or II ONFH who were receiving intra-arterial infusion of auto-PBSCs were recruited. A case form was designed to retrieve relevant data. Hip-preservation failure was defined as the endpoint. All participants were stratified by the categorical risk of collapse, which was statistically tested through log-rank analysis. All significant factors were evaluated using Cox proportional hazards regression model, and a predictive nomogram plot was generated. Results: In total, 47 hips were followed up for 53.96 ± 21.09 months; the median survival time was 60.18 months. Among the predictors, body mass index (BMI; P = 0.0015) and Harris hip score (HHS; P < 0.0001) independently affected femoral head survival. Patients with BMI ≥ 24 kg/m 2 exhibited a 2.58 times higher risk of hip-preservation failure [95% confidence interval (CI), 1.32-5.45] than those with BMI < 24 kg/m 2 , whereas those with HHS ≥ 70 exhibited a 0.19 times lower risk (95% CI, 0.09-0.38) than those with HHS < 70. Hazard ratios associated with age (P = 0.042), BMI (P = 0.012), HHS (P = 0.022), and necrotic volume (P = 0.000) were 1.038 (95% CI, 1.001-1.075), 1.379 (95% CI, 1.072-1.773), 0.961 (95% CI, 0.928-0.994), and 1.258 (95% CI, 1.120-1.412), respectively. A nomogram plot (score test P = 0.000; C-index = 0.8863) was available for the orthopedic doctor to predict hip survival probability. Conclusions: The results suggest that intra-arterial infusion of auto-PBSCs prolongs femoral head survival. Age, BMI, HHS, and necrotic volume can influence the efficacy of this intervention. This study was approved by ethics committee of the trial center, number 2019-KL-075-01.

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“…In clinical practice, it is challenging to determine how to prevent the progression of early-stage ONFH or to completely repair the necrotic areas to avoid THA. Core decompression is one of the available early treatments [4] and can significantly relieve pain in patients with early-stage ONFH [5]. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area [5].…”

Section: Introductionmentioning

confidence: 99%

“…Core decompression is one of the available early treatments [4] and can significantly relieve pain in patients with early-stage ONFH [5]. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area [5]. Femoral head necrosis is a disease involving the activity of local stem cells in the femoral head [6].…”

Section: Introductionmentioning

confidence: 99%

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

Sun

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression for early-stage ONFH.Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups.Results: At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05).Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

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Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

Cited by 68 publications

References 67 publications

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Hip osteonecrosis: stem cells for life or behead and arthroplasty?

Prognosis after autologous peripheral blood stem cell transplantation for osteonecrosis of the femoral head in the pre-collapse stage: a retrospective cohort study

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

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