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

Abstract

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.

Analysis of Readability, Quality, and Content of Online Information Available for “Stem Cell” Injections for Knee Osteoarthritis

“…To date, there is a gap in the armamentarium for the treatments of knee OA, and this has been one of the factors leading to the rapid growth of "stem cell" injections. Indeed, the use of stem cell injections for the treatment of knee OA has increased over the past decade, even while clinical evidence supporting their use still remains of low quality [9,10,22]. Furthermore, the overall stem cell injection market is well paid.…”

Autologous Stem Cells Combined Core Decompression for Treatment of Avascular Necrosis of the Femoral Head: A Systematic Meta-Analysis

“…The previous meta-analyses [ 55 , 56 ] concluded that there were limited evidence to prove the effectiveness of CDBMSCs for treating ANFH due to having a small sample size and low methodological quality. Therefore, a more clear evaluation on the CD combined BMSCs treatments in ANFH is essential.…”

The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery

“…Papakostidis et al (83) comprised the results of core decompression and local MSC in treatment of femoral head avascular necrosis and found that MSC therapy decreases the requirement of total knee arthroplasty in the patents with femoral head AVN.…”