Clinical Efficacy Of Treatment Of Early Femoral Head Necrosis With Bone Marrow Mesenchymal Stem Cell Transplantation

The present study is designed to evaluate the clinical efficacy and safety of the treatment of early osteonecrosis of the femoral head by percutaneous core decompression plus infusion of autologous bone marrow mesenchymal stem cells (MSCs). Twenty-one hips in 15 patients were treated with this operation during which the bone marrow taken from the patient's anterior iliac crest was concentrated before infusion. Patients were followed up for 9~22 months (13.5 months in average). According to patients'statement, pain was ameliorated in all except one. Eight of these treated patients (11 hips) with more detailed documentation were further quantitatively evaluated by the changes in the VAS, Harris, Lequesne and WOMAC hip scores and the progression in the radiographic stages. No complications were observed after the operation.The mean preoperative VAS score was 3.5 (0~10), and improved to 1.5 (0~9) postoperatively. The mean preoperative Harris hip score was 78.8 (39~100), and improved to 89.4 (71~97) postoperatively. The mean preoperative Lequesne score was 6.9 (2~16), and improved to 3.9 (0~7.5) postoperatively. The mean preoperative WOMAC score was 22.3 (8~59), and improved to 7.6 (3~19.5) postoperatively. Only the WOMAC scores before and after treatment showed statistically significant difference (paired T test showed that t=3.263, P=0.014).However, it should be pointed out that in the present follow-up study one case of traumatic necrosis of femoral head only stopped using crutches one week before the follow-up examination, thus resulting in poor scores in 3 of the 4 items due to short walking distances though the radiographic evaluation of this case was relatively good. More importantly, in 3 cases with poor results in one or more scores the disease was related to the use of corticosteroid. A reanalysis of the scores made before and after operation in the remaining 4 cases showed that with VAS score t=2.169 and p=0.055; with Harris score t=2.22 and p=0.050; with Lequesne score t=3.597 and p=0.011; with WOMAC score t=2.394 and p=0.053. This statistical analysis showed that the differences of scores made before and after operation are statistically significant in 2 items and nearly statistically significant in the remaining 2 items. This analysis implicates that the functional status of autologous bone marrow MSCs from patients with steroid-induced femoral head necrosis might be an important factor influencing the treatment result. Therefore, percutaneous multiple holes core decompression combined with infusion of autologous MSCs in good functional status may tentatively be considered as a promising new way to treat avascular necrosis of the femoral head. It is realized that a randomized prospective study on more cases is needed to compare with routine core decompression in the future.