Treatment Of Early Stage Osteonecrosis Of The Femoral Head With Croe Decompression Combined With Implantation Of Autologous Bone Marrow Mesenchymal Stem Cells:A Follow-up Evaluation

Objective:Osteonecrosis of femoral head is a painful disorder of the hip which often leads,in its final stage,to femoral head collapse and subsequent total hip arthroplasty.Literature reported patients who were 40 years and younger had slightly inferior results,with 85%10-year survivorship and 54%15-year survivorship,using any revision as an end point.As this disorder is commonly seen in young adults,joints-preserving therapeutic techniques have been studied extensively in the past decade and will be a major focus of orthopaedic research in the coming years.Core decompression of the hip is the most widespread procedure used to treat early-stage osteonecrosis of the femoral head,in which necrotic cancellous bone in the femoral head is drilled and removed from a lateral femoral cortical entry point.Core decompression performs the therapeutic effect mainly through the reduction of intra-medullary pressure.Human mesenchymal stem cells are thought to be multipotent cells,which are present in adult marrow,that can replicate as undifferentiated cells and that have the potential to differentiate to lineages of mesenchymal tissues,including bone,cartilage,fat,tendon,muscle,and marrow stroma.Stem cell-based therapies for early stage osteonecrosis of the femoral head are promising in the new era.Multipotential mesenchymal stem cells(MSCs)from bone marrow(BM)are on the leading edge because they are easy to expand in culture while maintaining their multilineage potential.In vitro assessment of the angiogenic and osteogenic potentials of cultured MSCs has been established,and the BM used in those experiments was exclusively from healthy donors via iliac crest aspiration.Since osteonecrosis is caused by the insufficient supply of mesenchymal cells or bone cells at the femoral head,the implantation of autologous bone marrow mesenchymal stem cells(BMMSC)into the core decompression tract has recently become a promising and effective treatment for the osteonecrosis.Moreover,the implanted BMMSC have been suggested to promote both osteogenesis and angiogenesis of the necrotic aera in femoral head THE aim of our study is to investigate the clinical result of the treatment in moderate and advanced ONFH by core decompression combined with implantation of autologous BMSCs.Methods:Six cases(8 hips)were treated by core decompression combined with implantation of autologous BMSCs from January 2015 to Augest 2015,including 2 case of bilateral hip surgery and 4 cases of sigle hip surgery.The mean age of the paitients was 45±10.1 years(with a range of 31-58 years),with 4 male and 2 female.Osteonecrosis was idiopathic in 4 hips,secondary to alcohol use in 2 hips.The preoperative ficat stages were stdge ? in 4 hips,stage? in 4 Hips.Core decompression combined with implantation of autologous BMSCs after the collection and centrifugation of autologous BMSCs.The patients followed for an average 31.3±2.7 months(28-35months).Under the local anesthesia,nearly 100ml-150ml of bone marrow was aspirated from the posterior iliac crest.The aspirate was processed in the laboratory untial the mesenchymal stem cells concentrate was available.After core decompression,the mesenchymal stem cells were implanted into the core decompression tract of the femoral head.Clinical evaluation included the pain relief,Harris hip score?visual analog scale(VAS)and the change of radiographs.We setted the collapse of femoral head as termination,then used Kapan-Meier method to conduct hip surgical analysis.All data analysis used SPSS 16.0 software(SPSS Inc.,Chicago,IL,USA).Results:Six cases(8 hips)were followed up for an average of 31.3±2.7 months(28-35 months).The Harris scores of patients after operation increased significantly(85.4± 10.9)compared with that before operation(72.4±3.1,P<0.05).Pain relief and function inproved in 7 hips(87.5%),another 1 hips collapsded to stage? and total hip arthroplasty was peformed.The VAS scores of patients after operation decreased significantly(1.3±2.0)compared with that before operation(4.6±0.74,P<0.05).Until december 2017,X-ray image showed five of eight fenmoral heads progressed,and one hip collpsed and performed THA.Conclusion:Results demonstrated that autologous bone marrow mesenchymal stem cells transplantation and core decompression can elevate curative effect?pain release and improve joint function,is an effective and simple procedure for early osteonecrosis of the femoral head.Although the findings of this study are promising,their interpretation is limited because of the small number of patients and the short duration of follow-up.Further study is needed to confirm the results.