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Zhu B, Li J, Li X, Feng S, Li B. Core decompression combined with platelet-rich plasma-augmented bone grafting for femur head necrosis: a systematic review and meta-analysis. Int J Surg 2024; 110:1687-1698. [PMID: 38181110 PMCID: PMC10942211 DOI: 10.1097/js9.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The clinical potential of biologic augmentation in core decompression and bone grafting for femoral head necrosis is widely acknowledged, with platelet-rich plasma (PRP) being a frequently employed biologic adjunct. However, its clinical application is not standardized, and high-level evidence is lacking. This study aimed to evaluate the efficacy and safety of core decompression and bone grafting combined with PRP for femur head necrosis. METHODS Several databases were systematically retrieved for randomized controlled trials comparing core decompression and bone grafting combined with or without PRP. A systematic review and meta-analysis were conducted following the PRISMA 2020 and AMSTAR 2 guidelines. The study is registered with PROSPERO under the code CRD42022361007, and it is also listed in the research registry under the identification number reviewregistry1537. RESULTS Eleven studies with 642 participants (742 hips) were included. The pooled estimates revealed that when core decompression and bone grafting were combined with PRP, the Harris hip score (mean difference: 7.98; 95% CI: 5.77-10.20; P <0.001), visual analog scale (SMD: -0.68; 95% CI: -0.96 - -0.40; P <0.001) and the pain component of Harris hip score (SMD: 8.4; 95% CI: 4.12-12.68; P <0.001), and reduction of radiographic progression [risk ratio (RR): 0.40; 95% CI: 0.27-0.59; P <0.001] were superior to core decompression and bone grafting alone. Fewer patients with treatment failure (RR: 0.27; 95% CI: 0.14-0.52; P <0.001) and higher good-to-excellent results (RR: 1.48; 95% CI: 1.17-1.86; P <0.001) were observed in treatment groups than control groups. Meanwhile, the pooled analysis substantiated the superior safety profile of PRP (RR: 0.29; 95% CI: 0.11-0.77; P =0.01). CONCLUSIONS The combination of core decompression and bone grafting with PRP is superior to the approach without PRP, demonstrating enhanced effectiveness in terms of function, pain relief, and radiographic progression. Additionally, it results in lower rates of treatment failure and adverse events. However, further high-quality RCTs are needed to evaluate their effectiveness due to methodological and implementation limitations observed in the existing evidence.
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Affiliation(s)
| | | | | | - Shengyi Feng
- Department of Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Bo Li
- Department of Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Li J, Zhao Y, Chen S, Wang S, Zhong W, Zhang Q. Research Hotspots and Trends of Bone Xenograft in Clinical Procedures: A Bibliometric and Visual Analysis of the Past Decade. Bioengineering (Basel) 2023; 10:929. [PMID: 37627814 PMCID: PMC10451653 DOI: 10.3390/bioengineering10080929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Bone defect therapy is a common clinical challenge for orthopedic and clinical physicians worldwide, and the therapeutic effect affects the physiological function and healthy life quality of millions of patients. Compared with traditional autogenous bone transplants, bone xenografts are attracting attention due to their advantages of unlimited availability and avoidance of secondary damage. However, there is currently a lack of bibliometric analysis on bone xenograft. This study aimed to use bibliometric methods to analyze the literature on bone xenograft from 2013 to 2023, to explore the current status, hotspots, and future trends of research in this field, and to promote its development and progress. METHODS Using the Web of Science Core Collection database, we retrieved and collected publication data related to xenogeneic bone grafting materials worldwide from January 2013 to March 2023. Origin (2021), CiteSpace (6.2.R2 standard), and an online bibliometric platform were used for bibliometric analysis and data visualization. RESULTS A total of 3395 documents were retrieved, and 686 eligible papers were selected. The country and institutions with the highest number of publications and centrality were the United States (125 papers, centrality = 0.44) and the University of Zurich (29 papers, centrality = 0.28), respectively. The most cited author was Araujo MG (163 times), and the author with the most significant centrality was Froum SJ (centrality = 0.09). The main keyword clusters were "tissue engineering", "sinus floor elevation", "dental implants", "tooth extraction", and "bone substitutes". The most significant bursting keywords in the last three years were "platelet rich fibrin". CONCLUSIONS Research on bone xenograft is steadily growing and will continue to rise. Currently, research hotspots and directions are mainly focused on dental implants related to bone-augmentation techniques and bone tissue engineering. In the future, research hotspots and directions may focus on decellularization technology and investigations involving platelet-rich fibrin.
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Affiliation(s)
- Jiayue Li
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Yujue Zhao
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Shili Chen
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Simin Wang
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Wen Zhong
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
| | - Qing Zhang
- Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510182, China
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 51081 BT Amsterdam, The Netherlands
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Ando W, Sakai T, Fukushima W, Kaneuji A, Ueshima K, Yamasaki T, Yamamoto T, Nishii T, Sugano N. Japanese Orthopaedic Association 2019 Guidelines for osteonecrosis of the femoral head. J Orthop Sci 2021; 26:46-68. [PMID: 33388233 DOI: 10.1016/j.jos.2020.06.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The Clinical Practice Guidelines for Osteonecrosis of the Femoral Head (ONFH) 2019 Edition, written by the working group for ONFH guidelines of the Japanese Investigation Committee (JIC) for ONFH under the auspices of the Japanese Ministry of Health, Labour, and Welfare and endorsed by the Japanese Orthopaedic Association, were published in Japanese in October 2019. The objective of this guideline is to provide a support tool for decision-making between doctors and patients. METHODS Procedures for developing this guideline were based on the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014, which proposed an appropriate method for preparing clinical guidelines in Japan. RESULTS This clinical practice guideline consists of 7 chapters: epidemiology; pathology; diagnosis; conservative therapy; surgical treatment: bone transplantation/cell therapy; surgical treatment: osteotomy; and surgical treatment: hip replacement. Twelve background questions and 13 clinical questions were determined to define the basic features of the disease and to be addressed when deciding treatment in daily practice, respectively. CONCLUSIONS The clinical practice guidelines for the ONFH 2019 edition will be useful for physicians, investigators, and medical staff in clinical practice, as well as for patients, during the decision-making process when defining how to treat ONFH.
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Affiliation(s)
- Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Keiichiro Ueshima
- Department of Orthopaedic Surgery, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Kyoto, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka, Japan
| | - Takashi Nishii
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | | | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Moon JK, Yoon JY, Kim CH, Lee SH, Kekatpure AL, Lee JS, Yoon PW. Multiple drilling and multiple matchstick-like bone allografts for large osteonecrotic lesions in the femoral head: an average 3-year follow-up study. Arch Orthop Trauma Surg 2020; 140:1655-1663. [PMID: 32034479 DOI: 10.1007/s00402-020-03364-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION We aimed to present the clinical outcomes of multiple drilling and multiple matchstick-like bone allograft for large osteonecrotic lesions of the femoral head as a joint-preserving surgery. MATERIALS AND METHODS Between March 2014 and March 2018, 57 patients (77 hips) who underwent multiple drilling and multiple matchstick-like bone allograft for large lesions (≥ 30%) in osteonecrosis of the femoral head (ONFH) were included. Harris hip scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained preoperatively and at the latest follow-up. Plain radiographs were obtained every 3 months. Femoral head collapse ≥ 2 mm was defined as a radiological failure, and conversion to total hip arthroplasty (THA) was regarded as a clinical failure. RESULTS After exclusion of 5 patients (5 hips) who lost to follow-up, 52 patients (34 men, 18 women; 72 hips) were finally enrolled. The mean follow-up period was 3.4 (range 2-4.5) years. Nineteen hips (28.4%) required conversion to THA at a mean of 21.6 (range 6-42) months postoperatively. In the remaining 53 hips (71.6%) with clinical success, the mean HHS and WOMAC improved from 63 and 31.3 preoperatively to 80.6 and 16.3 at the final follow-up, respectively (p < 0.001). Radiological failure occurred in four hips (6%). The overall failure rate was 31.9% (23/72 hips), and the mean survival duration until failure was 21.2 months (6-42 months). The lesion size, lesion location, and the use of corticosteroids as the cause of ONFH were associated with clinical failure. CONCLUSION Multiple drilling and multiple matchstick-like bone allograft may be a useful treatment option for alleviating the symptoms in ONFH patients with large lesions who want to preserve their hips.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Youn Yoon
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Sun Hyung Lee
- Department of Orthopaedic Surgery, Seuol National University Hospital, Seoul, South Korea
| | - Aditya L Kekatpure
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jun Seong Lee
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Pil Whan Yoon
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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Mao L, Jiang P, Lei X, Ni C, Zhang Y, Zhang B, Zheng Q, Li D. Efficacy and safety of stem cell therapy for the early-stage osteonecrosis of femoral head: a systematic review and meta-analysis of randomized controlled trials. Stem Cell Res Ther 2020; 11:445. [PMID: 33076978 PMCID: PMC7574494 DOI: 10.1186/s13287-020-01956-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background Osteonecrosis of femoral head (ONFH) is a seriously degenerative disease with no effective therapies to slow its progression. Several studies have reported short-term efficacy of stem cells on early-stage ONFH. However, its long-term effect was still unclear especially on progression events. This study was performed to evaluate the long-term efficacy and safety of stem cells and analyze its optimal age group and cell number. Methods Our review was registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number CRD42020136094. Following PRISMA guideline, we searched 8 electronic databases on January 5, 2020, and rigorous random controlled trials (RCTs) utilizing stem cell therapy on early-stage ONFH were included. Quality and bias were analyzed. Pooled analysis was performed to assess difference between various outcomes. Results A total of 13 RCTs (619 patients with 855 hips) were included. The application of stem cells significantly delayed collapse of femoral head(I2, 70%; RR, 0.54; 95% CI, 0.33 to 0.89; P < .00001) and total hip replacement (THR) (I2, 68%; RR, 0.55; 95% CI, 0.34 to 0.90; P = .02) in the long term. It effectively decreased the events of collapse of femoral head (≥ 60 months) (I2, 0%; RR, 0.37; 95% CI, 0.28 to 0.49; P < .00001) and THR (> 36 months) (I2, 0%; RR, 0.32; 95% CI, 0.23 to 0.44; P < .00001). There existed a beneficial effect for patients under 40 (Collapse of femoral head: I2, 56%; RR, 0.41; 95% CI, 0.23 to 0.76; P = .004) (THR: I2, 0%; RR, 0.31; 95% CI, 0.23 to 0.42; P < .00001). In addition, quantity of stem cells at 108 magnitude had better effects on disease progression events (I2, 0%; RR, 0.34; 95%CI, 0.16 to 0.74; P = .007). Besides, there were no significant differences on adverse events between the stem cell group and control group (I2, 0%; RR, 0.82; 95% CI, 0.39 to 1.73; P = .60). Conclusion Our findings build solid evidence that stem cell therapy could be expected to have a long-term effect on preventing early-stage ONFH patients from progression events, such as collapse of femoral head and total hip replacement. Furthermore, patients under 40 may be an ideal age group and the optimal cell number could be at 108 magnitude for this therapy. Further studies including strict RCTs are required to evaluate a clear effect of stem cells on ideal patient profile and the procedures of implantation.
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Affiliation(s)
- Lianghao Mao
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China
| | - Pan Jiang
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China
| | - Xuan Lei
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China
| | - Chenlie Ni
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China
| | - Yiming Zhang
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China
| | - Bing Zhang
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China
| | - Qiping Zheng
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Dapeng Li
- Affiliated Hospital of Jiangsu University, Jiefang Road No.438, Zhenjiang, 212001, Jiangsu, China.
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Kouroupis D, Ahari AF, Correa D, Shammaa R. Intralesional Injection of Bone Marrow Aspirate Concentrate for the Treatment of Osteonecrosis of the Knee Secondary to Systemic Lupus Erythematosus: A Case Report. Front Bioeng Biotechnol 2020; 8:202. [PMID: 32266233 PMCID: PMC7100546 DOI: 10.3389/fbioe.2020.00202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/02/2020] [Indexed: 01/08/2023] Open
Abstract
Case: An 18-year-old female patient with Systemic Lupus Erythematosus (SLE) and corticosteroid-associated extensive bilateral symptomatic knee Osteonecrosis (ON) (Ficat IV), treated with sequential intralesional injections of autologous bone marrow aspirate concentrate (BMAC) under ultrasound guidance. At 3 months, pain was almost absent (VAS) and KOOS/WOMAC showed significant improvement sustained up to 24 months. At 12 months MRI indicated bone maturation, significantly reduced BM edema and subchondral fluid volume, and no collapse/fragmentation signs. Discussion: The clinical and imaging significant improvement observed in this patient suggests that BMAC intralesional injections effectively restored the compromised bone structure. After larger studies, this technique can become an alternative to decompressing surgery for ON cases.
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Affiliation(s)
- Dimitrios Kouroupis
- Department of Orthopaedics, UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Amir F Ahari
- Canadian Centers for Regenerative Therapy, Toronto, ON, Canada
| | - Diego Correa
- Department of Orthopaedics, UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Miami, FL, United States.,Diabetes Research Institute & Cell Transplant Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Riam Shammaa
- Canadian Centers for Regenerative Therapy, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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The Use of Platelet-Rich Plasma for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2642439. [PMID: 32219128 PMCID: PMC7081027 DOI: 10.1155/2020/2642439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/20/2020] [Indexed: 12/18/2022]
Abstract
Background As a pathological process, osteonecrosis of the femoral head (ONFH) is characterized by the avascularity of the femoral head, cellular necrosis, microfracture, and the collapse of the articular surface. Currently, critical treatment for early-stage ONFH is limited to core decompression. However, the efficacy of core decompression remains controversial. To improve the core decompression efficacy, regenerative techniques such as the use of platelet-rich plasma (PRP) were proposed for early-stage ONFH. As a type of autologous plasma containing concentrations of platelets greater than the baseline, PRP plays an important role in tissue repair, regeneration, and the differentiation of mesenchymal stem cells (MSCs). In this review, we present a comprehensive overview of the operation modes, mechanism, and efficacy of PRP for early-stage ONFH treatment. Methods We searched for relevant studies in the PubMed, Web of Science, and Embase databases. By searching these electronic databases, the identification of either clinical or experimental studies evaluating PRP, MSC, core decompression, and ONFH was our goal. Results Seventeen studies of PRP and avascular necrosis of the femoral head were evaluated in our review. Ten studies related to the possible mechanism of PRP for treating ONFH were reviewed. Seven studies of the operation modes of PRP in treating ONFH were identified. We reviewed the efficacy of PRP in treating ONFH systematically and made an attempt to compare the PRP operation modes in 7 studies and other operation modes in past studies for early-stage ONFH treatment. Conclusion PRP treats ONFH mainly through three mechanisms: inducing angiogenesis and osteogenesis to accelerate bone healing, inhibiting inflammatory reactions in necrotic lesions, and preventing apoptosis induced by glucocorticoids. In addition, as an adjunctive therapy for core decompression, the use of PRP is recommended to improve the treatment of early-stage ONFH patients, especially when combined with stem cells and bone grafts, by inducing osteogenic activity and stimulating the differentiation of stem cells in necrotic lesions.
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Wang Q, Li D, Yang Z, Kang P. Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study. J Arthroplasty 2020; 35:652-660. [PMID: 31761674 DOI: 10.1016/j.arth.2019.10.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/14/2019] [Accepted: 10/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of femoral head and neck fenestration combined with compacted autograft (light bulb procedure) through a direct anterior approach for early stage nontraumatic osteonecrosis of the femoral head. METHODS We conducted a retrospective cohort study investigating 66 hips undergoing the light bulb procedure through the direct anterior approach (light bulb group) and 59 hips undergoing traditional core decompression (control group). Visual analog scale pain scores and range of hip motion were evaluated before discharge to assess the quality of functional recovery. Follow-up was conducted at 6 weeks, 3 months, 6 months, and annually after surgery until 4 years. The clinical effectiveness was evaluated by Harris hip score and the University of California Los Angeles activity-level score. Patients were followed up with postoperative X-ray and computed tomography. Survival was compared between the 2 groups by radiographic progression and receiving total hip arthroplasty. RESULTS There was no significant difference in quality of functional recovery between the 2 groups. There were no significant differences in clinical outcomes within 1 year after surgery. Patients in the light bulb group had significantly better Harris hip scores and University of California Los Angeles activity-level scores from 2 years after surgery to the end of follow-up. During the 4-year follow-up, significantly fewer patients in light bulb group had radiographic progression (22.7% vs 44.1%) or received total hip arthroplasty (15.2% vs 30.5%). CONCLUSIONS The light bulb procedure through a direct anterior approach offers significantly better results for the treatment of early stage nontraumatic osteonecrosis of the femoral head compared with traditional core decompression.
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Affiliation(s)
- Qiuru Wang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Donghai Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhouyuan Yang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Multiscale Stem Cell Technologies for Osteonecrosis of the Femoral Head. Stem Cells Int 2019; 2019:8914569. [PMID: 30728843 PMCID: PMC6341242 DOI: 10.1155/2019/8914569] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023] Open
Abstract
The last couple of decades have seen brilliant progress in stem cell therapies, including native, genetically modified, and engineered stem cells, for osteonecrosis of the femoral head (ONFH). In vitro studies evaluate the effect of endogenous or exogenous factor or gene regulation on osteogenic phenotype maintenance and/or differentiation towards osteogenic lineage. The preclinical and clinical outcomes accelerate the clinical translation. Bone marrow mesenchymal stem cells and adipose-derived stem cells have demonstrated better effects in the treatment of femoral head necrosis. Various materials have been used widely in the ONFH treatment in both preclinical and clinical trials. In a word, in vivo and multiscale efforts are expected to overcome obstacles in the approaches for treating ONFH and provide clinical relevance and commercial strategies in the future. Therefore, we will discuss the above aspects in this paper and present our opinions.
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10
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Dailiana ZH, Stefanou N, Khaldi L, Dimakopoulos G, Bowers JR, Fink C, Urbaniak JR. Vascular endothelial growth factor for the treatment of femoral head osteonecrosis: An experimental study in canines. World J Orthop 2018; 9:120-129. [PMID: 30254968 PMCID: PMC6153136 DOI: 10.5312/wjo.v9.i9.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the treatment of osteonecrosis of the femoral head (ONFH) with the use of vascular endothelial growth factor (VEGF).
METHODS In 30 mature beagles (6 groups of 5 beagles) ONFH was induced cryosurgically and one of the following solutions was administered locally in the femoral head (FH) in each group: Single injection of 500 μg VEGF (t-VEGFμ group); single injection of 500 ng VEGF (t-VEGFn group); continuous delivery of 500 μg VEGF through osmotic micropump (t-VEGFpump-μ group); continuous delivery of 500 ng VEGF through osmotic micropump (t-VEGFpump-n group); single injection of 0.9% sodium chloride (t-NS group), while one group that served as control group did not receive any local solution (No-t group). FHs were retrieved 12 wk postoperatively, underwent decalcification and hematoxylin/eosin and toluidine blue staining. In two canines per group, one half of FH was processed without decalcification and stained with modified Masson Trichrome. Histological sections were observed by light microscopy and measured with a semi-automatized bone histomorphometry system and Bone Volume/Total Volume (BV/TV), Marrow Volume/Total Volume (MaV/TV), and Trabecular Thickness (TbTh) were assessed. Standard and robust tests (Welch, Brown Forsythe) of analysis of variance along with multiple comparisons, were carried out among the categories.
RESULTS The untreated (No-t) group had signs of osteonecrosis, whereas the VEGF groups revealed reversal of the osteonecrosis. Statistical analysis of the decalcified specimens revealed a significantly better BV/TV ratio and a higher TbTh between the VEGF treatment groups (except the t-VEGFn group) and the No-t group or the control t-NS group. Single dose 500 μgVEGF group had significantly better BV/TV ratio and higher TbTh when compared to the No-t group (50.45 ± 6.18 vs 29.50 ± 12.27, P = 0.002 and 151.44 ± 19.07 vs 107.77 ± 35.15, P = 0.161 respectively) and the control t-NS group (50.45 ± 6.18 vs 30.9 ± 6.67, P = 0.004 and 151.44 ± 19.07 vs 107.14 ± 35.71, P = 0.151 respectively). Similar differences were found for the prolonged VEGF delivery/pump groups of 500 μg and 500 ng. Analysis of the totality of specimens (decalcified/non-decalcified) enhanced the aforementioned differences and additionally revealed significant differences in the comparison of the TbTh.
CONCLUSION In an experimental model of ONFH in canines it was found that local treatment with VEGF leads to bone tissue remodeling and new bone formation.
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Affiliation(s)
- Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, Larissa 41500, Greece
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, Larissa 41500, Greece
| | - Lubna Khaldi
- Department of Pathology, “Saint Savvas” Anti-Cancer Hospital, Athens 11522, Greece
| | - Georgios Dimakopoulos
- Medical Statistics, Epirus Science and Technology Park Campus of the University of Ioannina, Ioannina 45500, Greece
| | - James R Bowers
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
- Emerge Ortho, Independence Park, Durham, NC 27704, United States
| | - Cristian Fink
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
- Gelenkpunkt, Sports and Joint Surgery, Innsbruck 6020, Austria
- Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Tirol 6060, Austria
| | - James R Urbaniak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, United States
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Rackwitz L, Reichert JC, Haversath M, Nöth U, Jäger M. [Cell-based and future therapeutic strategies for femoral head necrosis]. DER ORTHOPADE 2018; 47:770-776. [PMID: 30143825 DOI: 10.1007/s00132-018-3619-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The application of cell- and growth factor-based techniques in conjunction with conventional surgical approaches has great therapeutic potential for the treatment of avascular necrosis of the femoral head (AVNFH). OBJECTIVES This review provides an overview of new strategies for the treatment of AVNFH, with emphasis on cell and growth factor-based approaches. MATERIALS AND METHODS The results of a literature search are summarised, the most relevant publications are presented and discussed by the authors. RESULTS In the focus of new strategies for treatment of AVNFH are bone marrow-derived cell concentrates and ex vivo-expanded mesenchymal stem cells. Besides local application during core decompression, the systemic administration of cells via blood vessels supplying the femoral head is an interesting approach. The application of osteogenic and angiogenic growth factor-laden scaffold materials has also been clinically tested. Initial results of randomised clinical trials using cell- and growth factor-based approaches underline the potential of these innovative therapeutic strategies. Cell-based therapies are governed by EU law and generally require a manufacturing authorization. CONCLUSION To date, only few randomized controlled clinical trials are available which additionally display a considerable diversity concerning cell parameters, cell processing, adjuvant surgical techniques and the quality outcome parameters. Therefore, a final statement about the effectiveness of new cell and growth factor-based strategies is currently not possible.
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Affiliation(s)
- L Rackwitz
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland.
| | - J C Reichert
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland
| | - M Haversath
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - U Nöth
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland
| | - M Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland
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Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:1689-1704. [PMID: 29411077 DOI: 10.1007/s00264-018-3787-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to document the available evidence on the use of regenerative techniques for the treatment of femoral head osteonecrosis (or avascular necrosis of femoral head, AVN) and to understand their benefit compared to core decompression (CD) alone in avoiding failure and the need for total hip replacement (THR). METHODS The search was conducted on three medical electronic databases according to PRISMA guidelines. The studies reporting number and timing of failures were included in a meta-analysis calculating cumulative survivorship with a Kaplan-Mayer curve. Moreover, the results on failures in treatment groups reported in RCT were compared with those documented in control groups, in order to understand the benefit of biological therapies compared to CD for the treatment of AVN. RESULTS Forty-eight studies were included in this systematic review, reporting results of different types of regenerative techniques: mesenchymal stem cell implantation in the osteonecrotic area, intra-arterial infiltration with mesenchymal stem cells, implantation of bioactive molecules, or platelet-rich plasma. Overall, reported results were good, with a cumulative survivorship of 80% after ten year follow-up, and better results when regenerative treatments were combined to CD compared to CD alone (89.9% vs 70.6%, p < 0.0001). CONCLUSION Regenerative therapies offer good clinical results for the treatment of AVN. The combination of CD with regenerative techniques provides a significant improvement in terms of survivorship over time compared with CD alone. Further studies are needed to identify the best procedure and the most suitable patients to benefit from regenerative treatments for AVN.
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Li D, Xie X, Kang P, Shen B, Pei F, Wang C. Percutaneously drilling through femoral head and neck fenestration combining with compacted autograft for early femoral head necrosis: A retrospective study. J Orthop Sci 2017; 22:1060-1065. [PMID: 28539248 DOI: 10.1016/j.jos.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical results, survivorship and quick rehabilitation effects of modified surgery of percutaneously drilling and decompression through femoral head and neck fenestration combined with compacted autograft for early femoral head necrosis. METHODS We conducted a retrospective cohort study with 83 hips performed percutaneous decompression through femoral head and neck fenestration (Modified group) combined with autogenous bone grafting for early ONFH. For comparison, another 90 hips treated with conventional core decompression with bone grafting (Control group). RESULTS Median follow-up was 36 months (32-44 months). The length of incision, blood loss in operation, incision drainage, operation time and hospital stays in Modified group had better results than those in control group (P < 0.001). There were four cases in Modified group and five cases in control group had complications (P = 0.9). The VAS score and range of hip motion were better in Modified group during hospital stays summarily (P < 0.05). The average Harris score in modified group was higher than the control group at the first month (P = 0.005), while at other time of follow-up the two groups were with similar Harris scores (P > 0.05). There were 22 hips progressed to stage III in Modified group, while 23 hips progressed to stage III in control group (P = 0.89). The clinical success rate in Modified group were 86.7%, compared with that in control group (87.8%) ( P= 0.84). CONCLUSION Percutaneous drilling and decompression through femoral head and neck fenestration combined with compacted autograft we reported showed an good surgical effect with a quick rehabilitation and had similar short-term effects compared with the conventional core decompression in treatment of early ONFH.
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Affiliation(s)
- Donghai Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan 610041, PR China.
| | - Xiaowei Xie
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan 610041, PR China.
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan 610041, PR China.
| | - Bin Shen
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan 610041, PR China.
| | - Fuxing Pei
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan 610041, PR China.
| | - Changde Wang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, Sichuan 610041, PR China.
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Toro G, Moretti A, Toro G, Tirelli A, Calabrò G, Toro A, Iolascon G. Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:317-323. [PMID: 29354160 PMCID: PMC5762222 DOI: 10.11138/ccmbm/2017.14.3.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CASE A clinical case of a 15-year-old cerebral palsy child with a Sandhu type 2 neglected femoral neck fracture is presented. The patient was treated using cannulated screws and cancellous bone graft augmented with mesenchymal stem cells. At 6 months after the surgery complete fracture healing was observed. CONCLUSION To early diagnose this fractures, it is mandatory to perform a comprehensive clinical and radiological evaluation including also a second level imaging. The use of cannulated screws with cancellous bone graft and MSCs is a viable treatment option in these patients.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Toro
- Unit of Radiology and Nuclear Medicine, “Santa Maria della Speranza” Hospital, Battipaglia (SA), Italy
| | | | - Giampiero Calabrò
- Unit of Orthopaedics and Traumatology, “Martiri del Villa Malta” Hospital, Sarno (SA), Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, “Martiri del Villa Malta” Hospital, Sarno (SA), Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Address for correspondence: Giovanni Iolascon, MD, Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy, E-mail:
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Calori GM, Mazza E, Colombo A, Mazzola S, Colombo M. Core decompression and biotechnologies in the treatment of avascular necrosis of the femoral head. EFORT Open Rev 2017; 2:41-50. [PMID: 28461967 PMCID: PMC5367599 DOI: 10.1302/2058-5241.2.150006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Avascular necrosis (AVN) of the femoral head (FH) causes 5% to 12% of total hip arthroplasties (THA). It especially affects active male adults between the third and fifth decades of life. The exact worldwide incidence is unknown. There are only few data related to each country, but most of it relates to the United States.Non-surgical management has a very limited role in the treatment of AVN of the FH and only in its earliest stages. Core decompression (CD) of the hip is the most common procedure used to treat the early stages of AVN of the FH. Recently, surgeons have considered combining CD with autologous bone-marrow cells, demineralised bone matrix or bone morphogenetic proteins or methods of angiogenic potential to enhance bone repair in the FH.Manuscripts were deemed eligible for our review if they evaluated treatment of early stage AVN of the FH with biotechnology implanted via CD. After application of eligibility criteria, we selected 19 reports for final analysis.The principal results showed that only by correctly mastering the therapeutic principles and adopting proper methods specifically oriented to different stages can the best therapeutic effect be achieved. Combining CD with biotechnology could result in a novel long-lasting hip- preserving treatment option.Furthermore, more refined clinical studies are needed to establish the effectiveness of biotechnology treatments in AVN of the FH. Cite this article: EFORT Open Rev 2017;2:41-50. DOI: 10.1302/2058-5241.2.150006.
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Affiliation(s)
- Giorgio Maria Calori
- ASST-Pini-CTO, University of Milan, Orthopaedic Reparative Surgery Department, Milan, Italy
| | - Emilio Mazza
- ASST-Pini-CTO, University of Milan, Orthopaedic Reparative Surgery Department, Milan, Italy
| | - Alessandra Colombo
- ASST-Pini-CTO, University of Milan, Orthopaedic Reparative Surgery Department, Milan, Italy
| | - Simone Mazzola
- ASST-Pini-CTO, University of Milan, Orthopaedic Reparative Surgery Department, Milan, Italy
| | - Massimiliano Colombo
- ASST-Pini-CTO, University of Milan, Orthopaedic Reparative Surgery Department, Milan, Italy
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16
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Calori GM, Capanna R, Piccioli A. Evolution of trauma care in Italy: What should we expect in the future? Injury 2016; 47 Suppl 4:S1-S2. [PMID: 27558244 DOI: 10.1016/j.injury.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- G M Calori
- Reparative Orthopaedic Surgery Department, ASST Pini/CTO, University of Milan, Italy.
| | - R Capanna
- Orthopaedic and Traumatologic Clinic, University of Pisa, Italy
| | - A Piccioli
- Oncologic Centre, Palazzo Baleani, Policlinico Umberto I, Rome, Italy
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Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord 2016; 17:344. [PMID: 27528281 PMCID: PMC4986261 DOI: 10.1186/s12891-016-1199-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Multiple small drilling for core decompression is widely used to preserve the femoral head in patients with avascular necrosis of the femoral head (ANFH). Nevertheless, the clinical outcome remains controversial. Simvastatin has been demonstrated to promote bone formation and reduce bone adsorption. The purpose of this study was to determine whether simvastatin enhanced the effect of multiple decompressions in preventing progression of ANFH and to identify independent risk factors associated with poor results. Methods We retrospectively analyzed 58 hips in 36 patients, with a follow-up of 36 months. 20 patients (32 hips) underwent multiple drilling combined with simvastatin treatment (SIM group); 16 patients (26 hips) underwent multiple drilling alone (MD group). We defined clinical failure as a requirement for subsequent hip surgery or Harris Hip Score < 75. New occurrence of collapse or increased collapse > 2 mm on plain radiographs was defined as radiological failure. Results Successful clinical results were achieved in 27 of 32 hips (84 %) in the SIM group compared with 15 of 26 hips (58 %) in the MD group (OR = 0.2, CI (0.1, 0.6.), P = 0.032). Successful radiological results were achieved in 27 of 32 hips (84 %) in the SIM group and in 16 of 26 hips (61.5 %) in the MD group (P = 0.048). Body mass index, disease stage and location of lesion were independent prognostic factors for overall survival. Conclusions We believe that simvastatin could enhance the effects of multiple decompressions in preventing progression of ANFH and reducing the risk of femoral head collapse.
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Affiliation(s)
- Han Yin
- Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China
| | - Zhenfeng Yuan
- Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China.
| | - Dawei Wang
- Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China
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Gao F, Sun W, Guo W, Wang B, Cheng L, Li Z. Combined with Bone Marrow-Derived Cells and rhBMP-2 for Osteonecrosis after Femoral Neck Fractures in Children and Adolescents: A case series. Sci Rep 2016; 6:30730. [PMID: 27477836 PMCID: PMC4967904 DOI: 10.1038/srep30730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/06/2016] [Indexed: 02/02/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) following femoral neck fractures is a rare, yet severe, disorder in children and adolescents. This study evaluated the effectiveness of core decompression (CD) combined with implantation of bone marrow-derived cells (BMDC) and rhBMP-2 for osteonecrosis of femoral head (ONFH) after femoral neck fractures in children and adolescents. This study included 51 patients, aged 11.4-18.1 years, with ARCO stages I-III ONFH after femoral neck fractures between 2004 and 2010. The hips were divided into two groups based on whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. All patients were followed up clinically and radiographically for a minimum of 5 years. 44 patients (86.3%) had improved clinical outcome. Radiologically, 9 of the 51 hips (17.6%) exhibited collapse onset or progression of the femoral head or narrowing of the hip joint space, and one patient in the non-LPFH group required hip arthroplasty due to the worsened syndrome. The technique provided an effective therapeutic option for children and adolescents with ONFH following femoral neck fractures. It relieves hip pain and prevents the progression of osteonecrosis in young patients lasting more than 5 years after surgery.
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Affiliation(s)
- Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedics, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100029, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedics, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100029, China
| | - Wanshou Guo
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedics, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100029, China
| | - Bailiang Wang
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedics, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100029, China
| | - Liming Cheng
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedics, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100029, China
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedics, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100029, China
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Fu Q, Tang NN, Zhang Q, Liu Y, Peng JC, Fang N, Yu LM, Liu JW, Zhang T. Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells. Yonsei Med J 2016; 57:1006-15. [PMID: 27189298 PMCID: PMC4951443 DOI: 10.3349/ymj.2016.57.4.1006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/23/2015] [Accepted: 12/09/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To explore the value of transplanting peripheral blood-derived mesenchymal stem cells from allogenic rabbits (rPBMSCs) to treat osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS rPBMSCs were separated/cultured from peripheral blood after granulocyte colony-stimulating factor mobilization. Afterwards, mobilized rPBMSCs from a second passage labeled with PKH26 were transplanted into rabbit ONFH models, which were established by liquid nitrogen freezing, to observe the effect of rPBMSCs on ONFH repair. Then, the mRNA expressions of BMP-2 and PPAR-γ in the femoral head were assessed by RT-PCR. RESULTS After mobilization, the cultured rPBMSCs expressed mesenchymal markers of CD90, CD44, CD29, and CD105, but failed to express CD45, CD14, and CD34. The colony forming efficiency of mobilized rPBMSCs ranged from 2.8 to 10.8 per million peripheral mononuclear cells. After local transplantation, survival of the engrafted cells reached at least 8 weeks. Therein, BMP-2 was up-regulated, while PPAR-γ mRNA was down-regulated. Additionally, bone density and bone trabeculae tended to increase gradually. CONCLUSION We confirmed that local transplantation of rPBMSCs benefits ONFH treatment and that the beneficial effects are related to the up-regulation of BMP-2 expression and the down-regulation of PPAR-γ expression.
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Affiliation(s)
- Qiang Fu
- Key Laboratory of Cell Engineering of Guizhou Province, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Ning Ning Tang
- Key Laboratory of Cell Engineering of Guizhou Province, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Qian Zhang
- Department of Human Anatomy, Zunyi Medical College, Zunyi, Guizhou, China
| | - Yi Liu
- Department of Bone and Joint Surgery, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Jia Chen Peng
- Department of Bone and Joint Surgery, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Ning Fang
- Key Laboratory of Cell Engineering of Guizhou Province, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Li Mei Yu
- Key Laboratory of Cell Engineering of Guizhou Province, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Jin Wei Liu
- Key Laboratory of Cell Engineering of Guizhou Province, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Tao Zhang
- Key Laboratory of Cell Engineering of Guizhou Province, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.
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Papakostidis C, Tosounidis TH, Jones E, Giannoudis PV. The role of "cell therapy" in osteonecrosis of the femoral head. A systematic review of the literature and meta-analysis of 7 studies. Acta Orthop 2016; 87. [PMID: 26220203 PMCID: PMC4940596 DOI: 10.3109/17453674.2015.1077418] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The 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 METHODS All 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. RESULTS The 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). INTERPRETATION Our 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.
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Affiliation(s)
- Costas Papakostidis
- Department of Trauma and Orthopaedics, G. Hatzikostas General Hospital, Ioannina, Greece,Correspondence:
| | - Theodoros H Tosounidis
- Academic Department of Trauma and Orthopaedic Surgery, University of Leeds, Leeds,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, University of Leeds, Leeds,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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Giannoudis PV, Calori GM, Bégué T, Schmidmaier G. Tissue loss and bone repair: Time to develop an international strategy? Injury 2015; 46 Suppl 8:S1-2. [PMID: 26747912 DOI: 10.1016/s0020-1383(15)30047-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA, Leeds, West Yorkshire, UK.
| | - Giorgio Maria Calori
- C.O.R., Reparative Orthopaedic Surgery Department, Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Thierry Bégué
- Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Gerhard Schmidmaier
- Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraβe 200a, D-69118 Heidelberg, Germany, HTRG - Heidelberg Trauma Research Group
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Abstract
Stem cells offer great promise to help understand the normal mechanisms of tissue renewal, regeneration, and repair, and also for development of cell-based therapies to treat patients after tissue injury. Most adult tissues contain stem cells and progenitor cells that contribute to homeostasis, remodeling, and repair. Multiple stem and progenitor cell populations in bone are found in the marrow, the endosteum, and the periosteum. They contribute to the fracture healing process after injury and are an important component in tissue engineering approaches for bone repair. This review focuses on current concepts in stem cell biology related to fracture healing and bone tissue regeneration, as well as current strategies and limitations for clinical cell-based therapies.
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Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
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24
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Alshameeri Z, McCaskie A. The role of orthobiologics in hip preservation surgery. J Hip Preserv Surg 2015; 2:339-54. [PMID: 27011858 PMCID: PMC4732367 DOI: 10.1093/jhps/hnv042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/21/2015] [Accepted: 05/17/2015] [Indexed: 02/06/2023] Open
Abstract
The potential regenerative role of different orthobiologics is becoming more recognized for the treatment of chronic and degenerative musculoskeletal conditions. Over the last few years there has been an increasing number of publications on cell therapy and other orthobiologics for the treatment of avascular necrosis of the femoral head and other hip conditions with promising short–term clinical results. In this article, we have used a systematic search of the literature to identify potentially relevant topics on orthobiologics and then selected those most applicable to hip preservation surgery. We identified several innovative strategies and present a summary of the currently available evidence on their potential role in hip preservation surgery. For many of these treatment strategies there was a lack of clinical evidence and therefore we suggest that there is a need for comparative studies in this field.
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Affiliation(s)
- Zeiad Alshameeri
- 1. Health Education East of England, 2-4 victoria house, Cambridge, CB21 5XB
| | - Andrew McCaskie
- 2. Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge and; 3. Arthritis Research UK Tissue Engineering Centre
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25
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Hoskinson S, Morison Z, Shahrokhi S, Schemitsch EH. Managing AVN following internal fixation: treatment options and clinical results. Injury 2015; 46:497-506. [PMID: 25548114 DOI: 10.1016/j.injury.2014.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/05/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results.
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Affiliation(s)
- Simon Hoskinson
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6
| | - Zachary Morison
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6
| | - Shahram Shahrokhi
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada M5C 1R6.
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26
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The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft non-unions after locked intramedullary nailing. Injury 2014; 45 Suppl 5:S7-S13. [PMID: 25528626 DOI: 10.1016/s0020-1383(14)70013-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the union rates in a series of patients with failed femoral shaft aseptic non-union who were treated with percutaneous concentrated autologous bone marrow grafting. Bone marrow harvesting and cell injection were performed under general anaesthesia in a single surgical procedure. Radiographic union was diagnosed in fractures with a score ≥ 10 according to the radiographic union scale in tibial fractures (RUST) and confirmed by clinical examination. Eight out of 16 patients progressed to consolidation (RUST score ≥ 10). Radiographic evidence of fracture union was observed at an average of 4.75 ± 1.75 months (range 3 to 8 months). All eight patients who did not progress to union within 12 months following the cell grafting procedure had a RUST score ≤ 10 (range 4 to 9). There were no differences in age, number of previous surgeries, duration of nonunion and preoperative RUST score between the patients that developed solid union and those with failed consolidation. However, a relationship between the number of osteoprogenitors injected and the rate of union was noted, 20.2 ± 8.6 × 10(8) versus 9.8 ± 4.3 × 10(8), p<0.005, between the patients with and without union, respectively. The efficacy of percutaneous autologous concentrated bone marrow grafting seems to be related to the number of osteoprogenitors available in the aspirates. Optimisation of the aspiration technique and concentration process is of paramount importance to increase the incidence of a successful outcome.
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