Core decompression isolated or combined with bone marrow-derived cell therapies for femoral head osteonecrosis

Expert Opinion on Biological Therapy, vol. 21, pp. 423–430

Abstract

Objectives: The regenerative capabilities of bone marrow-derived cell therapies (BMCTs) have been employed in combination with core decompression (CD) in the management of osteonecrosis of the femoral head to prevent or delay the necessity of total hip arthroplasty (THA).Methods: The authors conducted a meta-analysis to compare the results of level of evidence I trials comparing CD with and without BMCTs.Results: Overall, 579 procedures were analyzed: 265 in the CD group and 263 in the CD + BMCTs group. Comparability concerning age and gender, drill size, etiology, and grade of OFNH was found (P > 0.1). At a mean follow up of 82.29 (24 to 360) months, the VAS scored favourably for the CD + BMCTs group (mean difference: −12.88; P < 0.0001), as well the rate of THA (odd ratio: −0.14; P < 0.0001). Time to failure (P = 0.4) and to THA (P = 0.9) was similar between the two groups, as was the rate of failure (P = 0.3).Conclusion: In patients with femoral head osteonecrosis, core decompression combined with BMCTs demonstrated reduced pain and lower rate of total hip arthroplasty compared to core decompression as an isolated procedure.

Authors 5

1. Filippo Migliorini Aachen Department of Orthopaedics, University Clinic Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   University Clinic Aachen, RWTH Aachen University Clinic

   Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany

2. Nicola Maffulli corresponding

   University of London · University of Salerno · Queen Mary University of London · Mile End Hospital · Keele University

   Affiliation as printed

   Keele University School of Medicine, Thornburrow Drive

   Queen Mary University of London

   Surgery and Dentistry, University of Salerno

   Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy

   School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England

   d. Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, England

3. Jörg Eschweiler Aachen Department of Orthopaedics, University Clinic Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   University Clinic Aachen, RWTH Aachen University Clinic

   Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany

4. Markus Tingart Aachen Department of Orthopaedics, University Clinic Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   University Clinic Aachen, RWTH Aachen University Clinic

   Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany

5. Alice Baroncini Aachen Department of Orthopaedics, University Clinic Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   University Clinic Aachen, RWTH Aachen University Clinic

   Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany