Autologous concentrated bone marrow graft in the treatment of femoral head avascular necrosis: Clinical outcome after two years of follow up in a non-controlled prospective study

Abstract Background and Objective: Avascular necrosis of femoral head is a common Issue faced by orthopaedic surgeons which ranges between 10-18% but in sickle cell Disease the incidence reaches 30%. There is no definite treatment except joint arthroplasty. Regenerative medicine is an option to cure or delay joint arthroplasty. We report here our experience with injection of ABMDO to manage ANFH and report our long term results,progression of the ANFH if any and delay in THA (Total Hip Arthoplasty).Patients and Methods: Sixty-Three (63) consecutive patients with SCD with ANFH were examined, thoroughly investigated and those who had ANFH < grade II were consented to receive ABMDO. Pre-operatively patients were clinically assessed using Visual analogue scale (VAS), Modified Harris Hips Score (MHHS) and Azam-Sadat Score (ASS) for Quality of Life Score for Chronic Hip Disease. Ten milliliter of bone marrow was aspirated under local anesthesia and was placed in 20 CC culture media. Osteoblasts were cultured from the bone marrow aspirated. Under anesthesia using 3 mm cannulated drill, the osteonecrosed lesion was drilled and 5 million osteoblasts were injected at the lesion site. Patients were evaluated in out patient clinic after two weeks. At four months a repeat MRI was done and patients were followed up a minimum for 2 years.Results: The average age was 25.93±5.48 years. There were 41 (65%) females and 22 (35%) males. The mean hemoglobin S was 83.2±5.1 percent. The average follow up was 49.05±12.9 ( range 24-60) months. VAS significantly improved from 7.79±1.06 at 2 weeks 4.07±1.08 p<0.0001 continued to improve for the next 24 months 2.38±0.55 (P<0.0001). MHHS improved from 41.77±5.37 to 73.19± 6.48 at 4 months (P<0.001) and at 24 months it was 88.93±3.6 (p<0.001). The ASS also significantly improved from 2.76±0.49 preoperatively to 7.92±0.09 (p<0.0001) at 24 months. A comparison of the MRI’s of before and after osteoblast implantation revealed new bone formation and amelioration of the avascular lesions. Three patients were unhappy with the outcome and one patients repeated attacks of the vaso-occlusive crisis within six months of the osteoblasts injection.Conclusions: The results give credence to our earlier short follow up results that osteoblasts transplantation has a great potential in healing of avascular lesions. Our study fits the criteria of Phase II clinical trial and We believe a larger study equivalent to Phase III numbers and include patients not only with sickle cell disease but also steroid induced and idiopathic avascular necrosis.

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Comment on Medial Meniscus Scaffold Implantation in Combination with Concentrated Bone Marrow Aspirate Injection: Minimum 3-Year Follow-Up

The Journal of Knee Surgery ◽

10.1055/s-0040-1721037 ◽

2020 ◽

Author(s):

Mingjin Zhong ◽

Wei Lu ◽

Weimin Zhu

Keyword(s):

Bone Marrow ◽

Medial Meniscus ◽

Bone Marrow Aspirate ◽

Concentrated Bone Marrow

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Necrosis avascular

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.2.03 ◽

2020 ◽

Vol 63 (2) ◽

pp. 18-23

Author(s):

Alejandro Jardón Gómez ◽

Ana Cristina King ◽

Carlos Pacheco Díaz

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Femoral Fracture ◽

Open Fracture ◽

Clinical Presentation ◽

Femoral Fractures ◽

Proximal Femoral Fracture ◽

Young Population ◽

Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

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