The Use of Platelet-Rich Plasma for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review

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.

Download Full-text

The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: A systematic review

10.21203/rs.2.16398/v2 ◽

2019 ◽

Author(s):

Jun Han ◽

Fuqiang Gao ◽

Wei Sun ◽

Lijun Shi ◽

Xinjie Wu ◽

...

Keyword(s):

Stem Cells ◽

Femoral Head ◽

Early Stage ◽

Platelet Rich Plasma ◽

Articular Surface ◽

Experimental Studies ◽

Core Decompression ◽

Comprehensive Overview ◽

Autologous Plasma ◽

Operation Modes

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.

Download Full-text

The management of platelet-rich plasma in ONFH treatment: A systematic review

10.21203/rs.2.16398/v1 ◽

2019 ◽

Author(s):

Jun Han ◽

Fuqiang Gao ◽

Wei Sun ◽

Lijun Shi ◽

Xinjie Wu ◽

...

Keyword(s):

Stem Cells ◽

Femoral Head ◽

Early Stage ◽

Platelet Rich Plasma ◽

Articular Surface ◽

Autologous Blood ◽

Experimental Studies ◽

Core Decompression ◽

Comprehensive Overview ◽

Operation Modes

Abstract Background: Osteonecrosis of femoral head (ONFH) is a pathologic process characterized by the lacking vessel blood of femoral head leading to cellular death, fracture, and 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. With the purpose to improve the core decompression efficacy, regenerative techniques like platelet-rich plasma (PRP) have been proposed to address early stage ONFH. PRP is defined as a sample of autologous blood with concentrations of platelets above baseline values, which have an important role in tissue repair, regeneration, and differentiation of mesenchymal stem cells (MSCs). Within this review, we will present a comprehensive overview of operation modes, mechanism and efficacy of PRP for early stage ONFH treatment. Methods: We searched Pubmed, Embase, Web of Science databases for relevant studies. Any observational or experimental studies that evaluated PRP, MSC, core decompression and ONFH were our goal of searching the electric database. Results: 17 studies that researched PRP and ONFH were identiﬁed in this review. We reviewed 10 studies related to the possible mechanism of PRP for treating ONFH. On the other hand, 7 studies were about to the operation modes of PRP in treating ONFH so far. We reviewed the efficacy of PRP in treating ONFH systematically, with an attempt to make a comparison of PRP operation modes of 7 studies and other operation modes of past studies in early stage ONFH treatment. Conclusion: PRP works to treat ONFH mainly through three mechanisms: induce angiogenesis and osteogenesis to accelerating bone healing; inhibit inflammatory reaction in necrosis lesion; prevents apoptosis induced by glucocorticoid. In addition, PRP are recommended as an adjunctive therapy for core decompression to improve the treatment of early stage ONFH patients, especially combined with stem cells and bone graft to induce an osteogenic activity and stimulate differentiation of stem cell in necrosis lesion.

Download Full-text

New Advances in Stem Cell Therapy for Osteonecrosis of the Femoral Head

Current Stem Cell Research & Therapy ◽

10.2174/1574888x13666181025120252 ◽

2019 ◽

Vol 14 (3) ◽

pp. 226-229 ◽

Cited By ~ 11

Author(s):

Wei Zhou ◽

Ming Qu ◽

Yajie Lv ◽

Jinyu Zhu

Keyword(s):

Stem Cells ◽

Stem Cell ◽

Femoral Head ◽

Cell Therapy ◽

Stem Cell Therapy ◽

Hip Replacement ◽

Early Stage ◽

Platelet Rich Plasma ◽

Young Patients ◽

Plasma Therapy

Osteonecrosis of the femoral head (ONFH) is a common refractory orthopedic disease with multiple etiologies that more frequently occurs in middle-aged and young people. ONFH is the main cause of hip replacement in young patients. Since Professor Hernigou first reported the use of stem cells in the treatment of early stage ONFH, a large number of studies have demonstrated the potential of stem cells in the treatment of adult patients with ONFH. With the rise of interdisciplinary stem cell therapy combined with platelet-rich plasma therapy, gene therapy or other methods have gradually attracted the attention of researchers. This article summarizes the current advances in stem cell therapy for ONFH, as well as the problems and challenges, which may provide reference for further research.

Download Full-text

Addition of Bone Marrow Stem Cells Therapy Achieves Better Clinical Outcomes and Lower Rates of Disease Progression Compared With Core Decompression Alone for Early Stage Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analysis

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-19-00816 ◽

2020 ◽

Vol 28 (23) ◽

pp. 973-979 ◽

Cited By ~ 3

Author(s):

Chaofan Zhang ◽

Xinyu Fang ◽

Zida Huang ◽

Wenbo Li ◽

Wenming Zhang ◽

...

Keyword(s):

Systematic Review ◽

Stem Cells ◽

Bone Marrow ◽

Femoral Head ◽

Disease Progression ◽

Clinical Outcomes ◽

Early Stage ◽

Meta Analysis ◽

Core Decompression ◽

Stem Cells Therapy

Download Full-text

Survival Analysis after Core Decompression in Association with Platelet-Rich Plasma, Mesenchymal Stem Cells, and Synthetic Bone Graft in Patients with Osteonecrosis of the Femoral Head

Joints ◽

10.1055/s-0038-1626740 ◽

2018 ◽

Vol 06 (01) ◽

pp. 016-022 ◽

Cited By ~ 5

Author(s):

Riccardo D'Ambrosi ◽

Elena Biancardi ◽

Giulia Massari ◽

Vincenza Ragone ◽

Renato Facchini

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Femoral Head ◽

Bone Graft ◽

Platelet Rich Plasma ◽

Core Decompression ◽

Stage I ◽

Synthetic Bone ◽

Synthetic Bone Graft ◽

Kaplan Meier

Purpose The aim of this study was to report the rate of survivorship in patients with osteonecrosis of the femoral head treated with core decompression in association with mesenchymal stem cells (MSCs) implantation, platelet-rich plasma (PRP) injection, and synthetic bone graft. Methods We evaluated 24 hips in 16 patients, according to Ficat classification, treated by core decompression, injection of PRP and MSCs, and backfilling of the core tract with synthetic bone graft. Survivorship was estimated using Kaplan–Meier curves. Results The survivorship of core decompression in association with the procedure is 50% at 75 months of follow-up. The survival rate was 80% for patients in early stage and 28.6% for patients in advanced stage at 75 months. When we compared Kaplan–Meier survival curves of patients in stage III + IV and patients in stage I + II, we noticed that the survival functions are statistically different (p < 0.05, log-rank test), particularly in stage I + II where we had a greater surviving core decompression, in comparison to patients in stage III + IV. Conclusion This technique is safe and good preliminary results were obtained in patients with early stages of the disease with no reported complications. Level of Evidence Level IV, therapeutic case series.

Download Full-text