OUTCOMES OF CORE DECOMPRESSION WITH INJECTION OF BONE MARROW ASPIRATE FOR PEDIATRIC FEMORAL HEAD OSTEONECROSIS

Background: Pediatric patients with femoral head osteonecrosis (FHON) often suffer from significant pain with decreased mobility. Once femoral head collapse occurs, few options are available short of a total hip arthroplasty (THA).[1,2] Core decompression by drilling of the femoral head is used to improve pain and prevent further femoral head collapse, however most of the literature on this technique involves adult patients.[3-5] Purpose: To date, there is no description of this technique or its outcomes in pediatric patients with FHON secondary to other etiologies other than sickle cell disease (SCD).[6] The purpose of our study is to determine outcomes in patients with FHON after undergoing core decompression with injection of bone marrow aspirate (BMA). Methods: A retrospective chart review was performed of all pediatric patients at our institution between 2007-2019 with FHON that underwent core decompression with injection of BMA. The following etiologies were identified: SCD, steroid-induced, Perthes disease (PD), slipped capital femoral epiphysis (SCFE), trauma, idiopathic, or other. To determine if core decompression with injection results in cessation of further femoral head collapse, two outcomes were assessed: Stulberg classification and number of cases that required THA. Furthermore, we evaluated whether core decompression with injection occurred in combination with any additional surgical procedure. Results: Twenty-six hips with FHON were identified with the following etiologies: 12 SCD (46.3%), 8 steroid-induced (30.8%), 2 PD (7.7%), 1 SCFE (3.8%), 1 trauma (3.8%), 1 idiopathic (3.8%), 1 other (3.8%). Mean age at the time of surgery was 12.7 years (range: 8-18). Twenty hips (76.9%) were seen in males and 6 (23.1%) were seen in females. Twenty-two hips (84.6%) were seen in black patients and 4 (15.4%) in white patients. Mean follow-up was 37.9 months (range: 0.6-77.8). Mean Stulberg classification was 3.15 (SD: 1.26). Twelve hips (46.2%) required concomitant femoral and/or pelvic osteotomies while 14 hips (53.8%) underwent core decompression with injection alone. Six hips required conversion to THA after initial core decompression and injection. All hips requiring THA were seen in patients with core decompressions and injections but no additional femoral and/or pelvic osteotomies. Conclusion: Most hips undergoing core decompression with injection did not require THA. Of the hips that required THA, all were seen in patients who only had core decompression and injection of BMA but no concomitant femoral and/or pelvic osteotomies. [Figure: see text][Figure: see text][Figure: see text]

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Early Results of Core Decompression and Autologous Bone Marrow Mononuclear Cells Instillation in Femoral Head Osteonecrosis

The Journal of Arthroplasty ◽

10.1016/j.arth.2011.08.008 ◽

2012 ◽

Vol 27 (5) ◽

pp. 679-686 ◽

Cited By ~ 100

Author(s):

Ramesh Kumar Sen ◽

Sujit Kumar Tripathy ◽

Sameer Aggarwal ◽

Neelam Marwaha ◽

Ratti Ram Sharma ◽

...

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Mononuclear Cells ◽

Core Decompression ◽

Autologous Bone Marrow ◽

Bone Marrow Mononuclear Cells ◽

Femoral Head Osteonecrosis ◽

Early Results ◽

Autologous Bone

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

Expert Opinion on Biological Therapy ◽

10.1080/14712598.2021.1862790 ◽

2020 ◽

pp. 1-8

Author(s):

Filippo Migliorini ◽

Nicola Maffulli ◽

Jörg Eschweiler ◽

Markus Tingart ◽

Alice Baroncini

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Core Decompression ◽

Cell Therapies ◽

Femoral Head Osteonecrosis

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Bone marrow aspirate concentrate in combination with intravenous iloprost increases bone healing in patients with avascular necrosis of the femoral head: a matched pair analysis

Orthopedic Reviews ◽

10.4081/or.2016.6902 ◽

2017 ◽

Vol 8 (4) ◽

Cited By ~ 4

Author(s):

Hakan Pilge ◽

Bernd Bittersohl ◽

Johannes Schneppendahl ◽

Tobias Hesper ◽

Christoph Zilkens ◽

...

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Bone Marrow Aspirate ◽

Core Decompression ◽

Matched Pair ◽

Bone Marrow Aspirate Concentrate ◽

Matched Pair Analysis ◽

Group A ◽

Group B ◽

Pair Analysis

With disease progression, avascular necrosis (AVN) of the femoral head may lead to a collapse of the articular surface. The exact pathophysiology of AVN remains unclear, although several conditions are known that can result in spontaneous cell death, leading to a reduction of trabecular bone and the development of AVN. Hip AVN treatment is stage-dependent in which two main stages of the disease can be distinguished: pre-collapse (ARCO 0-II) and post-collapse stage (ARCO III-IV, crescent sign). In the pre-collapse phase, core decompression (CD), with or without the addition of bone marrow (e.g. bone marrow aspirate concentrate, BMAC) or bone graft, is a common treatment alternative. In the postcollapse phase, THA (total hip arthroplasty) must be performed in most of the patients. In addition to surgical treatment, the intravenous application of Iloprost has been shown to have a curative potential and analgesic effect. From October 2009 to October 2014, 49 patients with AVN (stages I-III) were treated with core decompression at our institution. All patients were divided into group A (CD + BMAC) and group B (CD alone). Of these patients, 20 were included in a matched pair analysis. The patients were matched to age, gender, ARCO-stage, Kerboul combined necrotic angle, the cause of AVN, and whether Iloprost-therapy was performed. The Merle d’Aubigné Score and the Kerboul combined necrotic angle in a-p and lateral radiographs were evaluated pre- and postoperatively. The primary endpoint was a total hip arthroplasty. In group A, two patients needed THA while in group B four patients were treated with THA. In group A, the Merle d’Aubigné Score improved from 13.5 (pre-operatively) to 15.3 (postoperatively). In group B there was no difference between the pre- (14.3) and postoperative (14.1) assessment. The mean of the Kerboul angle showed no difference in both groups compared pre- to postoperatively (group A: pre-op 212°, postop 220°, group B: pre-op 213, postop 222°). Regarding radiographic evaluation, the interobserver variability revealed a moderate agreement between two raters regarding the pre- (ICC 0.594) and postoperative analysis (ICC 0.604).This study demonstrates that CD in combination with the application of autologous bone marrow aspirate concentrate into the femoral head seems to be a safe and efficient treatment alternative in the early stages of AVN of the femoral head when compared to CD alone.

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Cell technologies in the treatment of femoral head osteonecrosis

Proceedings of the National Academy of Sciences of Belarus Medical series ◽

10.29235/1814-6023-2018-15-4-429-441 ◽

2019 ◽

Vol 15 (4) ◽

pp. 429-441

Author(s):

A. E. Murzich ◽

O. L. Eismont ◽

J. I. Isaykina ◽

D. V. Bukach ◽

R. S. Sirotkin

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Mononuclear Cells ◽

Bone Marrow Cells ◽

Core Decompression ◽

Autologous Bone Marrow ◽

X Rays ◽

Femoral Head Osteonecrosis ◽

Group A ◽

Group B

The review of the literature data and our results of surgical treatment of femoral head osteonecrosis in adult patients with the minimally invasive technologies are presented in this article. Using clinical scales, X-rays, MRI, the hip joint condition of 46 patients who underwent “core” decompression in combination with bone plastic (group A, 31 patients) and bone marrow mononuclear cells (group B, 15 patients) were evaluated. The percentage of osteonecrosis progression during the observation period up to 3 years in group A was higher than in group B, where the bone marrow concentrate was used (38.7 and 26.7 %, respectively). The methods of treatment used for femoral head osteonecrosis are not traumatic, have no complications and allow delaying hip replacement. The use of autologous bone marrow cells, in addition to decompression of the necrosis focus, creates the prerequisites for a better outcome of bone regeneration of the necrotic area.

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Treatment of stage I and II osteonecrosis of the femoral head with core decompression and bone marrow aspirate concentrate injection—A 2-year follow-up study

Seminars in Arthroplasty ◽

10.1053/j.sart.2018.03.001 ◽

2017 ◽

Vol 28 (4) ◽

pp. 239-245

Author(s):

Thomas A. Einhorn ◽

Afshin A. Anoushiravani ◽

Kevin K. Chen ◽

Ameer Elbuluk ◽

Tony Tsismenakis ◽

...

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Bone Marrow Aspirate ◽

Core Decompression ◽

Stage I ◽

Bone Marrow Aspirate Concentrate ◽

Follow Up Study

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Core decompression and autologous bone marrow concentrate for treatment of femoral head osteonecrosis: a randomized prospective study

Orthopedic Reviews ◽

10.4081/or.2016.6162 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 44

Author(s):

Wojciech Pepke ◽

Philip Kasten ◽

Nicholas Beckmann ◽

Patricia Janicki ◽

Marcus Egermann

Keyword(s):

Bone Marrow ◽

Femoral Head ◽

Clinical Outcome ◽

Core Decompression ◽

Harris Hip Score ◽

Bone Marrow Concentrate ◽

Functional Benefit ◽

Femoral Head Osteonecrosis ◽

Significant Difference

The aim of this study was to investigate the safety of injection of bone marrow aspirate concentrate during core decompression and to study its clinical (visual analogue scale; Harris-Hip-score) and radiological outcomes (magnetic resonance imaging). In this prospective and randomized clinical trial we evaluated 24 consecutive patients with nontraumatic femoral head necrosis (FHN) during a period of two years after intervention. In vitro analysis of mesenchymal stem cells was performed by evaluating the fibroblast colony forming units (CFU-Fs). Postoperatively, significant decrease in pain associated with a functional benefit lasting was observed. However, there was no difference in the clinical outcome between the two study groups. Over the period of two years there was no significant difference between the head survival rate between both groups. In contrast to that, we could not perceive any significant change in the volume of FHN in both treatment groups related to the longitudinal course after treating. The number of CFU showed a significant increase after centrifugation. This trial could not detect a benefit from the additional injection of bone marrow concentrate with regard to bone regeneration and clinical outcome in the short term.

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