scholarly journals 10-year follow-up results of the prospective, double-blinded, randomized, controlled study on autologous bone marrow buffy coat grafting combined with core decompression in patients with avascular necrosis of the femoral head

2020 ◽  
Author(s):  
Mengyuan Li ◽  
Yuanchen Ma ◽  
Guangtao Fu ◽  
Ruiying Zhang ◽  
Qingtian Li ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Buffy Coat ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Autologous Bone ◽  
Double Blinded

Abstract Background: Avascular necrosis of the femoral head (ANFH) is a severely disabling disease of the hip. Several clinical trials have shown promising outcomes on the use of mesenchymal stem cells for the treatment of ANFH, but long-term clinical assessments are lacking. Previously, we reported the two-year follow-up results of a prospective, double-blinded, randomized, controlled study on autologous bone marrow buffy coat grafting combined with core decompression in patients with ANFH. Here, we report the ten-year follow-up results of this study.Methods: We recruited 43 (53 hips) patients from 2009 to 2010. The hips were randomly allocated to code decompression (CD) with or without bone marrow buffy coat (BBC) grafting. Participants underwent follow-up at 24, 60, and 120 months postoperatively. The visual analogue scale (VAS), Lequesne algofunctional index and Western Ontario and McMaster Universities Arthritis Index (WOMAC) osteoarthritis scores were recorded. Survival rate analysis and prognostic factor analysis were performed. The endpoint was defined as progression to Ficat stage IV or conversion to hip arthroplasty.Results: A total of 31 patients (41 hips) were included in the final analysis. The CD + BBC group had better subjective assessment scores than the CD group. The average survival times were 102.3 months and 78.1 months in the CD + BBC group and CD group, respectively (log-rank test, P = 0.029). In the univariate Cox proportional hazards regression model, age [hazards ratio (HR) = 1.079, P = 0.047] and preoperative Ficat stage (HR = 3.283, P = 0.028) indicated a high risk for progression, while the use of BBC (HR = 0.332, P = 0.042) indicated a low risk. Preoperative Ficat stage III was isolated as an independent risk factor for clinical failure in the multivariate model (HR = 3.743, P = 0.018).Conclusion: The ten-year follow-up results of this prospective, double-blinded, randomized, controlled study showed that the use of autologous BBC in combination with core decompression was more effective than the use of core decompression alone.Trial Registration: ClinicalTrials.gov identifier NCT01613612. Registered 13 December 2011 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT01613612.

scholarly journals 10-year Follow-up of the Prospective, Double-blinded, Randomized, Controlled Study of Autologous Bone Marrow Buffy Coat Grafting Combined With Core Decompression in Patients With Avascular Necrosis of Femoral Head

2020 ◽  
Author(s):  
Mengyuan Li ◽  
Yuanchen Ma ◽  
Guangtao Fu ◽  
Ruiying Zhang ◽  
Qingtian Li ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Autologous Bone ◽  
Double Blinded ◽  
Necrosis Of Femoral Head

Abstract Background: Avascular necrosis of femoral head (ANFH) is a severely disabling disease of hip.Several clinical trials have shown promising outcomes on the use of mesenchymal stem cells for treatment of ANFH but long-term clinical assessment is lacking. Previously we have reported two year follow up of a prospective, double-blinded, randomized, controlled study of autologous bone marrow buffy coatgrafting combined with core decompression in patients with ANFH. Here we reported the outcome of ten year follow up on the study.Methods:We recruited 43 (53 hips) patients from 2009 to 2010. The hips were randomly allocated to code decompression (CD) with and without bone marrowbuffy coat (BBC). Participants were followed at 24, 60, 120 months postoperatively. Visual analogue scale (VAS), Lequesne algofunctional index and Western Ontario and McMaster Universities Arthritis Index (WOMAC) osteoarthritis scoring were recorded. Survival rate analysis and the prognostic factor analysis were performed. The endpoint was defined as progression to Ficat stage IV or conversion to hip arthroplasty.Results: 31 patients (41 hips) were included in the final analysis. CD + BBC group scored better in subjective assessing scores compared with CD group. The average survival time was 102.3 months and 78.1 months for CD + BBC group and CD group, respectively (Log-rank test, P = 0.029). In the univariate COX proportional-hazards regression model, age [hazards ratio (HR) = 1.079, P = 0.047] and pre-operative Ficat stage (HR = 3.283, P = 0.028) indicated high risk for progression, while the use of BBC (HR = 0.332, P = 0.042) indicated low risk. Pre-operative Ficat stage IIIwas isolated as an independent risk factor for clinical failure in the multivariate model (HR = 3.743, P = 0.018).Conclusion: The outcome of ten year follow up on this prospective, double-blinded, randomized,controlled study showed that use of the autologous BBC in combined with core decompression is more effective than core decompression alone.TrialRegistration: ClinicalTrials.gov identifier NCT01613612. Registered 13 December 2011 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT01613612.

scholarly journals Combining autologous bone marrow buffy coat and angioconductive bioceramic rod grafting with advanced core decompression improves short-term outcomes in early avascular necrosis of the femoral head: a prospective, randomized, comparative study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Qingtian Li ◽  
Weihong Liao ◽  
Guangtao Fu ◽  
Junxing Liao ◽  
Ruiying Zhang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Buffy Coat ◽  
Hip Preserving Surgery ◽  
Group A ◽  
Autologous Bone ◽  
Group B

Abstract Background Treatment of avascular necrosis of the femoral head (ANFH) in young patients remains a clinical challenge. A current controversy is whether hip-preserving surgery results in better outcomes. The adverse effects of hip-preserving surgery are associated with the fill material for the necrotic areas. This study aims to evaluate the early effects of autologous bone marrow buffy coat (BBC) and angioconductive bioceramic rod (ABR) grafting with advanced core decompression (ACD) on early ANFH. Methods Forty-four (57 hips) patients with early ANFH from 2015 to 2020 were recruited for this study. They were randomized into two groups: group A received ACD, BBC, and ABR grafting; group B received treatment of ACD with β-tricalcium phosphate (β-TCP) granules and ABR grafting. The outcomes were assessed using the Harris Hip Scores (HHS) and survival rate analysis. The follow-up endpoint was defined as conversion to total hip arthroplasty (THA). Results Forty patients (51 hips) were ultimately included in this study for analysis. Compared with group B, patients in group A had higher postoperative function score (P = 0.032) and postoperative Harris Hip Scores (HHS) (P = 0.041). Kaplan-Meier analysis showed a trend that the survivorship of the femoral head was higher in group A than in group B. Conclusion The short-term follow-up results showed that the autologous bone marrow buffy coat and angioconductive bioceramic rod grafting with advanced core decompression is effective in the treatment of early ANFH. Trial registration Chictr.org.cn, ChiCTR2000039595. Retrospectively registered on 11 February 2015.

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