scholarly journals Effect of Platelet-rich Plasma Combined With Core Decompression Bone Grafting for Osteonecrosis of Femoral Head: A Meta-Analysis

2021 ◽  
Author(s):  
QiZhong Lai ◽  
Kaishen Cai ◽  
Tianye Lin ◽  
Peng Yang ◽  
Binglang Xiong ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Bone Grafting ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Core Decompression ◽  
Osteonecrosis Of Femoral Head ◽  
Group A ◽  
Group B ◽  
Better Than

Abstract Objective: Core decompression bone grafting usually is used hip-preserving approach for osteonecrosis of femoral head (ONFH). Platelet-rich plasma (PRP) is an adjuvant therapy, combined with core decompression bone grafting for ONFH. However, it remains controversial. Therefore, its efficacy was systematically evaluated and meta-analysis in this study.Methods: Literature on core decompression bone grafting for ONFH was retrieved in CNKI, Wan Fang, PubMed, Embase, Cochrane Library and Web of Science from inception to March 2021. Review Manager 5.3 software and Stata 12.0 software were used for data synthesis.Results: A total of 10 RCTs were included. The results showed at final follow-up that, Harris hip score was significantly difference in the treatment group, adjuvant therapy with PRP (group A) better than the control group (group B), MD=7.53 [95%CI (5.29,9.77)]，P < 0.00001. There was MD=-0.71[95%CI (-0.96, -0.46)], P < 0.00001, of visual analog scale (VAS) of hip pain between the two groups. The excellent and good rate of function of hip was 1.42-fold higher in group A than that in group B, RR=1.42, 95%CI (1.25,1.62), P<0.00001. The progression and total hip arthroplasty were showed improvements, RR=0.37,95%CI (0.21,0.65), P=0.0006 and RR=0.39,95%CI (0.18,0.85), P=0.02, respectively. Begg's and Egger's tests did not indicate publication bias.Conclusion: It was shown that the use of PRP combined with core decompression bone grafting improved the symptoms better than core decompression bone grafting only, and might delay progression and total hip arthroplasty. However, as the study’s limitations, it needed to be fully verified by more large-sample multicenter prospective clinical studies.

scholarly journals Non Traumatic Hip Osteonecrosis Treated By Non Vascularised Bone Graft Versus Core Decompression

2016 ◽  
Vol 12 (2) ◽  
pp. 49-55
Author(s):  
Dhary F. Hassan ◽  
Ghadeer H. Majeed ◽  
Abed Falih Al-Sudani
Keyword(s):  
Femoral Head ◽  
Early Diagnosis ◽  
Bone Graft ◽  
Bone Grafting ◽  
Core Decompression ◽  
Cancellous Bone Graft ◽  
Group A ◽  
Group B ◽  
Vascularized Bone

Background: Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. AVN is associated with numerous conditions and usually involves the epiphysis of long bones, such as the femoral head. In clinical practice, AVN is most commonly encountered in the hip. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course. Without treatment, the process is almost always progressive, leading to joint destruction within 5 years.Treatment of a vascular necrosis depends mainly on early diagnosis which mainly based on clinical findings, x-ray finding & MRI.A variety of non vascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. Objectives: To treat non traumatic hip osteonecrosis by non vascularized bone graft versus core decompression. Type of the study: A retrospective study. Methods: We retrospectively reviewed 72 patients (88 hips) with osteonecrosis of the femoral head between May 2009, and March 2014,divided into two groups . Group A include 34 patients (44 hips) with osteonecrosis of the femoral head who had non vascularized bone grafting procedures done for them . Minimum follow-up was 12 months. We compared the outcomes in this cohort to similar hip number (44 hips) in 40 patients treated with core decompression only (group B). We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft taken from ipsilateral iliac crest or leave it without bone graft (decompression only). Results: We report the result of treatment for femoral head avascular necrosis depending on Ficat classification stage I, II, & III. The minimum follow up was 12 months (12m-36m). The success percentage of hips in our cohort of patients with non vascularized bone grafting group A are 86% (38 of 44 hips), which is higher than group B 63% (28 of 44 hips) with core decompression alone. Conclusions: These procedures core decompression and autogenous cancellous bone graft may defer joint arthroplasty in selected patients & it is more effective than core decompression alone in treating early stages of femoral head osteonecrosis.

scholarly journals 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

2017 ◽  
Vol 8 (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.

scholarly journals Correlation between the efficacy of stem cell therapy to osteonecrosis of the femoral head and cell viability

2019 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Mean Value ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of necrotic area is the key to treatment.At present, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas through the characteristics of stem cells. However, a considerable number of patients cannot achieve a satisfactory outcome in repairing the femoral head necrotic area. It is very important to find out the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression to early-stage of ONFH. Methods: A total of 30 patients with idiopathic ONFH were performed core decompression combined with autologous stem cell transplantation. The Harris score (HHS) and necrosis area change of patients before and after operation were observed. The mean value of repair ratio was set as a threshold dividing the patients into group A (ratios greater than the mean value) and group B (ratios less than the mean value). The ultrastructure, proliferative capacity and multidirectional differentiation ability were compared between the groups. Results: At 9 months after surgery, HHS and magnetic resonance imaging (MRI) findings had improved by varying degrees. Based on the repair ratio, i.e., (62.2 ± 27.0) %, 62.2% was set as a threshold dividing the patients into group A and group B. Better repair(Group A) showed faster proliferation efficiency and healthier ultrastructure. The cells of Group A also showed stronger specific staining after osteogenesis and chondrogenesis induced differentiation. The activity of alkaline phosphatase (ALP) was also higher in group A (OD 2.39 ± 0.44 vs 1.85 ± 0.52; P <0.05) after osteogenic differentiation. Conclusions: The quality of implanted stem cells is closely related to the efficacy of this procedure and determines whether the defects of self-repair in the necrotic areas can be corrected to enhance the repair capacity of necrotic tissue and to promote the repair of necrotic areas to achieve the desired therapeutic outcome.

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.

scholarly journals Cell technologies in the treatment of femoral head osteonecrosis

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. 

scholarly journals Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability

2020 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Necrotic Area ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression for early-stage ONFH. Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups. Results : At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05). Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

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