Yonsei Med J.  2013 Mar;54(2):510-515. 10.3349/ymj.2013.54.2.510.

Clinical Results of Auto-Iliac Cancellous Bone Grafts Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head: A Minimum 5-Year Follow-Up

• Kang JS
• Moon KH
• Kim BS
• Kwon DG
• Shin SH
• Shin BK
• Ryu DJ

• KMID: 1503918
• DOI: http://doi.org/10.3349/ymj.2013.54.2.510

Abstract

PURPOSE
There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH.
MATERIALS AND METHODS
Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis.
RESULTS
At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results.
CONCLUSION
The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures.

Keyword

Osteonecrosis; femoral head; mesenchymal stem cells; bone graft; core decompression

MeSH Terms

Autografts/radiography
*Bone Transplantation
Femur Head Necrosis/radiography/*therapy
Humans
Ilium/transplantation
*Mesenchymal Stem Cell Transplantation
Transplantation, Autologous
Treatment Outcome

Figure

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  Fig. 1 Preoperative radiography of a 48-year-old male patient.

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  Fig. 2 Initial MRI revealed bilateral medium sized ONFH. The patient complained of right hip pain, but none at the left hip. We administered a bone graft and cell therapy for the right hip only. MRI, magnetic resonance imaging; ONFH, osteonecrosis of femoral head.

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  Fig. 3 At postoperative excellent.

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  Fig. 4 Follow-up MRI showed a decreased lesion size in the right hip. The necrosis of the left femoral head had progressed and was now causing hip pain. MRI, magnetic resonance imaging.

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