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

Affiliations
  • 1Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea. oskwon@inha.ac.kr

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

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

  • 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.

  • Fig. 3 At postoperative excellent.

  • 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.


Cited by  1 articles

Preclinical Study of Cell Therapy for Osteonecrosis of the Femoral Head with Allogenic Peripheral Blood-Derived Mesenchymal Stem Cells
Qiang Fu, Ning-Ning Tang, Qian Zhang, Yi Liu, Jia-Chen Peng, Ning Fang, Li-Mei Yu, Jin-Wei Liu, Tao Zhang
Yonsei Med J. 2016;57(4):1006-1015.    doi: 10.3349/ymj.2016.57.4.1006.


Reference

1. Meyers MH. Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment. Clin Orthop Relat Res. 1988. 51–61.
2. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995. 77:459–474.
Article
3. Hungerford DS, Mont MA. Urbaniak JR, Jones JP, editors. The Role of Core Decompression in the Treatment of Osteonecrosis of the Femoral Head. Osteonecrosis: etiology, diagnosis and treatment. 1997. Rosemont, IL: American Academy of Orthopaedic Surgeons;287–292.
4. Katz RL, Bourne RB, Rorabeck CH, McGee H. Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations. Clin Orthop Relat Res. 1992. (281):145–151.
5. Mont MA, Marulanda GA, Seyler TM, Plate JF, Delanois RE. Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head. Instr Course Lect. 2007. 56:213–220.
6. Mont MA, Jones LC, Sotereanos DG, Amstutz HC, Hungerford DS. Understanding and treating osteonecrosis of the femoral head. Instr Course Lect. 2000. 49:169–185.
7. Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM. Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res. 1999. 262–271.
Article
8. Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am. 1986. 68:1313–1319.
Article
9. Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH. Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. J Bone Joint Surg Br. 1995. 77:870–874.
Article
10. Marcus ND, Enneking WF, Massam RA. The silent hip in idiopathic aseptic necrosis. Treatment by bone-grafting. J Bone Joint Surg Am. 1973. 55:1351–1366.
11. Mont MA, Einhorn TA, Sponseller PD, Hungerford DS. The trapdoor procedure using autogenous cortical and cancellous bone grafts for osteonecrosis of the femoral head. J Bone Joint Surg Br. 1998. 80:56–62.
Article
12. Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K. Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res. 1991. (268):140–151.
13. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, et al. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2001. (386):71–78.
Article
14. Gangji V, Hauzeur JP, Matos C, De Maertelaer V, Toungouz M, Lambermont M. Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study. J Bone Joint Surg Am. 2004. 86-A:1153–1160.
15. Gangji V, Hauzeur JP, Schoutens A, Hinsenkamp M, Appelboom T, Egrise D. Abnormalities in the replicative capacity of osteoblastic cells in the proximal femur of patients with osteonecrosis of the femoral head. J Rheumatol. 2003. 30:348–351.
16. Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002. 14–23.
Article
17. Hernigou P, Beaujean F. Abnormalities in the bone marrow of the iliac crest in patients who have osteonecrosis secondary to corticosteroid therapy or alcohol abuse. J Bone Joint Surg Am. 1997. 79:1047–1053.
Article
18. Hernigou P, Beaujean F, Lambotte JC. Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint Surg Br. 1999. 81:349–355.
Article
19. Yoshioka T, Mishima H, Akaogi H, Sakai S, Li M, Ochiai N. Concentrated autologous bone marrow aspirate transplantation treatment for corticosteroid-induced osteonecrosis of the femoral head in systemic lupus erythematosus. Int Orthop. 2011. 35:823–829.
Article
20. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995. 77:34–41.
Article
21. Nam KW, Kim YL, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Fate of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg Am. 2008. 90:477–484.
Article
22. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 1985. 67:3–9.
Article
23. Hungerford DS, Zizic TM. . Pathogenesis of ischemic necrosis of the femoral head. In the hip proceeding of the eleventh open scientific meeting of the Hip Society. 1983. Toronto: CV Mosby;219–262.
24. Launder WJ, Hungerford DS, Jones LH. Hemodynamics of the femoral head. J Bone Joint Surg Am. 1981. 63:442–448.
Article
25. Merle D'Aubigné R, Postel M, Mazabraud A, Massias P, Gueguen J, France P. Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br. 1965. 47:612–633.
26. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995. 77:459–474.
Article
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