CC BY-NC-ND 4.0 · Joints 2018; 06(01): 016-022
DOI: 10.1055/s-0038-1626740
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Survival Analysis after Core Decompression in Association with Platelet-Rich Plasma, Mesenchymal Stem Cells, and Synthetic Bone Graft in Patients with Osteonecrosis of the Femoral Head

Riccardo D'Ambrosi
1   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
2   Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
,
Elena Biancardi
1   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
2   Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
,
Giulia Massari
3   Università degli Studi di Milano, Milan, Italy
,
Vincenza Ragone
4   IRCCS Policlinico San Donato, San Donato Milanese, Italy
,
Renato Mario Facchini
2   Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
› Author Affiliations
Further Information

Publication History

14 August 2017

02 January 2018

Publication Date:
12 February 2018 (online)

Abstract

Purpose The aim of this study was to report the rate of survivorship in patients with osteonecrosis of the femoral head treated with core decompression in association with mesenchymal stem cells (MSCs) implantation, platelet-rich plasma (PRP) injection, and synthetic bone graft.

Methods We evaluated 24 hips in 16 patients, according to Ficat classification, treated by core decompression, injection of PRP and MSCs, and backfilling of the core tract with synthetic bone graft. Survivorship was estimated using Kaplan–Meier curves.

Results The survivorship of core decompression in association with the procedure is 50% at 75 months of follow-up. The survival rate was 80% for patients in early stage and 28.6% for patients in advanced stage at 75 months. When we compared Kaplan–Meier survival curves of patients in stage III + IV and patients in stage I + II, we noticed that the survival functions are statistically different (p < 0.05, log-rank test), particularly in stage I + II where we had a greater surviving core decompression, in comparison to patients in stage III + IV.

Conclusion This technique is safe and good preliminary results were obtained in patients with early stages of the disease with no reported complications.

Level of Evidence Level IV, therapeutic case series.

 
  • References

  • 1 Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop 2015; 6 (08) 590-601
  • 2 Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 2010; 92 (12) 2165-2170
  • 3 Amanatullah DF, Strauss EJ, Di Cesare PE. Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop 2011; 40 (09) E186-E192
  • 4 Ficat RP, Arlet J. Necrosis of the femoral head. In: Hungerford DS. , ed. Ischemia and Necrosis of Bone. Baltimore, MD: Williams & Wilkins; 1980: 171-182
  • 5 Issa K, Pivec R, Kapadia BH, Banerjee S, Mont MA. Osteonecrosis of the femoral head: the total hip replacement solution. Bone Joint J 2013; 95-B (11, Suppl A): 46-50
  • 6 D'Ambrosi R, Marciandi L, Frediani PV, Facchini RM. Uncemented total hip arthroplasty in patients younger than 20 years. J Orthop Sci 2016; 21 (04) 500-506
  • 7 Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg 2014; 22 (07) 455-464
  • 8 Yu PA, Peng KT, Huang TW, Hsu RW, Hsu WH, Lee MS. Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: a 5-year follow-up. Biomed J 2015; 38 (03) 257-261
  • 9 Rackwitz L, Eden L, Reppenhagen S. , et al. Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head. Stem Cell Res Ther 2012; 3 (01) 7
  • 10 Kuroda Y, Asada R, So K. , et al. A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head. Int Orthop 2016; 40 (08) 1747-1754
  • 11 Pak J, Lee JH, Jeon JH, Lee SH. Complete resolution of avascular necrosis of the human femoral head treated with adipose tissue-derived stem cells and platelet-rich plasma. J Int Med Res 2014; 42 (06) 1353-1362
  • 12 Meloni MC, Hoedemaeker WR, Fornasier V. Failed vascularized fibular graft in treatment of osteonecrosis of the femoral head. A histopathological analysis. Joints 2016; 4 (01) 24-30
  • 13 Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury 2016; 47 (Suppl. 06) S16-S26
  • 14 Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 1995; 77 (01) 42-49
  • 15 Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoral head. J Bone Joint Surg Am 1995; 77 (05) 674-680
  • 16 Lieberman JR, Engstrom SM, Meneghini RM, SooHoo NF. Which factors influence preservation of the osteonecrotic femoral head?. Clin Orthop Relat Res 2012; 470 (02) 525-534
  • 17 Hong YC, Zhong HM, Lin T, Shi JB. Comparison of core decompression and conservative treatment for avascular necrosis of femoral head at early stage: a meta-analysis. Int J Clin Exp Med 2015; 8 (04) 5207-5216
  • 18 Castro Jr FP, Barrack RL. Core decompression and conservative treatment for avascular necrosis of the femoral head: a meta-analysis. Am J Orthop 2000; 29 (03) 187-194
  • 19 Bednarek A, Atras A, Gągała J, Kozak Ł. Operative technique and results of core decompression and filling with bone grafts in the treatment of osteonecrosis of femoral head. Ortop Traumatol Rehabil 2010; 12 (06) 511-518
  • 20 Lieberman JR, Conduah A, Urist MR. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res 2004; (429) 139-145
  • 21 Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res 2002; (405) 14-23
  • 22 Persiani P, De Cristo C, Graci J, Noia G, Gurzì M, Villani C. Stage-related results in treatment of hip osteonecrosis with core-decompression and autologous mesenchymal stem cells. Acta Orthop Belg 2015; 81 (03) 406-412
  • 23 Tabatabaee RM, Saberi S, Parvizi J, Mortazavi SM, Farzan M. Combining concentrated autologous bone marrow stem cells injection with core decompression improves outcome for patients with early-stage osteonecrosis of the femoral head: a comparative study. J Arthroplasty 2015; 30 (9, Suppl): 11-15
  • 24 Sen RK, Tripathy SK, Aggarwal S, Marwaha N, Sharma RR, Khandelwal N. Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: a randomized control study. J Arthroplasty 2012; 27 (05) 679-686
  • 25 Li X, Xu X, Wu W. Comparison of bone marrow mesenchymal stem cells and core decompression in treatment of osteonecrosis of the femoral head: a meta-analysis. Int J Clin Exp Pathol 2014; 7 (08) 5024-5030
  • 26 Gangji V, De Maertelaer V, Hauzeur JP. Autologous bone marrow cell implantation in the treatment of non-traumatic osteonecrosis of the femoral head: five year follow-up of a prospective controlled study. Bone 2011; 49 (05) 1005-1009
  • 27 Rajagopal M, Balch Samora J, Ellis TJ. Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review. Hip Int 2012; 22 (05) 489-493