title: Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion.
abstract: OBJECTIVE
  To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell (BMCs) infusion.
  
  
  METHODS
  44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages.
  
  
  RESULTS
  No complications were observed after the operation. Before operation, there were stage I of femoral head necrosis in 8 hips, stage II in 15 hips, stage III in 14 hips, stage IV in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage I in 6 hips, stage II in 13 hips, stage III in 13 hips, stage IV in 7 hips, stage V in 4 hips. The mean preoperative Harris hip score was 58 (46-89), and improved to 86 (70-94) postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30%.
  
  
  CONCLUSIONS
  Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai 200032, China. healthbone@zshospital.net
authors.forename: Zuo-qin
authors.initials: ZQ
authors.lastname: Yan
authors.forename: Yun-su
authors.initials: YS
authors.lastname: Chen
authors.forename: Wen-jun
authors.initials: WJ
authors.lastname: Li
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Jian-zhong
authors.initials: JZ
authors.lastname: Huo
authors.forename: Zheng-rong
authors.initials: ZR
authors.lastname: Chen
authors.forename: Jian-hui
authors.initials: JH
authors.lastname: Shi
authors.forename: Jun-bo
authors.initials: JB
authors.lastname: Ge
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014182:Transplantation, Autologous; D016896:Treatment Outcome