Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells.
BACKGROUND
Since self-limited repair ability of the necrotic lesion may be a cause for failure of the technique, the possibility has been raised that bone marrow mononuclear cells (BMMCs) containing BMSCs implanted into a necrotic lesion of the femoral head with core decompression (CD) may be of benefit in the treatment of this condition. For this reason, we studied the implantation of the concentrated autologous bone marrow containing mononuclear cells in necrotic lesion of the femoral head to determine the effect of the method.


METHODS
The study included 45 patients (59 hips, 9 females, 36 males; mean age 37.5 years, range 16-56 years) with stages I-IIIA nontraumatic avascular necrosis of the femoral head according to the system of the Association Research Circulation Osseous. Concentrated bone marrow (30-50 ml) containing mononuclear cells has been gained from autologous bone marrow (100-180 ml) obtained from the iliac crest of patient with the cell processor system. Concentrated bone marrow was injected through a CD channel into the femoral head. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 27.6 months (range 12-40 months).


RESULTS
Pre- and post-operative evaluations showed that the mean Harris hip score increased from 71 to 83. Clinically, the overall success is 79.7%, and hip replacement was done in 7 of the 59 hips (11.9%). Radiologically, 14 of the 59 hips exhibited femoral head collapse or narrowing of the coxofemoral joint space, and the overall failure rate is 23.7%. The number of BMMCs increased from 12.2 +/- 3.2 x 10(6)/ml to 35.2 +/- 12 x 10(6)/ml between pre-concentration and post-concentration.


CONCLUSIONS
The concentrated autologous bone marrow containing mononuclear cells implantation relieves hip pain, prevents the progression of osteonecrosis. Therefore, it may be the treatment of choice particularly in stages I-II nontraumatic osteonecrosis of the femoral head.
Wang
Bai-Liang
BL
Department of Orthopaedic Surgery, Osteonecrosis and Joint-Preserving and Reconstruction Center, China-Japan Friendship Hospital, Beijing, China. bailiangwang@hotmail.com
Sun
Wei
W
Shi
Zhen-Cai
ZC
Zhang
Nian-Fei
NF
Yue
De-Bo
DB
Guo
Wan-Shou
WS
Xu
Shu-Qing
SQ
Lou
Jin-Ning
JN
Li
Zi-Rong
ZR
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D019299:Decompression, Surgical; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000637:transplantation*; D011446:Prospective Studies; D055815:Young Adult