title: Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells.
abstract: BACKGROUND
  Treatment of early-stage osteonecrosis of the femoral head (ONFH) with autologous implantation of iliac crest bone marrow-derived mononuclear cells, which contain tens of thousands of bone marrow mesenchymal stem cells (BMMSCs), recently achieved a promising outcome.
  
  
  METHODS
  One hundred patients with early-stage ONFH were recruited and randomly assigned to BMMSC treatment or core decompression (CD) treatment. Each BMMSC-treated hip received femoral head (FH) implantation of 2×10(6) autologous subtrochanteric bone marrow-derived and ex vivo expanded BMMSCs. The radiographic stage of ONFH according to the Association Research Circulation Osseous classification, Harris hip score (HHS), and the volume of the necrotic lesion or the low signal intensity zone (LowSIZ) in the FH were assessed before and 6, 12, 24, and 60 months after the initial operation.
  
  
  RESULTS
  Sixty months after the operation, only 2 of the 53 BMMSC-treated hips progressed and underwent vascularized bone grafting. In CD group, 7 hips lost follow-up, and 10 of the rest 44 hips progressed and underwent vascularized bone grafting (5 hips) or total hip replacement (5 hips). Compared with the CD group, BMMSC treatment significantly improved the HHS as well as decreased the volume of femoral head LowSIZ of the hips preoperatively classified at stage IC, IIB, and IIC (P<0.05, respectively; stage IIA, P=0.06, respectively). No complication was observed in both treatment groups.
  
  
  CONCLUSIONS
  Ex vivo expansion of autologous BMMSCs can reliably provide a greater number of BMMSCs for FH implantation. This intervention is safe and effective in delaying or avoiding FH collapse, which may necessitate total hip replacement.
authors.affiliation: Department of Biomedical Engineering, Dalian University of Technology, Dalian, Liaoning, 116023, China. dwzhao.md@gmail.com
authors.forename: Dewei
authors.initials: D
authors.lastname: Zhao
authors.forename: Daping
authors.initials: D
authors.lastname: Cui
authors.forename: Benjie
authors.initials: B
authors.lastname: Wang
authors.forename: Fengde
authors.initials: F
authors.lastname: Tian
authors.forename: Lin
authors.initials: L
authors.lastname: Guo
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
authors.forename: Baoyi
authors.initials: B
authors.lastname: Liu
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Yu
mesh_terms: D016026:Bone Marrow Transplantation; D005271:Femur Head Necrosis / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D045164:Mesenchymal Stem Cell Transplantation; D010020:Osteonecrosis / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome