title: Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head.
abstract: Avascular necrosis (AVN) of the femoral head is a debilitating disease of multifactorial genesis, predominately affects young patients, and often leads to the development of secondary osteoarthritis. The evolving field of regenerative medicine offers promising treatment strategies using cells, biomaterial scaffolds, and bioactive factors, which might improve clinical outcome. Early stages of AVN with preserved structural integrity of the subchondral plate are accessible to retrograde surgical procedures, such as core decompression to reduce the intraosseous pressure and to induce bone remodeling. The additive application of concentrated bone marrow aspirates, ex vivo expanded mesenchymal stem cells, and osteogenic or angiogenic growth factors (or both) holds great potential to improve bone regeneration. In contrast, advanced stages of AVN with collapsed subchondral bone require an osteochondral reconstruction to preserve the physiological joint function. Analogously to strategies for osteochondral reconstruction in the knee, anterograde surgical techniques, such as osteochondral transplantation (mosaicplasty), matrix-based autologous chondrocyte implantation, or the use of acellular scaffolds alone, might preserve joint function and reduce the need for hip replacement. This review summarizes recent experimental accomplishments and initial clinical findings in the field of regenerative medicine which apply cells, growth factors, and matrices to address the clinical problem of AVN.
authors.affiliation: Orthopaedic Center for Musculoskeletal Research, Department of Orthopaedic Surgery König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstrasse 11, 97074 Würzburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Rackwitz
authors.forename: Lars
authors.initials: L
authors.lastname: Eden
authors.forename: Stephan
authors.initials: S
authors.lastname: Reppenhagen
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Reichert
authors.forename: Franz
authors.initials: F
authors.lastname: Jakob
authors.forename: Heike
authors.initials: H
authors.lastname: Walles
authors.forename: Oliver
authors.initials: O
authors.lastname: Pullig
authors.forename: Rocky S
authors.initials: RS
authors.lastname: Tuan
authors.forename: Maximilian
authors.initials: M
authors.lastname: Rudert
authors.forename: Ulrich
authors.initials: U
authors.lastname: Nöth
mesh_terms: D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D005271:Femur Head Necrosis / Q000628:therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D017228:Hepatocyte Growth Factor / Q000627:therapeutic use; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use*; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D044968:Regenerative Medicine; D019089:Stem Cell Factor / Q000627:therapeutic use; D042461:Vascular Endothelial Growth Factor A / Q000627:therapeutic use
chemical_list: D019485:Bone Morphogenetic Proteins; D036341:Intercellular Signaling Peptides and Proteins; D019089:Stem Cell Factor; D042461:Vascular Endothelial Growth Factor A; D016179:Granulocyte Colony-Stimulating Factor; D017228:Hepatocyte Growth Factor