Clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for osteonecrosis of the femoral head: a minimum 5-year follow-up.
OBJECTIVE
There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH.


METHODS
Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis.


RESULTS
At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results.


CONCLUSIONS
The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures.
Department of Orthopaedic Surgery, Inha University Hospital 7-206, 3-ga, Shinheung-dong, Jung-gu, Incheon 400-103, Korea.
Joon Soon
JS
Kang
Kyoung Ho
KH
Moon
Bom-Soo
BS
Kim
Dae Gyu
DG
Kwon
Sang Hyun
SH
Shin
Byung Ki
BK
Shin
Dong-Jin
DJ
Ryu
D064592:Autografts / Q000000981:diagnostic imaging; D016025:Bone Transplantation; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D045164:Mesenchymal Stem Cell Transplantation; D011859:Radiography; D014182:Transplantation, Autologous; D016896:Treatment Outcome