Mid-term comparative outcomes of autologous bone-marrow concentration to treat osteonecrosis of the femoral head in standard practice.
OBJECTIVE
To evaluate mid-term effectiveness of core decompression (CD) followed by injection of bone-marrow concentration (BMC) in osteonecrosis of the femoral head (ONFH) compared with CD alone.


METHODS
We retrospectively studied 60 hips in 45 patients with ONFH Ficat I-II after a mean follow-up of 45 (range 24-171) months. Group A (19 hips) were treated with CD, and Group B (41 hips) with CD plus autologous BMC. Necrotic lesions were classified according to MRI findings in: (i) the lesion angle; and (ii) the relation of the necrotic area to the weight-bearing portion. Outcomes included clinical changes and radiographic femoral head collapse. Risk factors associated with radiological collapse were evaluated by Cox regression analysis.


RESULTS
Postoperative Merlé D´Aubigne and Postel hip score was similar in both groups. Femoral head collapse was observed in 10/19 hips in Group A and 22/41 in Group B. At 24 months, the probability of not having a collapse was 56.4% (95% CI, 33.6%-79.1%) for Group A and 57.6% (95% CI, 41.7%-73.4%) for Group B (p = 0.47). The risk of collapse increased in hips with a lesion angle higher than 150° (p&lt;0.02, hazard risk [HR] 4.073) in both groups.


CONCLUSIONS
With the standard BMC technique performed without monitoring the number of progenitors in the concentrate, we are uncertain to observe a significant decrease in femoral head collapse compared to CD alone. Improved outcomes may require the monitoring of progenitor cells injected into the femoral head, particularly in large lesions.
Orthopaedic Surgery Department, Hospital La Paz, Madrid - Spain.
Ana
A
Cruz-Pardos
Orthopaedic Surgery Department, Hospital La Paz, Madrid - Spain.
Eduardo
E
Garcia-Rey
Orthopaedic Surgery Department, Hospital La Paz, Madrid - Spain.
Jose A
JA
Ortega-Chamarro
Orthopaedic Surgery Department, Hospital La Paz, Madrid - Spain.
David
D
Duran-Manrique
Orthopaedic Surgery Department, Hospital La Paz, Madrid - Spain.
Enrique
E
Gomez-Barrena
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001853:Bone Marrow; D016026:Bone Marrow Transplantation; D019299:Decompression, Surgical; D005260:Female; D005270:Femur Head; D005271:Femur Head Necrosis / Q000601:surgery* / Q000628:therapy*; D006615:Hip; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult