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      Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress

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          Abstract

          Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis.

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          Bone histomorphometry: standardization of nomenclature, symbols, and units. Report of the ASBMR Histomorphometry Nomenclature Committee.

          A Parfitt, M K Drezner, F Glorieux … (1987)
          Article 0 comments Cited 619 times – based on 0 reviews     Review now
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            Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells.

            Dewei Zhao, Daping Cui, Benjie Wang … (2012)
            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. 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. 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. 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. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Autologous bone marrow cell implantation in the treatment of non-traumatic osteonecrosis of the femoral head: Five year follow-up of a prospective controlled study.

              Valérie Gangji, Jean-Philippe Hauzeur, Viviane de Oliveira (2011)
              To determine the efficacy of bone marrow cell implantation into the necrotic lesion of the femoral head on clinical symptoms and the progression of osteonecrosis of the femoral head in comparison with core decompression. We studied nineteen patients and twenty four hips with early stage osteonecrosis of the femoral head. The hips were allocated to either core decompression only or core decompression and implantation of bone marrow cells. Both patients and assessors were blind with respect to treatment group assignment. The primary outcomes were clinical symptoms and disease progression. Bone marrow implantation afforded a significant reduction in pain and in joint symptoms and reduced the incidence of fractural stages. At 60 months, eight of the eleven hips in the control group had deteriorated to the fractural stage whereas only three of the thirteen hips in the bone marrow graft group had progressed to that stage. Survival analysis showed a significant difference in the time to failure between the two groups at 60 months. Patients had only minor side-effects after the treatments. This long term follow-up study confirmed that implantation of autologous bone marrow cells in the necrotic lesion might be an effective treatment for patients with early stages of osteonecrosis of the femoral head. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Orthop Surg
                Journal ID (iso-abbrev): Clin Orthop Surg
                Journal ID (publisher-id): CIOS
                Title: Clinics in Orthopedic Surgery
                Publisher: The Korean Orthopaedic Association
                ISSN (Print): 2005-291X
                ISSN (Electronic): 2005-4408
                Publication date (Print): March 2016
                Publication date (Electronic): 13 February 2016
                Volume: 8
                Issue: 1
                Pages: 1-8
                Affiliations
                Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France.
                [* ]EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France.
                Author notes
                Correspondence to: Philippe Hernigou, MD. Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil 94010, France. Tel: +33-1-49-81-26-01, Fax: +33-1-49-81-26-08, philippe.hernigou@ 123456wanadoo.fr
                Article
                DOI: 10.4055/cios.2016.8.1.1
                PMC ID: 4761591
                PubMed ID: 26929793
                SO-VID: 973f2864-e7d7-41c7-9430-efebb7585481
                Copyright © Copyright © 2016 by The Korean Orthopaedic Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 January 2016
                Date accepted : 09 January 2016
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Surgery
                Keywords: hip,osteonecrosis,cell therapy,mesenchymal stromal cells,tissue engineering
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: hip, osteonecrosis, cell therapy, mesenchymal stromal cells, tissue engineering

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