Core decompression isolated or combined with bone marrow-derived cell therapies for femoral head osteonecrosis

ABSTRACT

Objectives: The regenerative capabilities of bone marrow-derived cell therapies (BMCTs) have been employed in combination with core decompression (CD) in the management of osteonecrosis of the femoral head to prevent or delay the necessity of total hip arthroplasty (THA).

Methods: The authors conducted a meta-analysis to compare the results of level of evidence I trials comparing CD with and without BMCTs.

Results: Overall, 579 procedures were analyzed: 265 in the CD group and 263 in the CD + BMCTs group. Comparability concerning age and gender, drill size, etiology, and grade of OFNH was found (P > 0.1). At a mean follow up of 82.29 (24 to 360) months, the VAS scored favourably for the CD + BMCTs group (mean difference: −12.88; P < 0.0001), as well the rate of THA (odd ratio: −0.14; P < 0.0001). Time to failure (P = 0.4) and to THA (P = 0.9) was similar between the two groups, as was the rate of failure (P = 0.3).

Conclusion: In patients with femoral head osteonecrosis, core decompression combined with BMCTs demonstrated reduced pain and lower rate of total hip arthroplasty compared to core decompression as an isolated procedure.

KEYWORDS:

• Avascular necrosis
• femoral head
• mesenchymal stem cell treatment
• core decompression
• joint replacement

Author’s contributions statement

Filippo Migliorini: conception, design, analysis, and interpretation of the data, drafting, final approval; Nicola Maffulli: supervision, revision, final approval; Jörg Eschweiler: supervision, final approval; Markus Tingart: supervision, final approval; Alice Baroncini: conception and design, drafting, final approval. All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.