Core decompression combined with intralesional autologous bone marrow derived cell therapies for osteonecrosis of the femoral head in adults: A systematic review and meta-analysis |
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| Affiliation: | 1. Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA;2. Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA;3. Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA;4. Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA;1. Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar;2. Department of Surgery, Hamad Medical Corporation, Doha, Qatar;3. College of Medicine, Qatar University, Doha, Qatar;4. College of Medicine, University of Glasgow, Glasgow, UK;1. Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Germany;2. Institute of Psychology III, Unit of Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Germany;3. Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;4. Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;5. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Dresden, Dresden, Germany;1. Department of Hepatobiliary and Transplant Surgery, St. Vincent''s University Hospital, Elm Park, Dublin 4, Ireland;2. Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland;3. Department of Pathology, St. Vincent''s University Hospital, Elm Park, Dublin, Ireland;1. Breast Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom;2. Breast Surgery, Royal Hampshire County Hospital, Hampshire, United Kingdom;3. The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom;4. Breast Surgery, Glenfield Hospital, Groby Road, Leicester, United Kingdom;5. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom;1. Department of General Surgery, Aberdeen Royal Infirmary, United Kingdom;2. Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom;3. Cancer Audit Team, NHS Grampain, United Kingdom;4. Health Services Research Unit, University of Aberdeen, United Kingdom |
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| Abstract: | BackgroundCore decompression (CD) is beneficial in the early stage of osteonecrosis of the femoral head (ONFH). Adjunctive bone marrow derived cell therapies (BMDCT) have been advocated which potentially aid the regenerative process.Question/purpose:This study was conducted to determine potential benefit of CD + BMDCT in ONFH, in terms of disease progression, conversion to arthroplasty (primary outcomes), and functional outcomes and complication rates (secondary outcomes).MethodsA systematic review of literature was performed on 3 databases. Studies reporting CD + BMDCT (intralesional instillation) in ONFH, with a minimum follow up of 1 year and reporting the pre-defined outcome measures were included in the review. Meta-analysis consisted of two different arms: a comparative arm, to compare CD + BMDCT to CD alone, and a non-comparative meta-analysis arm, to determine pooled rates of disease progression, conversion to arthroplasty and complication rates.ResultsA total of 18 studies were included in the systematic review. CD + BMDCT had lower rates of disease progression (OR 0.19 [95% CI, 0.09, 0.40]) and conversion to arthroplasty (OR 0.20 [95% CI, 0.11, 0.40]) as compared to CD alone. Functional score (MD = −7.07 [95% CI, −12.28, −1.86]) and visual analog scale also showed better improvement with the use of CD + BMAC (MD = −10.39 [95% CI, −12.87, −7.90]). Increasing age and post-collapse stage at presentation were noted to have an adverse effect on the outcomes.ConclusionCD + BMDCT was found to decrease disease progression and conversion to arthroplasty, and was noted to have better functional outcome scores as compared to CD alone. |
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| Keywords: | Stem cells Osteonecrosis femoral head Total hip replacement Disease progression |
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