Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion

Osteonecrosisfrequentlycausesfemoralheadcollapseanddisablingarthritis,whichultimatelyleadstototaljointreplacement.Ahighfailurerateofjointreplacementunderscoresthejoint preservingprocedures.Varioussurgicaltechniques havebeenusedasatherapyforosteonecrosisofthe femoralhead,whichincludecoredecompressionalone orwithnonvascualrizedorvascularizedbonegraft(DBM,IBG,vascularizedfibulaetc.).1Sofar,the mechanismoftheosteonecrosisisstillunclear(except traumatic),andthereisnouniversalmethodforit especiall…

Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion

Objective: To evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell (BMCs) infusion. Methods: 44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages. Results: No complications were observed after the operation. Before operation, there were stage I of femoral head necrosis in 8 hips, stage II in 15 hips, stage III in 14 hips, stage IV in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage I in 6 hips, stage II in 13 hips, stage III in 13 hips, stage IV in 7 hips, stage V in 4 hips. The mean preoperative Harris hip score was 58 (46-89), and improved to 86 (70-94) postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30%. Conclusions: Percutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.