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Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells

  • Orthopaedic Surgery
  • Published:
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Abstract

Background

Since self-limited repair ability of the necrotic lesion may be a cause for failure of the technique, the possibility has been raised that bone marrow mononuclear cells (BMMCs) containing BMSCs implanted into a necrotic lesion of the femoral head with core decompression (CD) may be of benefit in the treatment of this condition. For this reason, we studied the implantation of the concentrated autologous bone marrow containing mononuclear cells in necrotic lesion of the femoral head to determine the effect of the method.

Methods

The study included 45 patients (59 hips, 9 females, 36 males; mean age 37.5 years, range 16–56 years) with stages I–IIIA nontraumatic avascular necrosis of the femoral head according to the system of the Association Research Circulation Osseous. Concentrated bone marrow (30–50 ml) containing mononuclear cells has been gained from autologous bone marrow (100–180 ml) obtained from the iliac crest of patient with the cell processor system. Concentrated bone marrow was injected through a CD channel into the femoral head. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 27.6 months (range 12–40 months).

Results

Pre- and post-operative evaluations showed that the mean Harris hip score increased from 71 to 83. Clinically, the overall success is 79.7%, and hip replacement was done in 7 of the 59 hips (11.9%). Radiologically, 14 of the 59 hips exhibited femoral head collapse or narrowing of the coxofemoral joint space, and the overall failure rate is 23.7%. The number of BMMCs increased from 12.2 ± 3.2 × 106/ml to 35.2 ± 12 × 106/ml between pre-concentration and post-concentration.

Conclusion

The concentrated autologous bone marrow containing mononuclear cells implantation relieves hip pain, prevents the progression of osteonecrosis. Therefore, it may be the treatment of choice particularly in stages I–II nontraumatic osteonecrosis of the femoral head.

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Acknowledgment

This work was supported National Natural Science Foundation of China No 30672117/C03030306.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osteonecrosis and Joint-Preserving and Reconstruction Center, China-Japan Friendship Hospital, 100029, Beijing, China

    Bai-Liang Wang, Wei Sun, Zhen-Cai Shi, Nian-Fei Zhang, De-Bo Yue, Wan-Shou Guo & Zi-Rong Li

  2. Department of Pathophysiology, China-Japan Friendship Hospital, Beijing, China

    Shu-Qing Xu & Jin-Ning Lou

Authors
  1. Bai-Liang Wang
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  2. Wei Sun
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  3. Zhen-Cai Shi
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  4. Nian-Fei Zhang
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  5. De-Bo Yue
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  6. Wan-Shou Guo
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  7. Shu-Qing Xu
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  8. Jin-Ning Lou
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  9. Zi-Rong Li
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Corresponding author

Correspondence to Zi-Rong Li.

Additional information

B.-L. Wang and W. Sun contributed equally to this work.

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Wang, BL., Sun, W., Shi, ZC. et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg 130, 859–865 (2010). https://doi.org/10.1007/s00402-009-0939-0

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  • DOI: https://doi.org/10.1007/s00402-009-0939-0

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