Treatment of osteonecrosis of the femoral head: combination of operation and multiple cellular mediators.

The goal in the treatment of osteonecrosis of the femoral head is to preserve, not replace, the femoral head. Although many methods have been proposed, none has proved completely satisfactory. Cellular mediators as a supplement to bone grafting and decompression is an attractive approach to this problem because it combines the desirable features of other procedures, each of which has shown a certain degree of effectiveness in stimulating bone growth and repair. Basic and clinical researches have shown the efficacy of various cellular mediators (bone morphogenetic proteins, interleukins, angiogenic growth factors, etc.) in healing bone defects. The potential application of these cellular mediators to other musculoskeletal conditions, including osteonecrosis of the femoral head, only recently has been explored. The surgical alternatives may include core decompression, osteotomy, nonvascularized, and vascularized bone grafting, which might be enhanced with the use of cellular mediators. At least three of these factors are potential candidates as therapeutic modalities: cytokines, bone morphogenetic proteins, and angiogenic factors. Therefore, we hypothesized that the combination of operation and multiple cellular mediators is an attractive method to preserve the femoral head for the therapy of osteonecrosis of the femoral head.