Nicolas S Piuzzi1, Jorge Chahla2, John B Schrock3, Robert F LaPrade4, Cecilia Pascual-Garrido3, Michael A Mont5, George F Muschler6. 1. Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Instituto Universitario del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. 2. Department of Biomedical Engineering, Steadman Philippon Research Institute, Vail, Colorado. 3. Department of Orthopaedics, University of Colorado, Aurora, Colorado. 4. Instituto Universitario del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; The Steadman Clinic, Vail, Colorado. 5. Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio. 6. Department of Orthopaedics, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Cell-therapy has been promoted among the therapeutic arsenal that can aid in bone formation and remodeling, in early stages of osteonecrosis of the femoral head (ONFH). The purpose of this systematic review was to assess the evidence supporting the (1) clinical efficacy; (2) structural modifying effect, as evaluated radiographically; (3) revision rates; and (4) safety of cell-therapy for the treatment of ONFH. METHODS: A systematic review was performed including studies with a level-of-evidence of III or higher. A total of 1483 articles were screened. Eleven studies met the criteria for inclusion in this review (level-of-evidence: 6 level-I, 1 level-II, and 4 level-III), including 683 cases of ONFH. RESULTS: All 10 studies that reported patient-reported outcomes showed improved outcomes in the cell-therapy groups compared with the control group. Overall, 24.5% (93/380 hips) that received cell-therapy showed radiographic progression compared with 40% (98/245 hips) in the control group. Nine of 10 studies that reported failure rates showed a lower total hip arthroplasty conversion rate in the cell-therapy group 16% (62/380 hips) compared with the control group 21% (52/252 hips). There was a low complication rate (<3%) with no major adverse effects. CONCLUSION: Cell-therapies for the treatment of ONFH have been reported to be safe and suggest improved clinical outcomes with lower disease progression rate. However, there was substantial heterogeneity in the included studies, and in the cell-based therapies used. Specific clinical indications and cell-therapy standardization are required because studies varied widely with respect to cell sourcing, cell characterization, adjuvant therapies, and assessment of outcomes.
BACKGROUND: Cell-therapy has been promoted among the therapeutic arsenal that can aid in bone formation and remodeling, in early stages of osteonecrosis of the femoral head (ONFH). The purpose of this systematic review was to assess the evidence supporting the (1) clinical efficacy; (2) structural modifying effect, as evaluated radiographically; (3) revision rates; and (4) safety of cell-therapy for the treatment of ONFH. METHODS: A systematic review was performed including studies with a level-of-evidence of III or higher. A total of 1483 articles were screened. Eleven studies met the criteria for inclusion in this review (level-of-evidence: 6 level-I, 1 level-II, and 4 level-III), including 683 cases of ONFH. RESULTS: All 10 studies that reported patient-reported outcomes showed improved outcomes in the cell-therapy groups compared with the control group. Overall, 24.5% (93/380 hips) that received cell-therapy showed radiographic progression compared with 40% (98/245 hips) in the control group. Nine of 10 studies that reported failure rates showed a lower total hip arthroplasty conversion rate in the cell-therapy group 16% (62/380 hips) compared with the control group 21% (52/252 hips). There was a low complication rate (<3%) with no major adverse effects. CONCLUSION: Cell-therapies for the treatment of ONFH have been reported to be safe and suggest improved clinical outcomes with lower disease progression rate. However, there was substantial heterogeneity in the included studies, and in the cell-based therapies used. Specific clinical indications and cell-therapy standardization are required because studies varied widely with respect to cell sourcing, cell characterization, adjuvant therapies, and assessment of outcomes.
Authors: Venkata P Mantripragada; Nicolas S Piuzzi; Jaiben George; Wesley Bova; Mitchell Ng; Cynthia Boehm; George F Muschler Journal: Regen Med Date: 2019-07-19 Impact factor: 3.806
Authors: Andreas Roth; Johannes Beckmann; Klaus Bohndorf; Christian Heiß; Marcus Jäger; Stefan Landgraeber; Uwe Maus; Ulrich Nöth; Klaus M Peters; Christof Rader; Stephan Reppenhagen; Ulrich Smolenski; Ina Kopp; Markus Tingart Journal: Orthopade Date: 2018-09 Impact factor: 1.087
Authors: Joseph Purita; José Fábio Santos Duarte Lana; Morey Kolber; Bruno Lima Rodrigues; Tomas Mosaner; Gabriel Silva Santos; Carolina Caliari-Oliveira; Stephany Cares Huber Journal: World J Stem Cells Date: 2020-04-26 Impact factor: 5.326