Nakul S Talathi1, Atul F Kamath1. 1. Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
Abstract
OBJECTIVE: Avascular necrosis (AVN) of the femoral head is a painful, progressive disease that can lead to limited mobility and early hip replacement. Autologous stem cell implantation into the necrotic lesion of the femoral head has been described, on the basis that patients with AVN have a reduced number of stem cells in the marrow. In this study, we aim to describe our technique for decompression of the hip with autologous implantation of stem cells for AVN of the femoral head, as well as retrospectively analyze our results. METHODS: The records and imaging of patients with avascular necrosis of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with the combination of core decompression with autologous stem cell implantation from the iliac crest. Preoperatively, demographic information, stage of AVN per Association Research Circulation Osseous (ARCO) classification on magnetic resonance imaging and radiograph, and visual analogue pain scores (VAS) of the hip were recorded. Postoperatively, VAS were recorded and imaging was reviewed for progression of AVN or evidence of femoral head collapse. Statistical analysis was conducted comparing pre and postoperative VAS scores. RESULTS: Overall, we treated 43 hips in 28 patients with autologous stem cell implantation, with an average follow up of 16 months. Patients ranged from ARCO Ia to ARCO IIc classification of AVN. The average pre-operative visual analogue scale (VAS) of pain was 7.8. Post operatively, the average VAS score decreased to 2.5 (p < 0.0001), with 78% of patients reporting at least a 50% decrease in pain. 40 of the 43 operatively treated hips showed no radiologic progression of the disease during the follow up period, while 3 of the 43 hips had evidence of femoral head collapse and needed subsequent total hip arthroplasty at an average of 17 months after the initial decompression. CONCLUSION: Our findings indicate that hip compression with autologous stem cell implantation for AVN of the femoral head provides significant symptomatic relief and may be beneficial in arresting progression of disease.
OBJECTIVE: Avascular necrosis (AVN) of the femoral head is a painful, progressive disease that can lead to limited mobility and early hip replacement. Autologous stem cell implantation into the necrotic lesion of the femoral head has been described, on the basis that patients with AVN have a reduced number of stem cells in the marrow. In this study, we aim to describe our technique for decompression of the hip with autologous implantation of stem cells for AVN of the femoral head, as well as retrospectively analyze our results. METHODS: The records and imaging of patients with avascular necrosis of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with the combination of core decompression with autologous stem cell implantation from the iliac crest. Preoperatively, demographic information, stage of AVN per Association Research Circulation Osseous (ARCO) classification on magnetic resonance imaging and radiograph, and visual analogue pain scores (VAS) of the hip were recorded. Postoperatively, VAS were recorded and imaging was reviewed for progression of AVN or evidence of femoral head collapse. Statistical analysis was conducted comparing pre and postoperative VAS scores. RESULTS: Overall, we treated 43 hips in 28 patients with autologous stem cell implantation, with an average follow up of 16 months. Patients ranged from ARCO Ia to ARCO IIc classification of AVN. The average pre-operative visual analogue scale (VAS) of pain was 7.8. Post operatively, the average VAS score decreased to 2.5 (p < 0.0001), with 78% of patients reporting at least a 50% decrease in pain. 40 of the 43 operatively treated hips showed no radiologic progression of the disease during the follow up period, while 3 of the 43 hips had evidence of femoral head collapse and needed subsequent total hip arthroplasty at an average of 17 months after the initial decompression. CONCLUSION: Our findings indicate that hip compression with autologous stem cell implantation for AVN of the femoral head provides significant symptomatic relief and may be beneficial in arresting progression of disease.
Authors: Michael A Mont; Hytham S Salem; Nicolas S Piuzzi; Stuart B Goodman; Lynne C Jones Journal: J Bone Joint Surg Am Date: 2020-06-17 Impact factor: 6.558