Koji Goto1, Tomoki Aoyama2, Junya Toguchida3, Yutaka Kuroda1, Toshiyuki Kawai1, Yaichiro Okuzu1, Shuichi Matsuda1. 1. Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan. 2. Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Center for IPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: A prospective, open-label clinical trial, in which transplantation of cultured autologous bone marrow-derived multipotent mesenchymal stromal cells in combination with vascularised bone grafts for the treatment of post-collapse extensive osteonecrosis of the femoral head in ten patients, was conducted previously. The aim of this study was to assess the 10-year clinical and radiographic results of that study. METHODS: Patients were evaluated for radiographic progression of osteonecrosis of the femoral head using anteroposterior radiographs at 10 years postoperatively. Clinical score and hip function, including the timed up and go test, were also estimated. RESULTS: Osteoarthritic changes in the affected hip were found in five of the ten patients, two of whom had undergone total hip arthroplasty at 7 and 9 years postoperatively. Five of the six cases (83.3%) in which pre-operative femoral head collapse was less than 3 mm, had no further collapse. On the other hand, all four cases in which pre-operative femoral head collapse was ≥3 mm, showed osteoarthritic changes within 10 years. The average clinical score significantly improved postoperatively and was maintained at 10 years. CONCLUSIONS: Considering that eight of 10 post-collapse cases could avoid total hip arthroplasty conversion with good clinical results for 10 years and five of 6 post-collapse cases (collapse <3 mm) could avoid further collapse and osteoarthritic changes for 10 years, mesenchymal stromal cell transplantation in combination with vascularised bone grafts could be an effective treatment for post-collapse osteonecrosis of the femoral head.
BACKGROUND: A prospective, open-label clinical trial, in which transplantation of cultured autologous bone marrow-derived multipotent mesenchymal stromal cells in combination with vascularised bone grafts for the treatment of post-collapse extensive osteonecrosis of the femoral head in ten patients, was conducted previously. The aim of this study was to assess the 10-year clinical and radiographic results of that study. METHODS: Patients were evaluated for radiographic progression of osteonecrosis of the femoral head using anteroposterior radiographs at 10 years postoperatively. Clinical score and hip function, including the timed up and go test, were also estimated. RESULTS: Osteoarthritic changes in the affected hip were found in five of the ten patients, two of whom had undergone total hip arthroplasty at 7 and 9 years postoperatively. Five of the six cases (83.3%) in which pre-operative femoral head collapse was less than 3 mm, had no further collapse. On the other hand, all four cases in which pre-operative femoral head collapse was ≥3 mm, showed osteoarthritic changes within 10 years. The average clinical score significantly improved postoperatively and was maintained at 10 years. CONCLUSIONS: Considering that eight of 10 post-collapse cases could avoid total hip arthroplasty conversion with good clinical results for 10 years and five of 6 post-collapse cases (collapse <3 mm) could avoid further collapse and osteoarthritic changes for 10 years, mesenchymal stromal cell transplantation in combination with vascularised bone grafts could be an effective treatment for post-collapse osteonecrosis of the femoral head.
Authors: Byung-Ho Yoon; Michael A Mont; Kyung-Hoi Koo; Chung-Hwan Chen; Edward Y Cheng; Quanjun Cui; Wolf Drescher; Valerie Gangji; Stuart B Goodman; Yong-Chan Ha; Philippe Hernigou; Marc W Hungerford; Richard Iorio; Woo-Lam Jo; Lynne C Jones; Vikas Khanduja; Harry K W Kim; Shin-Yoon Kim; Tae-Young Kim; Hee Young Lee; Mel S Lee; Young-Kyun Lee; Yun Jong Lee; Junichi Nakamura; Javad Parvizi; Takashi Sakai; Nobuhiko Sugano; Masaki Takao; Takuaki Yamamoto; De-Wei Zhao Journal: J Arthroplasty Date: 2019-11-27 Impact factor: 4.757
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