The Journal of Bone and Joint Surgery (American). 2005;87:106-112.
doi:10.2106/JBJS.D.02662
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gangji, V.
Right arrow Articles by Hauzeur, J.-P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gangji, V.
Right arrow Articles by Hauzeur, J.-P.
Related Collections
Right arrow Surgical Techniques
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Treatment of Osteonecrosis of the Femoral Head with Implantation of Autologous Bone-Marrow Cells

Valérie Gangji, MD1 and Jean-Philippe Hauzeur, MD, PhD1

1 Department of Rheumatology and Physical Medicine, Erasme University Hospital, 808 Route de Lennik, 1070 Brussels, Belgium. E-mail address for V. Gangji: vgangji{at}ulb.ac.be

Investigation performed at the Department of Rheumatology and Physical Medicine, Erasme University Hospital, Brussels, Belgium

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 1153-1160, June 2004

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

BACKGROUND:

Aseptic nontraumatic osteonecrosis of the femoral head is a disorder that can lead to femoral head collapse and the need for total hip replacement. Since osteonecrosis may be a disease of mesenchymal cells or bone cells, the possibility has been raised that bone marrow containing osteogenic precursors implanted into a necrotic lesion of the femoral head may be of benefit in the treatment of this condition. For this reason, we studied the implantation of autologous bone-marrow mononuclear cells in a necrotic lesion of the femoral head to determine the effect on the clinical symptoms and the stage and volume of osteonecrosis.

METHODS:

We studied thirteen patients (eighteen hips) with stage-I or II osteonecrosis of the femoral head, according to the system of the Association Research Circulation Osseous. The hips were allocated to a program of either core decompression (the control group) or core decompression and implantation of autologous bone-marrow mononuclear cells (the bone-marrow-graft group). Both patients and assessors were blind with respect to treatment-group assignment. The primary outcomes studied were safety, clinical symptoms, and disease progression.

RESULTS:

After twenty-four months, there was a significant reduction in pain (p = 0.021) and in joint symptoms measured with the Lequesne index (p = 0.001) and the WOMAC index (p = 0.013) within the bone-marrow-graft group. At twenty-four months, five of the eight hips in the control group had deteriorated to stage III, whereas only one of the ten hips in the bone-marrow-graft group had progressed to this stage. Survival analysis showed a significant difference in the time to collapse between the two groups (p = 0.016). Implantation of bone-marrow mononuclear cells was associated with only minor side effects.

CONCLUSIONS:

Implantation of autologous bone-marrow mononuclear cells appears to be a safe and effective treatment for early stages of osteonecrosis of the femoral head. Although the findings of this study are promising, their interpretation is limited because of the small number of patients and the short duration of follow-up. Further study is needed to confirm the results.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
M. A. Mont, G. A. Marulanda, L. C. Jones, K. J. Saleh, N. Gordon, D. S. Hungerford, and M. E. Steinberg
Systematic Analysis of Classification Systems for Osteonecrosis of the Femoral Head
J. Bone Joint Surg. Am., November 1, 2006; 88(suppl_3): 16 - 26.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
Q. Cui, Z. Xiao, X. Li, K. J. Saleh, and G. Balian
Use of Genetically Engineered Bone-Marrow Stem Cells to Treat Femoral Defects: An Experimental Study
J. Bone Joint Surg. Am., November 1, 2006; 88(suppl_3): 167 - 172.
[Abstract] [Full Text] [PDF]