Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

Soo-Ho Lee; Gyeong-Bo Sim; Jun-Bum Lee; Won-Kyeong Kim

doi:10.5371/hp.2014.26.1.7

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Lee, Sim, Lee, and Kim: Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

Original Article

Hip & Pelvis 2014; 26(1): 7-13.

Published online: 31 March 2014

DOI: https://doi.org/10.5371/hp.2014.26.1.7

Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

Soo-Ho Lee, MD, Gyeong-Bo Sim, MD, Jun-Bum Lee, MD, Won-Kyeong Kim, MD

Department of Orthopedic Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.

Address reprint request to Gyeong-Bo Sim, MD. Department of Orthopedic Surgery, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. TEL: +82-2-3010-0834, FAX: +82-2-488-7877, alert79@hanmail.net

Received 31 July 2013 Revised 20 February 2014 Accepted 21 February 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated mid-term clinical and radiological results of autologous bone marrow transplantation (BMT) for early stage osteonecrosis of the femoral head (ONFH) and analyzed prognostic factors.

Materials and Methods

From November 2003 to April 2008, 101 hips of 93 patients with early stage ONFH who underwent autologous BMT were followed for at least five years. For clinical results, preoperative and postoperative Harris hip scores (HHS) were evaluated and survival rate was obtained at the point of performing total hip arthroplasty or femoral head collapse progression. Radiologic results were assessed by changes in necrosis size on magnetic resonance imaging performed preoperative and postoperatively. For evaluation of prognostic factors, survival rate was analyzed according to age, gender, etiology, stage, necrosis size, and location.

Results

Averaged HHS at latest follow up showed no significant change in comparison with preoperative HHS. Of 101 hips, 35 hips required arthroplasty and six hips were running head collapse. Groups with use of steroid, lateral location of necrosis, large size of necrosis, or large necrotic angles showed lower survival rate. However, age, gender, and stage had no effect.

Conclusion

In early days, autologous BMT for early ONFH can be considered as a treatment for improvement of clinical features and delay of radiologic progress. However, after some years, there was no effect compared with the natural course of ONFH.

Keywords: Osteonecrosis of the femoral head, Autologous bone marrow transplantation, Risk factors

Figures and Tables

Fig. 1

Forty-eight-year old male with osteonecrosis of the both femoral heads. To check amount of osteonecrosis, we evaluated T1-weighted coronal and sagittal magnetic resonance image. (A) Relative value of the osteonecrosis was evaluated by the tool measuring size in the picture archiving and communication system (PACS). (B) Necrotic angle of the osteonecrosis was evaluated by the tool measuring angle in the PACS.

Table 1

Survival Rate according to the Stage

P-value=0.111

THA: total hip arthroplasty

Table 2

Survival Rate according to the Size of the Necrosis and Necrotic Angle

^*RV-a=RV-c+RV-s / 2, ^†Sum=NA-c+NA-s.

RV: relative value, RV-a: average RV, RV-c: RV in coronal image, RV-s: RV in saggital image, NA: necrotic angle, NA-c: NA in coronal image, NA-s: NA in saggital image.

Table 3

Survival Rate according to the Location of the Necrosis

P-value=0.07

THA: total hip arthroplasty

Notes

The abstract of this article has been presented at the 57th Annual Meeting of the Korean Hip Society (2013).

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