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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 December;59(6):365-72
Cell therapy of hip osteonecrosis with autologous bone marrow grafting
Hernigou P., Zilber S., Filippini P., Chouk A., Rouard H., Poignard A.
Hospital Henri Mondor, University Paris XII, Creteil, France
Between 1990 and 2000, 342 patients (534 hips) with a vascular osteonecrosis at early stages (Stage I and Stage II) were treated with decompression and autologous bone marrow grafting. In the current series, grafting was done with autologous bone marrow obtained from the iliac crest of patients operated on for osteonecrosis of the hip. From 1990 to 2000, 1 359 hips with osteonecrosis were operated on; therefore, the 534 hips in the current series represent only 39% of the hips with osteonecrosis treated at the current authors’ institution. The bone marrow was harvested with the patient under general anesthesia. The usual sites were the anterior iliac crests. The aspirated marrow was reduced in volume by concentration and injected into the femoral head after core decompression with a small trocar. To measure the number of progenitor cells transplanted, the fibroblast colony forming unit was used as an indicator of the stroma cell activity. Total hip replacement was necessary in 94 hips (evolution to collapse) among the 534 hips operated before collapse (Stage I and Stage II). Sixty-nine hips demonstrated total resolution of osteonecrosis based on preoperative and postoperative MRI studies; these hips did not show any changes on plain radiographs: All these 69 hips had stage I osteonecrosis of the femoral head at the time of treatment with autologous bone marrow grafting. Patients who had the greater number of progenitor cells transplanted in their hips had better outcomes.