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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2011 December;62(6):423-33
Treatment of avascular necrosis of femoral head by core decompression and use of mesenchymal stem cells and growth factors in clinical experience
Caretti V., Peschiera V., Costa P., Mosconi M., Benazzo F.
Clinica Ortopedica e Traumatologica Fondazione IRCCS Policlinico San Matteo, Pavia, Italia
AIM: The aim of this study was to investigate the results of implantation of concentrated autologous mesenchymal stem cells and platelets growth factors in association with core decompression as first choice treatment in early stages of osteonecrosis of the femoral head.
METHODS: We studied 12 patients (14 hips) with avascular necrosis at early stages (one hip stage I, ten stage II, three stage III) according to Arlet and Ficat system. The aspirated marrow was reduced in volume by centrifugation in order to preserve only mesenchymal stem cells. A concentrate of platelet rich of growth factors obtained by the same technique was added to the graft.
RESULTS:The mean follow-up was 2.6 years. Total hip replacement was necessary in 2 hips among the 14 hips operated, both in stage III at the time of surgery. Nine hips with stage I-II osteonecrosis of femoral head at the time of surgery demonstrated complete resolution of clinical symptoms and no desease progression based on preoperative and post operative MRI studies. The remaining three hips (two patients) with stage II-III demonstrated improvement in clinical symptoms in comparison to the time before surgery but these patients still referred functional limitation and pain.
CONCLUSION: According to our experience, concentrated autologous mesenchymal stem cells and platlet growth factors implantation after core decompression relieves hip pain and functional limitation and prevents the progression of osteonecrosis in selected patients. Therefore, it is likely to be first choice treatment in stages I-II of osteonecrosis of the femoral head.