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Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head.

Zhao D, Liu B, Wang B, Yang L, Xie H, Huang S, Zhang Y, Wei X - Biomed Res Int (2015)

Bottom Line: However, there have been unsatisfactory success rates for end-stage ONFH.The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs) associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH.The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Zhongshan Hospital of Dalian University, Jiefang Street No. 6, Dalian, Liaoning 116001, China.

ABSTRACT
Tantalum rod implantation with vascularized iliac grafting has been reported to be an effective method for the treatment of young patients with osteonecrosis of the femoral head (ONFH) to avert the need for total hip arthroplasty (THA). However, there have been unsatisfactory success rates for end-stage ONFH. The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs) associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH. A total of 24 patients (31 hips) with end-stage ONFH were treated with surgery; ARCO IIIc stage was observed in 19 hips and ARCO IV stage was observed in 12 hips. All patients were followed for a mean time of 64.35 ± 13.03 months (range 26-78). Operations on only five hips were converted to THA. The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV. The mean Harris hip score of the 31 hips improved significantly from 38.74 ± 5.88 points (range 22-50) to 77.23 ± 14.75 points (range 33-95). This intervention was safe and effective in delaying or avoiding total hip replacement for end-stage ONFH.

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Related in: MedlinePlus

To understand how our procedure outcome is after operation, we made a Kaplan-Meier survivorship curve with conversion to total hip arthroplasty as the end point. We set up the time point from 0 month to 80 months on the x-axis. The y-axis shows the survival rate. The blue longer-dotted line shows the survival rate of stage III hips while the green shorter-dotted line shows the survival rate for ARCO stage IV hips. Looking across all of the hips we can see that the joint-preserving success rate of the stage IIIc group was 89.47% 5 years postoperatively while 75% for IV hips and the performance of total hip arthroplasty may emerge during the postoperative 20 months to 60 months. Now we have demonstrated the effect of this technique for end-stage osteonecrosis of the femoral head. However, comparison with a larger group or a control group of patients is necessary to further confirm the effect of this technique.
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fig4: To understand how our procedure outcome is after operation, we made a Kaplan-Meier survivorship curve with conversion to total hip arthroplasty as the end point. We set up the time point from 0 month to 80 months on the x-axis. The y-axis shows the survival rate. The blue longer-dotted line shows the survival rate of stage III hips while the green shorter-dotted line shows the survival rate for ARCO stage IV hips. Looking across all of the hips we can see that the joint-preserving success rate of the stage IIIc group was 89.47% 5 years postoperatively while 75% for IV hips and the performance of total hip arthroplasty may emerge during the postoperative 20 months to 60 months. Now we have demonstrated the effect of this technique for end-stage osteonecrosis of the femoral head. However, comparison with a larger group or a control group of patients is necessary to further confirm the effect of this technique.

Mentions: Five hips were converted to THA by the last follow-up including 2 hips with ARCO stage IIIc disease and 3 hips with ARCO stage IV disease (Figure 3). The average time between the joint-preserving surgery and conversion to THA was 41.20 ± 11.71 months (range, 26–54). The joint-preserving success rate of the entire group was 83.87% 5 years postoperatively, with 89.47% for stage IIIc disease and 75% for stage IV disease (Figure 4). The success rate for stage IV disease was lower compared to the success rate for stage III disease.


Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head.

Zhao D, Liu B, Wang B, Yang L, Xie H, Huang S, Zhang Y, Wei X - Biomed Res Int (2015)

To understand how our procedure outcome is after operation, we made a Kaplan-Meier survivorship curve with conversion to total hip arthroplasty as the end point. We set up the time point from 0 month to 80 months on the x-axis. The y-axis shows the survival rate. The blue longer-dotted line shows the survival rate of stage III hips while the green shorter-dotted line shows the survival rate for ARCO stage IV hips. Looking across all of the hips we can see that the joint-preserving success rate of the stage IIIc group was 89.47% 5 years postoperatively while 75% for IV hips and the performance of total hip arthroplasty may emerge during the postoperative 20 months to 60 months. Now we have demonstrated the effect of this technique for end-stage osteonecrosis of the femoral head. However, comparison with a larger group or a control group of patients is necessary to further confirm the effect of this technique.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352743&req=5

fig4: To understand how our procedure outcome is after operation, we made a Kaplan-Meier survivorship curve with conversion to total hip arthroplasty as the end point. We set up the time point from 0 month to 80 months on the x-axis. The y-axis shows the survival rate. The blue longer-dotted line shows the survival rate of stage III hips while the green shorter-dotted line shows the survival rate for ARCO stage IV hips. Looking across all of the hips we can see that the joint-preserving success rate of the stage IIIc group was 89.47% 5 years postoperatively while 75% for IV hips and the performance of total hip arthroplasty may emerge during the postoperative 20 months to 60 months. Now we have demonstrated the effect of this technique for end-stage osteonecrosis of the femoral head. However, comparison with a larger group or a control group of patients is necessary to further confirm the effect of this technique.
Mentions: Five hips were converted to THA by the last follow-up including 2 hips with ARCO stage IIIc disease and 3 hips with ARCO stage IV disease (Figure 3). The average time between the joint-preserving surgery and conversion to THA was 41.20 ± 11.71 months (range, 26–54). The joint-preserving success rate of the entire group was 83.87% 5 years postoperatively, with 89.47% for stage IIIc disease and 75% for stage IV disease (Figure 4). The success rate for stage IV disease was lower compared to the success rate for stage III disease.

Bottom Line: However, there have been unsatisfactory success rates for end-stage ONFH.The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs) associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH.The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Zhongshan Hospital of Dalian University, Jiefang Street No. 6, Dalian, Liaoning 116001, China.

ABSTRACT
Tantalum rod implantation with vascularized iliac grafting has been reported to be an effective method for the treatment of young patients with osteonecrosis of the femoral head (ONFH) to avert the need for total hip arthroplasty (THA). However, there have been unsatisfactory success rates for end-stage ONFH. The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs) associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH. A total of 24 patients (31 hips) with end-stage ONFH were treated with surgery; ARCO IIIc stage was observed in 19 hips and ARCO IV stage was observed in 12 hips. All patients were followed for a mean time of 64.35 ± 13.03 months (range 26-78). Operations on only five hips were converted to THA. The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV. The mean Harris hip score of the 31 hips improved significantly from 38.74 ± 5.88 points (range 22-50) to 77.23 ± 14.75 points (range 33-95). This intervention was safe and effective in delaying or avoiding total hip replacement for end-stage ONFH.

Show MeSH
Related in: MedlinePlus