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The role of "cell therapy" in osteonecrosis of the femoral head. A systematic review of the literature and meta-analysis of 7 studies.

Papakostidis C, Tosounidis TH, Jones E, Giannoudis PV - Acta Orthop (2015)

Bottom Line: The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR).The pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08-0.6; p = 0.02).The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3-1.02; p = 0.06).

View Article: PubMed Central - PubMed

Affiliation: a 1 Department of Trauma and Orthopaedics, G. Hatzikostas General Hospital , Ioannina, Greece.

ABSTRACT

Background and purpose: The value of core decrompression for treatment of osteonecrosis of the femoral head (ONFH) is unclear. We investigated by a literature review whether implantation of autologous bone marrow aspirate, containing high concentrations of pluripotent mesenchymal stem cells, into the core decompression track would improve the clinical and radiological results compared with the classical method of core decompression alone. The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR).

Patients and methods: All randomized and non-randomized control trials comparing simple core decompression with autologous bone marrow cell implantation into the femoral head for the treatment of ONFH were considered eligible for inclusion. The methodological quality of the studies included was assessed independently by 2 reviewers using the Cochrane Collaboration tool for assessing risk of bias in randomized studies. Of 496 relevant citations identified, 7 studies formed the basis of this review.

Results: The pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08-0.6; p = 0.02). The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3-1.02; p = 0.06).

Interpretation: Our findings suggest that implantation of autologous mesenchymal stem cells (MSCs) into the core decompression track, particularly when employed at early (pre-collapse) stages of ONFH, would improve the survivorship of femoral heads and reduce the need for hip arthroplasty.

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Forest plot of structural failure of the femoral head.
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Figure 0004: Forest plot of structural failure of the femoral head.

Mentions: Structural failure (collapse) of the femoral head (FH). 6 studies (with 421 participants) provided relevant data (Yamasaki et al. 2010, Gangji et al. 2011, Zhao et al. 2012, Lim et al. 2013, Liu et al. 2013, Ma et al. 2014). The pooled estimate of effect size for structural failure of the FH favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were shown to be decreased by 5 times compared to the control (CD) group (OR = 0.2, 95% CI: 0.08–0.6; p = 0.02). However, this result should be interpreted with caution due to the presence of significant statistical heterogeneity (I2 = 68%, Q-test = 16, df = 5, and p = 0.008) (Figure 4).


The role of "cell therapy" in osteonecrosis of the femoral head. A systematic review of the literature and meta-analysis of 7 studies.

Papakostidis C, Tosounidis TH, Jones E, Giannoudis PV - Acta Orthop (2015)

Forest plot of structural failure of the femoral head.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940596&req=5

Figure 0004: Forest plot of structural failure of the femoral head.
Mentions: Structural failure (collapse) of the femoral head (FH). 6 studies (with 421 participants) provided relevant data (Yamasaki et al. 2010, Gangji et al. 2011, Zhao et al. 2012, Lim et al. 2013, Liu et al. 2013, Ma et al. 2014). The pooled estimate of effect size for structural failure of the FH favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were shown to be decreased by 5 times compared to the control (CD) group (OR = 0.2, 95% CI: 0.08–0.6; p = 0.02). However, this result should be interpreted with caution due to the presence of significant statistical heterogeneity (I2 = 68%, Q-test = 16, df = 5, and p = 0.008) (Figure 4).

Bottom Line: The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR).The pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08-0.6; p = 0.02).The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3-1.02; p = 0.06).

View Article: PubMed Central - PubMed

Affiliation: a 1 Department of Trauma and Orthopaedics, G. Hatzikostas General Hospital , Ioannina, Greece.

ABSTRACT

Background and purpose: The value of core decrompression for treatment of osteonecrosis of the femoral head (ONFH) is unclear. We investigated by a literature review whether implantation of autologous bone marrow aspirate, containing high concentrations of pluripotent mesenchymal stem cells, into the core decompression track would improve the clinical and radiological results compared with the classical method of core decompression alone. The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR).

Patients and methods: All randomized and non-randomized control trials comparing simple core decompression with autologous bone marrow cell implantation into the femoral head for the treatment of ONFH were considered eligible for inclusion. The methodological quality of the studies included was assessed independently by 2 reviewers using the Cochrane Collaboration tool for assessing risk of bias in randomized studies. Of 496 relevant citations identified, 7 studies formed the basis of this review.

Results: The pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08-0.6; p = 0.02). The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3-1.02; p = 0.06).

Interpretation: Our findings suggest that implantation of autologous mesenchymal stem cells (MSCs) into the core decompression track, particularly when employed at early (pre-collapse) stages of ONFH, would improve the survivorship of femoral heads and reduce the need for hip arthroplasty.

Show MeSH
Related in: MedlinePlus