Impacting bone grafting with and without concentrated bone marrow mononuclear cells for osteonecrosis of the femoral head

WANG Liang; LIU Shu-bin; LIU Yao-sheng

doi:10.3969/j.issn.2095-252X.2015.04.014

Abstract：Objective To retrospectively analyze the clinical outcomes of impacting bone grafting with and without concentrated bone marrow mononuclear cells ( BMMCs ) in the treatment of osteonecrosis of the femoral head ( ONFH ) of stage II B and II C according to Association Research Circulation Osseous ( ARCO ) classiifcation system.Methods A total of 34 patients ( 53 hips ) with nontraumatic ONFH were followed up, including 27 males and 7 females. The mean age at the time of operation was 38.1 years old ( range: 28-42 years ). The necrosis was removed by minimally invasive expanding core decompression, and then impacting bone graft was performed. In the BMMCs group, 5 ml concentrated BMMCs was used, but not in the group of simple impacting bone grafting. The Harris Hip Score ( HHS ) was used to evaluate the postoperative improvement of the hip function and the Visual Analogue Scale ( VAS ) to assess the intensity of pain. The collapse and repair of lesions of the femoral head were detected based on the radiological data.Results In the latest follow-up, the HHSs were signiifcantly increased in both groups ( 64.1±4.6 ) pointsvs ( 78.8±4.8 ) points (P=0.0000 ). The magnitude of increase was significantly greater in the BMMCs group when compared with that of the control group ( 28.6±0.5 ) %vs ( 18.4±1.7 ) % (P<0.0001 ). The VAS scores were signiifcantly decreased in the latest follow-up in both groups ( 6.3±0.9 ) pointsvs ( 2.6±0.7 ) points (P=0.0000 ). The magnitude of decrease was signiifcantly greater in the BMMCs group when compared with that of the control group ( -66.3±1.4 ) %vs ( -51.7±2.9 ) % (P<0.0001 ). The clinical success rate was obviously higher in the BMMCs group when compared with that in the control group ( 21 / 26 )vs ( 10 / 27 ), and the differrences between them were statistically significant (P=0.001 ). The radiological success rate was obviously higher in the BMMCs group when compared with that in the control group ( 23 / 26 )vs ( 11 / 27 ), and the differrences between them were statistically signiifcant (P=0.001 ).Conclusions Necrosis is removed by minimally invasive expanding core decompression, and then impacting bone grafting is performed. It may achieve excellent medium-term outcomes in the treatment of nontramatic ONFH in the suitable early and middle stages ( stage II B and II C ). The surgical results and quality of bone repair of the preserved hip will be improved by impacting bone grafting with concentrated BMMCs.