Talathi Nakul S, Kamath Atul F
Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
J Clin Orthop Trauma. 2018 Oct-Dec;9(4):349-352. doi: 10.1016/j.jcot.2018.05.014. Epub 2018 Jun 2.
Avascular necrosis (AVN) of the femoral head is a painful, progressive disease that can lead to limited mobility and early hip replacement. Autologous stem cell implantation into the necrotic lesion of the femoral head has been described, on the basis that patients with AVN have a reduced number of stem cells in the marrow. In this study, we aim to describe our technique for decompression of the hip with autologous implantation of stem cells for AVN of the femoral head, as well as retrospectively analyze our results.
The records and imaging of patients with avascular necrosis of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with the combination of core decompression with autologous stem cell implantation from the iliac crest. Preoperatively, demographic information, stage of AVN per Association Research Circulation Osseous (ARCO) classification on magnetic resonance imaging and radiograph, and visual analogue pain scores (VAS) of the hip were recorded. Postoperatively, VAS were recorded and imaging was reviewed for progression of AVN or evidence of femoral head collapse. Statistical analysis was conducted comparing pre and postoperative VAS scores.
Overall, we treated 43 hips in 28 patients with autologous stem cell implantation, with an average follow up of 16 months. Patients ranged from ARCO Ia to ARCO IIc classification of AVN. The average pre-operative visual analogue scale (VAS) of pain was 7.8. Post operatively, the average VAS score decreased to 2.5 (p < 0.0001), with 78% of patients reporting at least a 50% decrease in pain. 40 of the 43 operatively treated hips showed no radiologic progression of the disease during the follow up period, while 3 of the 43 hips had evidence of femoral head collapse and needed subsequent total hip arthroplasty at an average of 17 months after the initial decompression.
Our findings indicate that hip compression with autologous stem cell implantation for AVN of the femoral head provides significant symptomatic relief and may be beneficial in arresting progression of disease.
股骨头缺血性坏死(AVN)是一种疼痛性、进行性疾病,可导致活动受限并需早期进行髋关节置换。鉴于AVN患者骨髓中的干细胞数量减少,已有将自体干细胞植入股骨头坏死病灶的相关描述。在本研究中,我们旨在描述用于治疗股骨头AVN的自体干细胞植入髋关节减压技术,并对我们的结果进行回顾性分析。
对由单一外科医生治疗的股骨头缺血性坏死患者的记录和影像资料进行回顾性分析。所有患者均接受了髓芯减压联合自体髂嵴干细胞植入治疗。术前记录人口统计学信息、磁共振成像和X线片上根据骨循环研究协会(ARCO)分类的AVN分期以及髋关节的视觉模拟疼痛评分(VAS)。术后记录VAS评分,并复查影像资料以评估AVN的进展或股骨头塌陷的证据。对术前和术后的VAS评分进行统计学分析。
总体而言,我们对28例患者的43个髋关节进行了自体干细胞植入治疗,平均随访16个月。患者的AVN分类从ARCO Ia到ARCO IIc。术前疼痛的平均视觉模拟量表(VAS)评分为7.8。术后,平均VAS评分降至2.5(p<0.0001),78%的患者报告疼痛至少减轻了50%。43个接受手术治疗的髋关节中有40个在随访期间未出现疾病的放射学进展,而43个髋关节中有3个有股骨头塌陷的证据,在初次减压后平均17个月需要进行全髋关节置换。
我们的研究结果表明,自体干细胞植入治疗股骨头AVN的髋关节减压术能显著缓解症状,可能有助于阻止疾病进展。