Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea.
Clin Orthop Surg. 2021 Mar;13(1):37-46. doi: 10.4055/cios20128. Epub 2020 Dec 21.
Outcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH.
Eighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint.
Preoperatively, the necrotic lesion extent was 63.0% (38.4%-96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2).
Our outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.
传统治疗股骨头坏死（ONFH）的效果并不总是令人满意。因此，已经尝试了细胞补充疗法来促进坏死组织再生。与骨髓来源的 MSC 植入相比，脂肪来源的间充质干细胞（ADMSC）移植具有潜在优势，但对于 ONFH 的效果仍不清楚。本研究旨在确定培养的自体 ADMSC 移植治疗 ONFH 的 2 年影像学和临床结果。
纳入了 18 髋患有涉及股骨头≥30%坏死病变的患者。通过脂肪抽吸术采集 ADMSCs，并在 3 周内通过 3 个传代进行培养扩增。使用 6mm 单钻头钻孔，将 ADMSCs 植入坏死区。所有患者均在筛查时和术后 6 个月、12 个月和 24 个月进行磁共振成像（MRI）和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）检查。主要结局是 MRI 上坏死面积的变化。次要结局是临床评分和 SPECT/CT 上放射性摄取的变化。全髋关节置换术（THA）转换定义为终点。
术前，坏死病变范围为股骨头的 63.0%（38.4%-96.7%）。Harris 髋关节评分平均为 89.2，加州大学洛杉矶分校（UCLA）评分为 5.6，西安大略和麦克马斯特大学关节炎指数（WOMAC）评分为 79.4。3 例患者接受了 THA 治疗，1 例患者在事故中死亡。最后，11 例患者（14 髋）可进行≥2 年随访。末次随访时，无手术相关并发症发生，17 髋中有 14 髋（82%）无需 THA 即可进行日常活动。MRI 上任何 2 个时间点之间的病变大小均无显著减小。然而，在 14 髋中有 9 髋（64%）观察到坏死病变内 T2 加权图像上高信号带的增宽；在术后 2 年，14 髋中有 11 髋（79%）显示 SPECT/CT 上血管增多。术前和 24 个月的平均 Harris 髋关节评分（89.2 比 88.6）、WOMAC（79.4 比 75.7）和 UCLA 评分（5.6 比 6.2）无显著差异。
我们的结果表明，培养的 ADMSC 移植是一种可行的治疗方法，用于治疗 ONFH，且无不良事件。
