Chow Simon K-H, Rainey Joshua P, Mont Michael A, Jones Lynne P, Goodman Stuart B
Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
J Arthroplasty. 2025 Jun 10. doi: 10.1016/j.arth.2025.06.018.
Osteonecrosis of the femoral head (ONFH) can cause pain, diminished function, and eventual articular collapse, disproportionately impacting younger patients. Core decompression (CD) is used to halt or at least delay postcollapse disease in patients who suffer from ONFH, but it can have variable outcomes. Orthobiologics are cellular therapies, growth factors, and biomaterial substances obtained from human cells and tissue that promote biological healing and have recently gained attention in the treatment of osteonecrosis. In this review, the role of orthobiologics in the treatment of osteonecrosis is discussed.
We reviewed the existing literature regarding orthobiologics in the treatment of precollapse ONFH. A total of 11 studies were included, consisting of six randomized controlled trials and five retrospective reviews. The included literature was obtained through a PubMed query of all studies from 1990 to 2024 that evaluated the role of ancillary cell-based therapies in the treatment of precollapse ONFH. Level IV and non-human studies were not included.
There were seven studies that supported the use of orthobiologics as an augmentation strategy to CD in terms of radiographic outcomes (i.e., prevention of femoral head collapse), clinical symptoms, or conversion to total hip arthroplasty. There were four studies (one retrospective review and three randomized controlled trials) that found no clinical or radiographic difference in collapse progression in patients who received CD versus CD along with an orthobiologic augmentation strategy.
In summary, further adequately powered, multicenter, blinded, randomized controlled trials are necessary. In addition, many of the studies had other limitations, including a large variability in mesenchymal cell content and standardization. Although the current literature regarding orthobiologic augmentation in the treatment of precollapse ONFH appears promising, further investigation is necessary to conclude its efficacy.
股骨头坏死（ONFH）可导致疼痛、功能减退及最终的关节塌陷，对年轻患者影响尤甚。核心减压（CD）用于阻止或至少延缓ONFH患者塌陷后疾病的发展，但效果可能各异。骨科生物制剂是从人类细胞和组织中获取的细胞疗法、生长因子及生物材料物质，可促进生物愈合，最近在骨坏死治疗中受到关注。在本综述中，探讨了骨科生物制剂在骨坏死治疗中的作用。
我们回顾了关于骨科生物制剂治疗塌陷前ONFH的现有文献。共纳入11项研究，包括6项随机对照试验和5项回顾性研究。纳入的文献通过对1990年至2024年所有评估辅助细胞疗法在塌陷前ONFH治疗中作用的研究进行PubMed检索获得。不包括IV级研究和非人类研究。
有7项研究支持将骨科生物制剂作为CD的增强策略，在影像学结果（即预防股骨头塌陷）、临床症状或转换为全髋关节置换方面。有4项研究（1项回顾性研究和3项随机对照试验）发现，接受CD治疗的患者与接受CD联合骨科生物制剂增强策略治疗的患者在塌陷进展方面没有临床或影像学差异。
总之，需要进一步开展有足够样本量、多中心、盲法、随机对照试验。此外，许多研究还有其他局限性，包括间充质细胞含量差异大及缺乏标准化。尽管目前关于骨科生物制剂增强治疗塌陷前ONFH的文献看起来很有前景，但仍需进一步研究以确定其疗效。
