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Mid-term results of concentrated autologous bone marrow aspirate transplantation for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus

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Abstract

Purpose

We had previously established concentrated autologous bone marrow aspirate transplantation (CABMAT), a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head (ONFH). This study aimed to evaluate the effects of CABMAT as a hip-preserving surgical approach, preventing conversion to total hip arthroplasty (THA) and femoral head collapse in patients with systemic lupus erythematosus (SLE).

Methods

Since 2003, 52 SLE patients (8 male, 44 female, 92 hips, mean age 35.3 (16–77) (years) were treated with CABMAT. The mean follow-up period was 5.5 (0.7–14) years. Conversion rate to THA and its predicting factors were analyzed.

Results

The overall conversion rate to THA was 29% (27/92). Conversion rate to THA was 0% (0/3), 0% (0/4), 22% (9/41), and 41% (18/44) in types A, B, C1, and C2, respectively. Conversion rate to THA was 26% (5/19), 26% (6/23), 28% (11/39), 44% (4/9), and 50% (1/2) in stages 1, 2, 3A, 3B, and 4, respectively. In multivariate logistic regression analysis, sex, body mass index (BMI), pre-operative type, and pre-operative stage were significantly correlated with conversion to THA.

Conclusion

The conversion rate to THA was lower than that in the natural course and core decompression, but was higher than that seen in other bone marrow transplantation and osteotomy. Since sex, pre-operative type, and pre-operative stage were significantly correlated with conversion to THA, it is suggested that the higher proportion of women, advanced stage (stage 3A or above), and advanced type (type C or above) in this study affected the THA conversion rate.

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Acknowledgements

The authors would like to thank Ms. Chizuko Fujisawa and Toshiki Kato, PhD, for assistance with the analysis of concentrated bone marrow aspirates.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Yohei Tomaru, Katsuya Aoto, Hiroshi Wada, Hiroshi Akaogi, Masashi Yamazaki & Hajime Mishima

  2. Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Tomokazu Yoshioka & Hisashi Sugaya

  3. Department of Rehabilitation Medicine, University of Tsukuba, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Yukiyo Shimizu

Authors
  1. Yohei Tomaru
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  2. Tomokazu Yoshioka
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  3. Hisashi Sugaya
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  4. Yukiyo Shimizu
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  5. Katsuya Aoto
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  7. Hiroshi Akaogi
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  9. Hajime Mishima
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Corresponding author

Correspondence to Tomokazu Yoshioka.

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Tomaru, Y., Yoshioka, T., Sugaya, H. et al. Mid-term results of concentrated autologous bone marrow aspirate transplantation for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus. International Orthopaedics (SICOT) 42, 1623–1630 (2018). https://doi.org/10.1007/s00264-018-3959-y

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  • DOI: https://doi.org/10.1007/s00264-018-3959-y

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