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International Orthopaedics

, Volume 42, Issue 7, pp 1689–1704 | Cite as

Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis

  • Luca Andriolo
  • Giulia Merli
  • Carlos Tobar
  • Sante Alessandro Altamura
  • Elizaveta Kon
  • Giuseppe Filardo
Review

Abstract

Purpose

The aim of this study was to document the available evidence on the use of regenerative techniques for the treatment of femoral head osteonecrosis (or avascular necrosis of femoral head, AVN) and to understand their benefit compared to core decompression (CD) alone in avoiding failure and the need for total hip replacement (THR).

Methods

The search was conducted on three medical electronic databases according to PRISMA guidelines. The studies reporting number and timing of failures were included in a meta-analysis calculating cumulative survivorship with a Kaplan-Mayer curve. Moreover, the results on failures in treatment groups reported in RCT were compared with those documented in control groups, in order to understand the benefit of biological therapies compared to CD for the treatment of AVN.

Results

Forty-eight studies were included in this systematic review, reporting results of different types of regenerative techniques: mesenchymal stem cell implantation in the osteonecrotic area, intra-arterial infiltration with mesenchymal stem cells, implantation of bioactive molecules, or platelet-rich plasma. Overall, reported results were good, with a cumulative survivorship of 80% after ten year follow-up, and better results when regenerative treatments were combined to CD compared to CD alone (89.9% vs 70.6%, p < 0.0001).

Conclusion

Regenerative therapies offer good clinical results for the treatment of AVN. The combination of CD with regenerative techniques provides a significant improvement in terms of survivorship over time compared with CD alone. Further studies are needed to identify the best procedure and the most suitable patients to benefit from regenerative treatments for AVN.

Keywords

Hip Avascular necrosis of femoral head Osteonecrosis Regenerative therapies Biological therapies Core decompression 

Notes

Acknowledgements

The authors thank Elettra Pignotti for the assistance in the statistical analysis and Lucia Mancini for English editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.II Orthopaedic and Traumatologic ClinicRizzoli Orthopaedic InstituteBolognaItaly
  2. 2.Nano-Biotechnology Laboratory-NaBiResearch and Innovation Technology DepartmentBolognaItaly
  3. 3.Department of Orthopedics and TraumatologyAvansalud Clinic of SantiagoSantiagoChile
  4. 4.Humanitas University Department of Biomedical SciencesMilanItaly
  5. 5.Humanitas Clinical and Research CenterMilanItaly

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