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Clinical outcomes of autologous platelet-rich plasma and bone marrow mononuclear cells grafting combined with core decompression for Association Research Circulation Osseous II–IIIA stage non-traumatic osteonecrosis of the femoral head

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Abstract

Purpose

This study aimed to investigate the efficacy and safety of autologous platelet-rich plasma (PRP) and bone marrow mononuclear cells (BMMCs) grafting combined with core decompression (CD) in the treatment of Association Research Circulation Osseous (ARCO) II–IIIA stage non-traumatic osteonecrosis of the femoral head (ONFH).

Methods

The clinical data of 44 patients (44 hips) with non-traumatic ONFH from December 2018 to December 2019 were retrospectively reviewed. Twenty-four patients underwent CD combined with autologous PRP and BMMCs grafting (PRP+BMMCs group), and 20 patients underwent core decompression alone (CD group). During a minimum follow-up of 36 months, radiographic outcomes were evaluated using X-ray, radiographic failure rates were compared, and Harris hip score (HHS) and visual analog scale (VAS) were selected to evaluate clinical outcomes. The percentage of patients with minimal clinically important difference (MCID) in both groups was analyzed. Clinical failure was defined as further total hip arthroplasty (THA) with Kaplan-Meier survival analysis. Surgical complications were recorded.

Results

All patients had well healed wounds, and no complications such as infection and thrombosis occurred. HHS and VAS scores in both the PRP+BMMCs and CD groups were better than those preoperatively (P<0.05). At the last follow-up, the HHS and VAS scores of the PRP+BMMCs group were significantly better than those of the CD group (P<0.05). In ARCO II–IIIA stage, 66.7% of the PRP+BMMCs group and 30.0% of the CD group achieved the MCID (P<0.05). The clinical and imaging failure rates in the PRP+BMMCs group were 12.5% and 20.8%, respectively, compared with 40.0% and 50.0% in the CD group (P<0.05). In ARCO II stage, the MCID, clinical and imaging failure rates of PRP+BMMCs group and CD group were 66.7% and 33.3% (P<0.05), 4.8% and 33.3% (P<0.05), 14.3% and 44.4% (P<0.05), respectively. The PRP+BMMCs group had better hip survival rate compared with CD group (P<0.05).

Conclusion

CD combined with autologous PRP and BMMCs grafting is a safe and effective method for the treatment of ARCO II–IIIA stage non-traumatic ONFH, especially for ARCO II stage, effectively reducing the collapse rate of the femoral head and delaying or even avoiding THA.

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Availability of data and materials

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by the special subject of scientific research on traditional Chinese medicine in Henan Province (20-21ZY2085).

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Authors and Affiliations

  1. Zhengzhou Medical Hospital District, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, China

    Dawei Liang, Jia Pei & Xiaohui Zhang

  2. Luoyang Medical Hospital District, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, 471000, China

    Xiantao Chen

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  1. Dawei Liang
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  2. Jia Pei
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Contributions

Dawei Liang contributed significantly to analysis and wrote the manuscript. Jia Pei and Xiantao Chen performed the data analyses. Xiaohui Zhang helped perform the analysis with constructive discussions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiantao Chen.

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Ethical approval

This study was approved by the medical Ethics Committee of the Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital) institution.

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Informed consent was obtained from all individual participants included in the study.

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The manuscript is approved by all authors for publication.

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Liang, D., Pei, J., Zhang, X. et al. Clinical outcomes of autologous platelet-rich plasma and bone marrow mononuclear cells grafting combined with core decompression for Association Research Circulation Osseous II–IIIA stage non-traumatic osteonecrosis of the femoral head. International Orthopaedics (SICOT) 47, 2181–2188 (2023). https://doi.org/10.1007/s00264-023-05779-w

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