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Adipose-derived stromal vascular fraction injection following core decompression and biochemistry artificial bone graft implantation in osteonecrosis of the femoral head

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A Letter to the Editor to this article was published on 11 July 2023

Abstract

Purpose

To determine how adipose-derived stromal vascular fraction (SVF) injection following core decompression (CD) and biochemistry artificial bone graft implantation affects outcomes in patients with osteonecrosis of the femoral head (ONFH).

Methods

A total of 19 patients (28 hips) with stage I-IIIA ONFH received adipose-derived SVF injection and combined core decompression and biochemistry artificial bone graft implantation, followed up for a minimum of two years. Disease progression was evaluated according to the Association Research Circulation Osseous (ARCO) staging system, and the change of the ratio of the necrotic volume to femoral head volume was calculated with MRI before and after operation.

Results

At the last follow-up, 15 hips remained stable, and 13 hips had a progression, according to the ARCO staging system. A total of eight hips (5 with ARCO stage II and 3 with staged IIIA at baseline) progressed to post-collapse stage (stage IIIB-IV). In total, seven of eight hips with post-collapse stage and one with IIIA stage at follow-up converted to THAs in an average of 17.5 months (range, 11–68 months) postoperatively. The mean ratio of the necrotic lesion volume to the femoral head significantly decreased in hips with ARCO stage I (17.9 ± 3.0% to 9.8 ± 1.3%, p = 0.012, Δ necrosis ratio = 8.1 ± 4.2%) and stage II (22.7 ± 6.3% to 17.1 ± 9.4%, p = 0.001, Δ necrosis ratio = 5.7 ± 6.6%) at baseline. For the eight hips that progressed to post-collapse stage, the mean necrosis ratio increased from 27.4 ± 5.4% to 31.1 ± 4.0% (p = 0.146), Δ necrosis ratio =  − 3.7 ± 3.9%. For the other 20 hips radiological survived, the mean necrosis ratio improved from 19.9 ± 4.4% to 11.8 ± 3.3% (p < 0.001), with Δ necrosis ratio = 8.1 ± 4.9%.

Conclusion

Adipose-derived SVF injection following core decompression and biochemistry artificial bone graft implantation is safe and could effectively repair the necrosis lesion and delay disease progression in patients with early-stage ONFH.

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Data availability

The data that support the findings of this study are available upon request from the corresponding author.

Code availability

Not applicable.

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Funding

This study was supported by grants from the Key R&D projects of Zhejiang Province (CN) (2021C03078).

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Authors and Affiliations

  1. Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China

    Zheping Hong & Qing Bi

  2. Department of Orthopaedic Surgery, Zhejiang Provincial People’s Hospital and People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China

    Zheping Hong, Yin Zhang, Jihang Chen & Qing Bi

Authors
  1. Zheping Hong
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  2. Yin Zhang
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  4. Qing Bi
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Zheping Hong and Yin Zhang. The study was designed by Zheping Hong and Qing Bi. The first draft of the manuscript was written by Zheping Hong. Jihang Chen and Qing Bi reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qing Bi.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Zhejiang Provincial People’s Hospital (2021QT276).

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

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Not applicable.

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The authors declare no competing interests.

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Hong, Z., Zhang, Y., Chen, J. et al. Adipose-derived stromal vascular fraction injection following core decompression and biochemistry artificial bone graft implantation in osteonecrosis of the femoral head. International Orthopaedics (SICOT) 47, 1481–1486 (2023). https://doi.org/10.1007/s00264-023-05792-z

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  • DOI: https://doi.org/10.1007/s00264-023-05792-z

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