The safety and efficacy of combined autologous concentrated bone marrow grafting and low-intensity pulsed ultrasound in the treatment of osteonecrosis of the femoral head

  • Hajime MishimaEmail author
  • Hisashi Sugaya
  • Tomokazu Yoshioka
  • Katsuya Aoto
  • Hiroshi Wada
  • Hiroshi Akaogi
  • Naoyuki Ochiai
Original Article • HIP - OSTEONECROSIS


Osteonecrosis of the femoral head (ONFH) is commonly treated with total hip arthroplasty; however, the disadvantages of this form of treatment, especially in young patients, include the need for revision arthroplasty. Here we describe a novel, combined approach to the treatment of ONFH based on autologous concentrated bone marrow grafting and low-intensity pulsed ultrasound (LIPUS). The 7 male and 7 female patients (mean age: 40 years; 22 hips) underwent autologous concentrated bone marrow grafting followed by 6 months of continuous LIPUS. The mean follow-up period was 26 months. We evaluated site-specific bacterial infection of the grafted bone marrow concentrate microbiologically and site-specific cancer by magnetic resonance imaging 24 months after grafting. All patients were assessed using the visual analogue scale (VAS) for pain and the Japanese Orthopedic Association (JOA) hip score. Clinical and plain radiographic evaluations were performed before grafting and at the most recent follow-up. Computed tomography (CT) scans were obtained before and 12 months after grafting. None of the grafted bone marrow concentrates were infected, and none of the patients developed a tumor at the treatment site. The VAS and JOA scores improved in all patients. Collapse progressed in 8 of the 22 hips, but none required total hip arthroplasty. The mean volume of new bone formation 12 months post-grafting as seen on CT was 1256 mm3. New bone formation was observed in all patients. Our study demonstrates the safety and efficacy of autologous concentrated bone marrow grafting and LIPUS as a joint-preserving procedure for patients with ONFH.


Bone marrow grafting Osteonecrosis of the femoral head Low-intensity pulsed ultrasound Joint-preserving procedure 


Compliance with ethical standards

Conflict of interest

The authors have no competing interests to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

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


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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Hajime Mishima
    • 1
    Email author
  • Hisashi Sugaya
    • 1
  • Tomokazu Yoshioka
    • 1
  • Katsuya Aoto
    • 1
  • Hiroshi Wada
    • 1
  • Hiroshi Akaogi
    • 1
  • Naoyuki Ochiai
    • 1
  1. 1.Department of Orthopaedic Surgery, Faculty of MedicineUniversity of TsukubaTsukubaJapan

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