Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study

Aims: Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. Th...

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Autores principales:	Matthew T. Houdek, Cody C. Wyles, John-Rudolph H. Smith, Andre Terzic, Atta Behfar, Rafael J. Sierra
Formato:	article
Lenguaje:	EN
Publicado:	The British Editorial Society of Bone & Joint Surgery 2021
Materias:	osteonecrosis femoral head hip preservation bone marrow derived stem cells platelet-rich plasma (prp) hips corticosteroid-induced osteonecrosis of the femoral head bone marrow bone marrow aspirate concentrate (bmac) corticosteroids femoral head collapse total hip arthroplasty (tha) mri Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/cd4ffb8562d34f23840d31cc407b0ef7
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spelling	oai:doaj.org-article:cd4ffb8562d34f23840d31cc407b0ef72021-12-01T18:44:47ZHip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study2633-146210.1302/2633-1462.211.BJO-2021-0132.R1https://doaj.org/article/cd4ffb8562d34f23840d31cc407b0ef72021-11-01T00:00:00Zhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.211.BJO-2021-0132.R1https://doaj.org/toc/2633-1462Aims: Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. The purpose of the current study is to examine the mid-term outcome of this treatment in patients with precollapse corticosteroid-induced ON of the femoral head. Methods: In all, 22 patients (35 hips; 11 males and 11 females) with precollapse corticosteroid-induced ON of the femoral head underwent hip decompression combined with BMAC and PRP. Mean age and BMI were 43 years (SD 12) and 31 kg/m² (SD 6), respectively, at the time of surgery. Survivorship free from femoral head collapse and total hip arthroplasty (THA) and risk factors for progression were evaluated at minimum five-years of clinical follow-up with a mean follow-up of seven years (5 to 8). Results: Survivorship free from femoral head collapse and THA for any reason was 84% and 67% at seven years postoperatively, respectively. Risk factors for conversion to THA included a high preoperative modified Kerboul angle (grade 3 or 4) based on preoperative MRI (hazard ratio (HR) 3.96; p = 0.047) and corticosteroid use at the time of decompression (HR 4.15; p = 0.039). The seven-year survivorship for patients with grade 1 or 2 Kerboul angles for conversion to THA for articular collapse, and THA for any reason, were 96% and 72%, respectively, versus THA for articular collapse and THA for any reason in patients with grade 3 or 4 Kerboul angles of 40% (p = 0.003) and 40% (p = 0.032). Conclusion: At seven years, hip decompression augmented with BMAC and PRP provided a 67% survivorship free from THA in patients with corticosteroid-induced ON. Ideal candidates for this procedure are patients with low preoperative Kerboul angles and can stop corticosteroid treatment prior to decompression. Cite this article: Bone Jt Open 2021;2(11):926–931.Matthew T. HoudekCody C. WylesJohn-Rudolph H. SmithAndre TerzicAtta BehfarRafael J. SierraThe British Editorial Society of Bone & Joint Surgeryarticleosteonecrosisfemoral headhip preservationbone marrow derived stem cellsplatelet-rich plasma (prp)hipscorticosteroid-induced osteonecrosis of the femoral headbone marrowfemoral headbone marrow aspirate concentrate (bmac)corticosteroidsfemoral head collapsetotal hip arthroplasty (tha)mriOrthopedic surgeryRD701-811ENBone & Joint Open, Vol 2, Iss 11, Pp 926-931 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	osteonecrosis femoral head hip preservation bone marrow derived stem cells platelet-rich plasma (prp) hips corticosteroid-induced osteonecrosis of the femoral head bone marrow femoral head bone marrow aspirate concentrate (bmac) corticosteroids femoral head collapse total hip arthroplasty (tha) mri Orthopedic surgery RD701-811
spellingShingle	osteonecrosis femoral head hip preservation bone marrow derived stem cells platelet-rich plasma (prp) hips corticosteroid-induced osteonecrosis of the femoral head bone marrow femoral head bone marrow aspirate concentrate (bmac) corticosteroids femoral head collapse total hip arthroplasty (tha) mri Orthopedic surgery RD701-811 Matthew T. Houdek Cody C. Wyles John-Rudolph H. Smith Andre Terzic Atta Behfar Rafael J. Sierra Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
description	Aims: Bone marrow-derived mesenchymal stem cells obtained from bone marrow aspirate concentrate (BMAC) with platelet-rich plasma (PRP), has been used as an adjuvant to hip decompression. Early results have shown promise for hip preservation in patients with osteonecrosis (ON) of the femoral head. The purpose of the current study is to examine the mid-term outcome of this treatment in patients with precollapse corticosteroid-induced ON of the femoral head. Methods: In all, 22 patients (35 hips; 11 males and 11 females) with precollapse corticosteroid-induced ON of the femoral head underwent hip decompression combined with BMAC and PRP. Mean age and BMI were 43 years (SD 12) and 31 kg/m² (SD 6), respectively, at the time of surgery. Survivorship free from femoral head collapse and total hip arthroplasty (THA) and risk factors for progression were evaluated at minimum five-years of clinical follow-up with a mean follow-up of seven years (5 to 8). Results: Survivorship free from femoral head collapse and THA for any reason was 84% and 67% at seven years postoperatively, respectively. Risk factors for conversion to THA included a high preoperative modified Kerboul angle (grade 3 or 4) based on preoperative MRI (hazard ratio (HR) 3.96; p = 0.047) and corticosteroid use at the time of decompression (HR 4.15; p = 0.039). The seven-year survivorship for patients with grade 1 or 2 Kerboul angles for conversion to THA for articular collapse, and THA for any reason, were 96% and 72%, respectively, versus THA for articular collapse and THA for any reason in patients with grade 3 or 4 Kerboul angles of 40% (p = 0.003) and 40% (p = 0.032). Conclusion: At seven years, hip decompression augmented with BMAC and PRP provided a 67% survivorship free from THA in patients with corticosteroid-induced ON. Ideal candidates for this procedure are patients with low preoperative Kerboul angles and can stop corticosteroid treatment prior to decompression. Cite this article: Bone Jt Open 2021;2(11):926–931.
format	article
author	Matthew T. Houdek Cody C. Wyles John-Rudolph H. Smith Andre Terzic Atta Behfar Rafael J. Sierra
author_facet	Matthew T. Houdek Cody C. Wyles John-Rudolph H. Smith Andre Terzic Atta Behfar Rafael J. Sierra
author_sort	Matthew T. Houdek
title	Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
title_short	Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
title_full	Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
title_fullStr	Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
title_full_unstemmed	Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
title_sort	hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study
publisher	The British Editorial Society of Bone & Joint Surgery
publishDate	2021
url	https://doaj.org/article/cd4ffb8562d34f23840d31cc407b0ef7
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Hip decompression combined with bone marrow concentrate and platelet-rich plasma for corticosteroid-induced osteonecrosis of the femoral head: mid-term update from a prospective study

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