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ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2012, Number 5

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Acta Ortop Mex 2012; 26 (5)

Stem cell implant with neck-head decompression for aseptic necrosis of the femoral head

Ceballos-Mesa A, Wilford LM, Balmaseda-Manent CR, Figueredo-Peguero I, Rivero-Hernández J, Herrera-Rojas AM

Language: Spanish
References: 27
Page: 290-297
PDF size: 174.30 Kb.


ABSTRACT

Adult aseptic necrosis of the femoral head progresses from its reversible phase, stages I-II-III (Ficat-ARCO), to stages IV-V coxarthrosis, and this represents a health problem. An observational, descriptive, prospective, case-series type of study was conducted to prove the hypothesis that the boring decompression of the femoral neck-head cancellous layer, together with the local implantation of multipotent adult autologous stem cells processed according to Ficoll at approximate amounts of 16.1 x 106 cells/ml, is the treatment of choice for stages I-II-III of aseptic necrosis of the femoral head. These cells create the necessary tissue conditions to preserve the structure of the femoral head thus avoiding or delaying its degeneration and the resulting prosthetic arthroplasty. A total of 16 patients with a diagnosis of stages I-II-III aseptic necrosis of the hip, ages 40-70, all of whom were at the reversible stage and accepted the above mentioned procedure, were included. The evaluation was conducted in June 2011 applying Harris’ pain-function scale. Its score was used to determine the mean, the standard deviation and the median. Pain relief and functional recovery without surgical or immune complications were proven. According to Harris’ score, 3 stage-III patients were under the median. One stage-III patient required prosthetic arthroplasty, so 93.7% of the patients retained their femoral head more than 2 years after the surgery. We conclude that the proposed procedure is the procedure of choice for stages I-II and it makes us be more selective in the case of stage III necrosis.


REFERENCES

  1. Ficat P, Arlet J: Treatment of bone ischemia and necrosis. In: Hungerford DS(ed). Ischemia and necrosis of bone. Baltimore: Williams and Wilkins; 1980: 171-82.

  2. Arlet J, Ficat P: Biopsy drilling as a means of early diagnosis in idiopathic ischemic necrosis of the femoral head in adults. Baltimore: Univet Park Press; 1971: 14-30.

  3. Hugerford DS, Lennox DW: The importance of increased intraosseus pressure in the development of osteonecrosis of the femoral head: Implicactions for treatment. Orthop Clin North Am 1985; 16: 635-52.

  4. ARCO (Association Research Circulation Osseous): Committee on terminology and classification. Arco News 1993; 5: 79-82.

  5. Steimberg ME, Hayken GD, Steimberg DR: A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1955; 77: 34-41.

  6. Sugano N, Atsumi T, Ohzono K, Kubot T, Takaoka K: The 2001 revised criteria for diagnosis classification and staging of idiopathic, osteonecrosis of the femoral head. J Orthop Sci 2002; 7: 601-5.

  7. Camp JF, Colwel CW Jr: Core decompression for femoral head osteonecrosis. J Bone Joint Surg Am 1986; 68: 1313-9.

  8. Steimberg ME, Larcom PG, Strafford B, Husick WB, Coroes A: Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 2001; 386: 71-8.

  9. Judet M, Gilbert A: Long term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res 2001; 386: 114-9.

  10. Feng Y, Wang S, Jin D, Sheng J: Free vascularized fibular grafting with Osteo Set® 2 demineralized bone matrix versus autograft for large osteonecrosis lesion of the femoral head. International Orthopaedic (SICOT) 2011; 356: 475-81.

  11. Sakai S, Mishima H, Ishii T, Akaogi H, Yoshioka T, Uemura T, et al.: Concentration of bone marrow aspirate for osteogenic repair using simple centrifugal method. Acta Orthop 2008; 79: 445-8.

  12. Floerkemeier T, Thorey F, Daentzer D, Learcit M: Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. International Orthopaedic (SICOT) 2011; 35: 480-95.

  13. Vats A, Tolley NS, Buttery LDK, Polak IM: The stem cell in orthopedic surgery J Bone Joint Surg 2004; 86B: 1959-64.

  14. Friedenstein AJ, Petrakova KV, Kurolesona A: Heterotopic transplants of bone marrow. Analysis of precursor cells for osteogenesis and hematopoetic tissue. Transplantation 1968; 6: 230-47.

  15. Handschel J, Kubler N: Cells sources for bone reconstruction therapies. European Musculosketal Rev 2006: 11-3.

  16. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2000: 284: 3043-5.

  17. Tuki R, Seghatoleslami MR, Tuli S: A simple highyield method for obtaining multipotential mesenchymal progenitor cells from trabecular bone. Mol Biothechnol 2003; 23: 49-52.

  18. Harris WH: Traumatic arthritis of hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737-55.

  19. Schmitt-Sody M, Kirchhoff MW, Goebel M: Avascular necrosis of the femoral head, inter and intra observer variations of Ficat-ARCO classifications. Int Orthop 2008; 32: 283-7.

  20. Urbaniak JR, Harvey EJ: Revascularization of the femoral head in osteonecrosis, J Am Acad Orthop Surg 1998; 6: 44-54.

  21. Hernigou P, Beaunjean F, Lambotte JC: Decrease in the mesenchymal stem-cells pool in the proximal femur in corticosteroid induced osteonecrosis. J Bone Joint Surg Br 1999; 81: 349-55.

  22. Ceballos MA, Balmaseda R, Puente R, Díaz MJ, Suárez SO: Revascularización de la cabeza femoral. Rev Investigaciones Médico Quirúrgicas 1997: 1(1): 56-61.

  23. Ceballos MA, Balmaseda MR, Puente RR, Pedroso CM: Descompresión cérvico-cefálica en la necrosis aséptica de la cabeza femoral. Rev Investigaciones Médico Quirúrgicas 2003: 2(3): 7-14.

  24. Yoshioka T, Mishima H, Akaogi H, Sakai S: Concentrated autologous bone marrow aspirate transplantation treatment for corticosteroid-induced osteonecrosis of the femoral head in systemic lupus erythematosus. International Orthopaedisc (SICOT) 2011; 35: 823-9.

  25. Mont MA, Ragland PS, Etienene G: Core decompression of the femoral head for osteonecrosis using percutaneous multiple small diameter drilling. Clin Orthop Relat Res 2004; 429: 131-8.

  26. Holgate A, Asha S, Craig J, et al: Comparison of verbal numeric range scale with the visual analogue scale for the measurement of acute pain. Emerg Med 2003; 15: 441-6.

  27. Yin S, Zhang C, Jin D, Chen S: Treatment of osteonecrosis of the femoral head in lymphoma patient by free vascularized fibular grafting. International Orthopaedics (SICOT) 2011; 35: 1125-35.




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