Prospective And Controlled Study Of Core Decompression Combined With Autologous Bone Marrow Nucleated Cells Transplantation In Nontraumatic Avascular Necrosis Of The Femoral Head

Objective: To evaluate clinical outcomes of core decompression combined with autologous bone marrow nucleated cells (BMNCs) implantation for the treatment of nontraumatic avascular necrosis of the femoral head (ANFH).Methods: Forty-four hips in 34 patients with nontraumatic avascular necrosis of the femoral head were treated by core decompression combined with autologous BMNCs implantation (Nuclear cell group) , and 19 hips in 15 patients were treated by core decompression combined with bone graft (Bone graft group) . There were no significant differences of the preoperative indicators between two groups. The primary evaluated parameters included safety, clinical efficiency and pathological progression indicated by radiological examination. The mean follow-up was 21 months (range 12 to 31 months).Results: There was significant difference in the WOMAC index between Nuclear cell group and Bone graft group, P= 0.001; In the Nuclear cell group, patients with Ficat stage I/II osteonecrosis have better improvement of limb function than those with stage III/IV as indicated by the Lequesne (P=0.008) and the WOMAC index (P=0.001). Four patients (4 hips; Nuclear cell group 3, Bone graft group 1)progressed to graft failure and underwent second surgery of total hip arthroplasty, as 3 of them were corticosteroid users.Conclusion: Core decompression followed by autologous BMNCs implantation could used as am alternative surgical approach for the treatment of early stage ostoenecrosis of femoral head. The short-term follow-up suggests that the technique is safe, effective, minimal invasive, well tolerated and cost effective. Prolonged observation is indispensable to evaluate its long term outcome.