Bone Marrow Derived Stem Cell Therapy Combined With Core Decompression Technique For The Treatment Of Early Stages Of Osteonecrosis Of The Femoral Head.a Systemic Review

Objectives:The aim of this study was to study cell based therapy such as stem cell therapy combined with core decompression technique in the treatment of early stages of osteonecrosis of femoral head and evaluate stem cell doses,hip survivorship,patient related clinical outcomes such as HHS,VAS pain score,WOMAC score and complications and failure rate to THA(revision rate).Introduction:AVN results from cellular impairment due to reduction on cellular blood flow of the femoral head.With the advance in stem cell research and regenerative medicine,Stem cell therapy at early stage might help in overcoming these conditions and improve the local cellular blood flow environment in the affected hip.At present mesenchymal stem cell because of their self renewal,multi differentiation to adipocytes,osteocytes,chondrocytes and inflammatory and effects have made promising candidate for cell therapy.Thus,a focus on early disease management aimed at joint preservation by preventing or delaying progression is key.The use of stem cells(SC)for the treatment of AVN of the FH has been proposed.I wanna undertake a systematic review of the medical literature examining the use of Stem Cell therapy combined with core decompression for the treatment of early stage(pre-collapse)AVN of the Femoral head.Methods:Searched for AVN,femoral heard,core decompression and stem cell therapy at PUBMED,embase,springer,Cochrane library site and total of 678 publications were identified and 667 publications were excluded from the study.11 publications met the inclusion criteria and were kept for the study.Abstract were retrieved for all manuscripts considered relevant by title.Abstracts were independently reviewed and any disagreements were resolved using by discussion.Full length articles of relevant abstracts were reviewed for inclusion.Papers having potential for eligibility,full text was obtained and evaluated against the inclusion criteria.Discussion were done between reviewer to solve any disagreements.All the data were extracted from all eligible scientific papers such as demographic data,baseline characteristics,f/up data,outcome data etc.Initially we obtained 678 individual scientific papers.11 papers met our inclusion criteria and were identified and included for our systematic review.All scientific papers were eligible for inclusion having randomized and non randomized control trial and case series on human comparing core decompression with autologous bone marrow mesenchymal stem cell transplantation into the early stages of osteonecrosis of femoral head(ficat stage 1-3).All language studies were eligible along with most recent publications.Exclusion criteria were experimental or animal studies,cadaveric studies,papers with less than 10 subjects,editorials,preclinical studies.Findings:we prospectively analyzed all 11 studies that reported patient-reported outcomes which showed improved outcomes in the stem cell-therapy groups compared with the control group(core decompression).Overall,all our scientific studies contained 811 patients with 1113 hipsaffected with osteonecrosis of femoral head.Total hips 913 are to receive stem cell therapy with core decompression and various mode of adjuvant therapy and the total hips only to receive core decompression as mode of treatment are 200 hips.The total of 11 studies 8 studies were case control and 3 studies were case series.613 hips were studied in case series while 500 hips were studied in different RCTs.3 studies did not show any improvement in hip survivorship compared to baseline or control study while remaining 8 studies showed improvement in hip survivorship.There was very low complication rate of less than 3% with pain and infection at donor site with no any major site affects.Conclusion:Cell-therapies,stem cell therapy for the treatment of early stages of ONFH have been reported to be safe and shows improved clinical outcomes with lower disease progression rate.This long term follow-up study(24 to 60 months)confirmed that implantation of autologous bone marrow cells in the necrotic lesion might be an effective treatment for patients with early stages of osteonecrosis of the femoral head usually with ficat scoring 1-2 or ARCO staging 1-2.Our finding in this study suggest improved survivorship of the femoral head and reduce the need for hip arthroplasty when implantation of stem cells combined with core decompression technique particularly when employed at early stages(pre-collapse)of ONFH.Moreover,this study we found out improved clinical outcomes;improved hip survivorship;decreased revision rate(rate of conversion to THA);low complication rate in early stages ofosteonecrosis of femoral head treated with stem cell combined with core decompression technique.