scholarly journals Bone marrow aspirate concentrate in combination with intravenous iloprost increases bone healing in patients with avascular necrosis of the femoral head: a matched pair analysis

2017 ◽  
Vol 8 (4) ◽  
Author(s):  
Hakan Pilge ◽  
Bernd Bittersohl ◽  
Johannes Schneppendahl ◽  
Tobias Hesper ◽  
Christoph Zilkens ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Bone Marrow Aspirate ◽  
Core Decompression ◽  
Matched Pair ◽  
Bone Marrow Aspirate Concentrate ◽  
Matched Pair Analysis ◽  
Group A ◽  
Group B ◽  
Pair Analysis

With disease progression, avascular necrosis (AVN) of the femoral head may lead to a collapse of the articular surface. The exact pathophysiology of AVN remains unclear, although several conditions are known that can result in spontaneous cell death, leading to a reduction of trabecular bone and the development of AVN. Hip AVN treatment is stage-dependent in which two main stages of the disease can be distinguished: pre-collapse (ARCO 0-II) and post-collapse stage (ARCO III-IV, crescent sign). In the pre-collapse phase, core decompression (CD), with or without the addition of bone marrow (e.g. bone marrow aspirate concentrate, BMAC) or bone graft, is a common treatment alternative. In the postcollapse phase, THA (total hip arthroplasty) must be performed in most of the patients. In addition to surgical treatment, the intravenous application of Iloprost has been shown to have a curative potential and analgesic effect. From October 2009 to October 2014, 49 patients with AVN (stages I-III) were treated with core decompression at our institution. All patients were divided into group A (CD + BMAC) and group B (CD alone). Of these patients, 20 were included in a matched pair analysis. The patients were matched to age, gender, ARCO-stage, Kerboul combined necrotic angle, the cause of AVN, and whether Iloprost-therapy was performed. The Merle d’Aubigné Score and the Kerboul combined necrotic angle in a-p and lateral radiographs were evaluated pre- and postoperatively. The primary endpoint was a total hip arthroplasty. In group A, two patients needed THA while in group B four patients were treated with THA. In group A, the Merle d’Aubigné Score improved from 13.5 (pre-operatively) to 15.3 (postoperatively). In group B there was no difference between the pre- (14.3) and postoperative (14.1) assessment. The mean of the Kerboul angle showed no difference in both groups compared pre- to postoperatively (group A: pre-op 212°, postop 220°, group B: pre-op 213, postop 222°). Regarding radiographic evaluation, the interobserver variability revealed a moderate agreement between two raters regarding the pre- (ICC 0.594) and postoperative analysis (ICC 0.604).This study demonstrates that CD in combination with the application of autologous bone marrow aspirate concentrate into the femoral head seems to be a safe and efficient treatment alternative in the early stages of AVN of the femoral head when compared to CD alone.

Efficacy and Toxicity of Conditioning Regimens BEAM and BEM in Autologous Hematopoietic Cell Transplantation for Lymphomas: Preliminary Results of a Comparative (Matched Pair) Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4530-4530
Author(s):  
Ioanna Sakellari ◽  
Despina Mallouri ◽  
Batsis Ioannis ◽  
Constantinou Varnavas ◽  
Iskas Michalis ◽  
...  
Keyword(s):  
Hematopoietic Cell Transplantation ◽  
Salvage Treatment ◽  
Matched Pair ◽  
Matched Pair Analysis ◽  
Stage Disease ◽  
Group A ◽  
Conditioning Regimens ◽  
Group B ◽  
Pair Analysis ◽  
Autologous Hematopoietic Cell Transplantation

Abstract Abstract 4530 Autologous hematopoietic cell transplantation (AHCT) is the standard of care for relapsed or primary refractory Hodgkin's (HL) and Non Hodgkin's lymphoma (NHL). The conditioning regimens used are considered equal and none has demonstrated any superiority. During the last 2 years, primarily due to Carmustine (BCNU) unavailability, a new alternative conditioning regimen was constructed in our unit consisting of intravenous Busulphan (Busilvex) (3.2mg/kg/day for 3 days), Etoposide (400mg/m∧2/day for 2 days) and Melphalan (140mg/m∧2) (BEM). We retrospectively analysed the outcome of patients (pts) who underwent AHCT following conditioning with the standard BEAM and BEM regimen. The pts were stratified by age, pre-transplantation disease phase and previous lines of treatment. In total, 50 pts conditioned with BEM (group A) and 93 pts with BEAM (group B) were included. Group B pts were selected among 184 pts who underwent AHCT with BEAM regimen during the last decade. Stratification by disease risk was followed by a 1:2 selection. Fifty percent of the pts were younger than 34 in both study groups with a range of 11–68 years old. The pts of group B were more likely to suffer from HL (63) than NHL (30); whereas disease diagnosis for group A was HL in 28 and NHL in 22 pts. Disease was chemoresistant to salvage treatment in 46% of group A pts versus (vs) 23% of group B pts. There were no other significant differences concerning the patients' characteristics such as age above median, pre-transplantation lines of treatment (1–2: 40%, 3–4: 46%, ≥5: 14%), disease status (complete remission: 27%, primary refractory: 52%, relapse: 21%), advanced stage disease (52%). Complete remission post-AHCT was obtained in 50% of group A and 56% of group B pts. Progression free survival (PFS) at 2 years and overall survival (OS) were similar among the two study group populations (66% vs 63% and 80% vs 78% respectively). Given the fact that there were more pts with chemoresistant disease in group A, a second matched pair analysis was conducted upon stratification by disease chemosensitivity to salvage treatment instead of age as a risk factor. Efficacy was again similar for both conditioning regimens. In multivariate analysis favorable factors in terms of PFS were HL, chemosensitivity to salvage treatment and stage <IIB whereas in terms of OS non-bulky disease, HL and stage <IIB. Treatment related mortality (TRM) was 3.2% (3/93 pts) in group B and no TRM in group A. Detailed toxicity associated with the two study regimens is further analyzed. There are currently no randomized studies clarifying the optimal conditioning among multiple regimens in terms of efficacy and toxicity. In this study the two conditioning regimens, BEAM and BEM, were found to be equivalent. Additionally, the efficacy of the newly designed BEM regimen in chemoresistant and advanced stage disease is encouraging. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Combining autologous bone marrow buffy coat and angioconductive bioceramic rod grafting with advanced core decompression improves short-term outcomes in early avascular necrosis of the femoral head: a prospective, randomized, comparative study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Qingtian Li ◽  
Weihong Liao ◽  
Guangtao Fu ◽  
Junxing Liao ◽  
Ruiying Zhang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Buffy Coat ◽  
Hip Preserving Surgery ◽  
Group A ◽  
Autologous Bone ◽  
Group B

Abstract Background Treatment of avascular necrosis of the femoral head (ANFH) in young patients remains a clinical challenge. A current controversy is whether hip-preserving surgery results in better outcomes. The adverse effects of hip-preserving surgery are associated with the fill material for the necrotic areas. This study aims to evaluate the early effects of autologous bone marrow buffy coat (BBC) and angioconductive bioceramic rod (ABR) grafting with advanced core decompression (ACD) on early ANFH. Methods Forty-four (57 hips) patients with early ANFH from 2015 to 2020 were recruited for this study. They were randomized into two groups: group A received ACD, BBC, and ABR grafting; group B received treatment of ACD with β-tricalcium phosphate (β-TCP) granules and ABR grafting. The outcomes were assessed using the Harris Hip Scores (HHS) and survival rate analysis. The follow-up endpoint was defined as conversion to total hip arthroplasty (THA). Results Forty patients (51 hips) were ultimately included in this study for analysis. Compared with group B, patients in group A had higher postoperative function score (P = 0.032) and postoperative Harris Hip Scores (HHS) (P = 0.041). Kaplan-Meier analysis showed a trend that the survivorship of the femoral head was higher in group A than in group B. Conclusion The short-term follow-up results showed that the autologous bone marrow buffy coat and angioconductive bioceramic rod grafting with advanced core decompression is effective in the treatment of early ANFH. Trial registration Chictr.org.cn, ChiCTR2000039595. Retrospectively registered on 11 February 2015.

scholarly journals Cell technologies in the treatment of femoral head osteonecrosis

2019 ◽  
Vol 15 (4) ◽  
pp. 429-441
Author(s):  
A. E. Murzich ◽  
O. L. Eismont ◽  
J. I. Isaykina ◽  
D. V. Bukach ◽  
R. S. Sirotkin
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Mononuclear Cells ◽  
Bone Marrow Cells ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
X Rays ◽  
Femoral Head Osteonecrosis ◽  
Group A ◽  
Group B

The review of the literature data and our results of surgical treatment of femoral head osteonecrosis in adult patients with the minimally invasive technologies are presented in this article. Using clinical scales, X-rays, MRI, the hip joint condition of 46 patients who underwent “core” decompression in combination with bone plastic (group A, 31 patients) and bone marrow mononuclear cells (group B, 15 patients) were evaluated. The percentage of osteonecrosis progression during the observation period up to 3 years in group A was higher than in group B, where the bone marrow concentrate was used (38.7 and 26.7 %, respectively). The methods of treatment used for femoral head osteonecrosis are not traumatic, have no complications and allow delaying hip replacement. The use of autologous bone marrow cells, in addition to decompression of the necrosis focus, creates the prerequisites for a better outcome of bone regeneration of the necrotic area. 

Treatment of stage I and II osteonecrosis of the femoral head with core decompression and bone marrow aspirate concentrate injection—A 2-year follow-up study

2017 ◽  
Vol 28 (4) ◽  
pp. 239-245
Author(s):  
Thomas A. Einhorn ◽  
Afshin A. Anoushiravani ◽  
Kevin K. Chen ◽  
Ameer Elbuluk ◽  
Tony Tsismenakis ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Bone Marrow Aspirate ◽  
Core Decompression ◽  
Stage I ◽  
Bone Marrow Aspirate Concentrate ◽  
Follow Up Study

scholarly journals Bone marrow aspirate concentrate/platelet-rich fibrin augmentation accelerates healing of aseptic upper limb nonunions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alessandro Mazzotta ◽  
Cesare Stagni ◽  
Martina Rocchi ◽  
Nicola Rani ◽  
Nicolandrea Del Piccolo ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Upper Limb ◽  
Bone Marrow Aspirate ◽  
Healing Time ◽  
Long Bones ◽  
Platelet Rich Fibrin ◽  
Bone Marrow Aspirate Concentrate ◽  
Group A ◽  
Group B

Abstract Introduction Nonunions remain a significant burden in orthopedics, often afflicting young males of working age. Positive findings have been published using bone marrow aspirate concentrate (BMAC) and platelet-rich fibrin (PRF) for the treatment augmentation of lower limb nonunions. The aim of this study was to investigate if the treatment augmentation with BMAC and PRF can also accelerate the healing of nonunions of the upper limb. Materials and methods Sixty-eight patients (45 men, 23 women) affected by 75 nonunions of long bones of the upper limb were treated and divided into two groups. The first series was treated with standard surgery alone (group A); afterwards, the second series benefited from standard surgery with the addition of BMAC and PRF applied on lyophilized bone chips. Nonunions were classified radiographically according to the Weber–Cech method and prognostically using the Calori and Moghaddam scores. All patients were radiographically assessed at 1.5, 3, 6, 12, and 24 months of follow-up. Results Baseline demographic characteristics did not present differences between groups. No differences were documented in terms of complications (two in group A and three in group B). Significant differences were instead documented in terms of healing time. The first healing signs were observed 1.5 months after surgery in 90.7% of patients in group B and 34.4% of group A (p < 0.0005). At 1.5, 3, 6, and 12 months, a higher radiographic score was found for group B (all p < 0.0005), while no difference was found at final follow-up of 24 months (90.6% of group A and 97.7% of group B achieved radiological healing). Faster healing with BMAC/PRF augmentation was confirmed for all bones, as well as for the subgroup of patients affected by atrophic nonunions (p = 0.001). Conclusion This study showed the benefits of restoring both mechanical and biological aspects when addressing nonunions of the long bones of the upper limb. In particular, the association of BMAC and PRF to lyophilized bone chips was safe and able to accelerate healing time. These good results were confirmed for humerus, radius, and ulna sites, as well as for challenging atrophic nonunions of the upper limb.

scholarly journals Effect of Platelet-rich Plasma Combined With Core Decompression Bone Grafting for Osteonecrosis of Femoral Head: A Meta-Analysis

2021 ◽  
Author(s):  
QiZhong Lai ◽  
Kaishen Cai ◽  
Tianye Lin ◽  
Peng Yang ◽  
Binglang Xiong ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Bone Grafting ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Core Decompression ◽  
Osteonecrosis Of Femoral Head ◽  
Group A ◽  
Group B ◽  
Better Than

Abstract Objective: Core decompression bone grafting usually is used hip-preserving approach for osteonecrosis of femoral head (ONFH). Platelet-rich plasma (PRP) is an adjuvant therapy, combined with core decompression bone grafting for ONFH. However, it remains controversial. Therefore, its efficacy was systematically evaluated and meta-analysis in this study.Methods: Literature on core decompression bone grafting for ONFH was retrieved in CNKI, Wan Fang, PubMed, Embase, Cochrane Library and Web of Science from inception to March 2021. Review Manager 5.3 software and Stata 12.0 software were used for data synthesis.Results: A total of 10 RCTs were included. The results showed at final follow-up that, Harris hip score was significantly difference in the treatment group, adjuvant therapy with PRP (group A) better than the control group (group B), MD=7.53 [95%CI (5.29,9.77)]，P < 0.00001. There was MD=-0.71[95%CI (-0.96, -0.46)], P < 0.00001, of visual analog scale (VAS) of hip pain between the two groups. The excellent and good rate of function of hip was 1.42-fold higher in group A than that in group B, RR=1.42, 95%CI (1.25,1.62), P<0.00001. The progression and total hip arthroplasty were showed improvements, RR=0.37,95%CI (0.21,0.65), P=0.0006 and RR=0.39,95%CI (0.18,0.85), P=0.02, respectively. Begg's and Egger's tests did not indicate publication bias.Conclusion: It was shown that the use of PRP combined with core decompression bone grafting improved the symptoms better than core decompression bone grafting only, and might delay progression and total hip arthroplasty. However, as the study’s limitations, it needed to be fully verified by more large-sample multicenter prospective clinical studies.

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