gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Cultured mesenchymal stem cells in the treatment of osteonecrosis of the femoral head

Meeting Abstract

  • presenting/speaker Alejandro Hernandez - Vall d'Hebron Hospital, Barcelona, Spain
  • Roberto Velez - Vall d'Hebron Hospital, Barcelona, Spain
  • Ruth Coll - Banc de Sang i Teixits, Clinical Development. Xcelia- Advanced Therapies Division, Barcelona, Spain
  • Joan García - Banc de Sang i Teixits, Clinical Development. Xcelia- Advanced Therapies Division, Barcelona, Spain
  • Alba López - Vall d' Hebron Institute of Research (VHIR), Barcelona, Spain
  • Marius Aguirre - Vall d'Hebron Hospital, Barcelona, Spain

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN11-1289

doi: 10.3205/17dkou009, urn:nbn:de:0183-17dkou0091

Veröffentlicht: 23. Oktober 2017

© 2017 Hernandez et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: The natural history of untreated ONCF is devastating in most cases and ultimately leads to the development of secondary osteoarthritis. Surgical treatments have been effective when applied in the early stages of the disease. The gold standard in the treatment of ONCF is core decompression getting success rates between 60% and 70% if applied in stage I or II classification of ARCO. The use of bio-based treatments in the ONCF is based on the knowledge that there is a decrease in the cellular mechanisms of tissue repair. Some previous studies suggest that mesenchymal stem cells (MSCs) are capable of improving the results of core decompression isolated and produce bone regeneration in the ONCF

Hypothesis: Implantation of cultured mesenchymal stem cells associated with core decompression in ONCF stimulates bone regeneration and prevents the collapse of the femoral head.

Methods: Randomized clinical trial phase I-II. The study consists of eight hips in the study group and 8 hips in the control group. Patients in the study group MSCs were obtained from bone marrow and culture was carried out for 3 weeks and finally adhered to 5 cc. lyophilized bone. The bone with MSCs was added to the necrotic zone 3 weeks later associated with a core decompression of the femoral head. Patients in the control group received an isolated core decompression.

During a time of 1 year follow-up clinical and radiological reviews preoperatively and at 12 days, 3 months, 6 months and 1 year were performed. Furthermore, survival between treatment groups as final event considering the occurrence of collapse of the femoral head was evaluated.

Results and Conclusion: No clinically significant differences between the two groups at one year were observed.

Two hips in both groups evolved toward collapse at one year. The average survival at one year was higher in the study group, although the differences were not significant (347.43 days Vs 324.25 days). MRI studies also showed no significant differences between groups.

Studies of positron emission tomography (PET) made in some patients in the study showed signs of osteoblastic activity.

The pathological examination of the femoral head of a patient in the study group that required the placement of a total hip replacement showed areas of bone regeneration.

No serious adverse effects were reported in any of the patients.

Discussion: Although no significant differences between treatment groups in either clinical or radiologic findings were observed, the procedure was safe and feasible. Furthermore, the findings of revascularization of necrotic area in the MRI, signs of osteoblastic activity in the PET and bone regeneration zones in the femoral head of the patient requiring a hip prosthesis suggest that the cultured mesenchymal stem cells associated with a core decompression may be able to produce bone regeneration. It's need randomized controlled phase III studies to demonstrate process efficiency.