gms | German Medical Science

Objectives: We have developed autologous concentrated bone marrow grafting as the joint-preserving procedure for osteonecrosis of the femoral head (ONFH). The purpose of this study was to evaluate the mid-term results of autologous concentrated bone marrow grafting for steroid-associated femoral head osteonecrosis with systemic lupus erythematosus (SLE).

Methods: We retrospectively reviewed 55 patients (97 hips) who treated autologous concentrated bone marrow grafting for steroid-associated femoral head osteonecrosis with SLE between April 2003 and June 2014. 10 persons (19 hips) were male and 45 persons (78 hips) were female with an average age at the time of bone marrow grafting of 35.3 years (range: 16-77 years). The mean follow-up period was 6.2 years. Based on the 2001 Japanese Orthopaedic Association (JOA) ONFH staging system, of the 97 hips, 25, 29, 30, 11, 2 hips were stage 1, 2, 3A, 3B, and 4. Also based on the 2001 JOA ONFH classification system, of the 97 hips, 3, 5, 43, and 46 were types A, B, C1, and C2, respectively.

Bone marrow was aspirated from the iliac crest and concentrated using a conventional manual blood bag centrifugation technique used to extract the buffy coat. Multi-directional holes were made to perforate the interface between the areas of ONFH, by drilling with a Kirschner wire. Aspirate was then injected into the area of ONFH.

The endpoint of evaluation was set as the time point which the patient required Total Hip Arthroplasty (THA) depending on the spontaneous hip pain, x-ray change, and social back ground. Also in the early stage of ONFH, the endpoint of evaluation was set as the time point at the onset of the collapse, too. The following factors were investigated: age, sex, body mass index (BMI), unilateral or bilateral, etiological factors, preoperative classification and staging, and a history of steroid pulse therapy. The 97 hips were divided into two groups: a THA conversion (THA) group and a non-THA conversion (non-THA) group. A multivariate analysis was performed using a logistic regression model.

Results and Conclusion: In this series, of the 97 hips, 28 hips (29%) converted THA. In the early stage (Stage 1 and 2), 14 hips (26%) were converted THA, and 14 hips (33%) in the late stage (Stage 3 and 4) were converted THA. In the multivariate logistic regression analysis about THA conversion, BMI and disease type were significantly correlated. In the point of collapse, of the 54 hips in the early stage, 34 hips (63%) occurred collapses. 10 hips, of the 34 collapsed hips, were stage 3A but only the crescent sign.

The strong predictors of THA conversion after bone marrow grafting were BMI and type. The results suggest that the additional osteogenic therapy may be needed such as PTH or LIPUS in the cases with high BMI or wide necrosis area. This combination therapy with bone marrow grafting and PTH or LIPUS may be more suitable joint-preserving procedure for steroid-associated femoral head osteonecrosis with SLE.