[Cell-based and future therapeutic strategies for femoral head necrosis]

Abstract

Background: The application of cell- and growth factor-based techniques in conjunction with conventional surgical approaches has great therapeutic potential for the treatment of avascular necrosis of the femoral head (AVNFH).

Objectives: This review provides an overview of new strategies for the treatment of AVNFH, with emphasis on cell and growth factor-based approaches.

Materials and methods: The results of a literature search are summarised, the most relevant publications are presented and discussed by the authors.

Results: In the focus of new strategies for treatment of AVNFH are bone marrow-derived cell concentrates and ex vivo-expanded mesenchymal stem cells. Besides local application during core decompression, the systemic administration of cells via blood vessels supplying the femoral head is an interesting approach. The application of osteogenic and angiogenic growth factor-laden scaffold materials has also been clinically tested. Initial results of randomised clinical trials using cell- and growth factor-based approaches underline the potential of these innovative therapeutic strategies. Cell-based therapies are governed by EU law and generally require a manufacturing authorization.

Conclusion: To date, only few randomized controlled clinical trials are available which additionally display a considerable diversity concerning cell parameters, cell processing, adjuvant surgical techniques and the quality outcome parameters. Therefore, a final statement about the effectiveness of new cell and growth factor-based strategies is currently not possible.

Keywords: Bone marrow; Cell therapy; Growth factors; Mesenchymal stem cell; Osteonecrosis.