Autologous stem cell implantation with core decompression for avascular necrosis of the femoral head using a new device

Abstract

Introduction: Autologous stem cell progenitor implantation into necrotic lesions of the femoral head has previously been described as a potential treatment for avascular necrosis (AVN), on the basis that there is a reduced number of functioning stem cells in the marrow within the necrotic segment. We present a case series of patients with AVN that underwent core decompression with autologous stem cell implantation using a new device.

Methods: The records and imaging of patients with AVN of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with core decompression and stem cell progenitor implantation, using the PerFuse system. Preoperatively, demographic information, AVN staging (as per Ficat and Arlet classification) and visual analogue pain scores (VAS) of the hips were recorded. These results were compared with postoperative VAS and imaging, with further review on the progression of AVN.

Results: We treated 14 hips in 13 patients with an average follow up of 12 months. Patients with Ficat I-II were selected for the procedure. The average preoperative VAS was 3.9. Postoperatively, this dropped to 2.6, with over half of patients reporting at least a two-point decrease in pain. Eight of the 14 treated hips showed no radiological progression of the disease, while six showed femoral head collapse requiring total hip arthroplasty (THA) at an average of ten months after treatment.

Conclusion: Our early findings indicate that hip decompression with stem cell progenitor implantation for AVN of the femoral head provides symptomatic relief and may be beneficial in arresting progression of disease using this simple new device.

Keywords: Autologous bone marrow implantation; Avascular necrosis; Femoral head; PerFuse; Stem cell progenitor.

Figure 1

Biomet PerFuse instruments used during the procedures. (a) Equipment used for percutaneous core decompression; (b) instrument used to acquire bone marrow aspirate for the autologous stem cell implantation.

Figure 2

Graph comparing the visual analogue scores (VAS) of patients before and after decompression surgery with stem cell injection, where 0 is no pain and 10 is the worst imaginable. The mean preoperative VAS score is 3.92, and the mean postoperative score drops to 2.62. Also shown is the 95% confidence interval for each bar.

Figure 3

(a) Bilateral anteroposterior (AP) and left-sided lateral x-rays of the patient’s hip prior to hip decompression and stem cell injection showing the level of deterioration of the joint. (b) Bilateral MRI scan of the patient’s hips showing the progressive deterioration of the left hip. (c) Bilateral AP x-ray post left-sided total hip arthroplasty (THA).

Figure 4

(a) Preoperative bilateral anteroposterior (AP) x-ray of the patient showing degeneration of both hips. (b) Postoperative lateral view computed tomography scan of left hip following decompression and autologous stem cell implantation. (c) Bilateral AP x-rays showing progressive worsening of left hip after surgical decompression and stem cell implantation, which eventually led to total hip arthroplasty (THA) of the left hip as well as the right.