Concentrated autologous bone marrow aspirate transplantation versus conservative treatment for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus

Yohei TOMARU; Tomokazu YOSHIOKA; Junichi NANAKAMURA; Hisashi SUGAYA; Shigeo HAGIWARA; Kento NAWATA; Seiji OHTORI; Masashi YAMAZAKI; Hajime MISHIMA

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Concentrated autologous bone marrow aspirate transplantation versus conservative treatment for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus

VernacularTitle:Concentrated autologous bone marrow aspirate transplantation versus conservative treatment for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus
Author: Yohei TOMARU ¹ ; Tomokazu YOSHIOKA ² ; Junichi NANAKAMURA ³ ; Hisashi SUGAYA ² ; Shigeo HAGIWARA ³ ; Kento NAWATA ³ ; Seiji OHTORI ³ ; Masashi YAMAZAKI ¹ ; Hajime MISHIMA ¹
Author Information

1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
2. Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
3. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
Keywords: Osteonecrosis of the femoral head; joint-preserving surgery; concentrated autologous bone marrow aspirate transplantation; matching adjusted comparison
From:Journal of Rural Medicine 2021;16(1):1-7
CountryJapan
Language:English
Abstract: Objective: To compare the outcomes of steroid-associated osteonecrosis of the femoral head in patients with systemic lupus erythematosus who underwent conservative treatment and concentrated autologous bone marrow aspirate transplantationMethods: Osteonecrosis of the femoral head was classified according to the Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate transplantation was performed by aspirating the bone marrow from both iliac crests and then transplanting it to the necrotic area after the core decompression. Patients with >2-year follow-up after the concentrated autologous bone marrow aspirate transplantation in our institution (Group I) and those with >2-year follow-up after the first hospital visit in a cooperative institution (Group II) were included in this study. After a randomized matching based on age, sex, type, stage, and etiology, the collapse rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were compared between the two groups.Results: After the matching adjustment, 33 pairs of hips were included. Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2, respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B, respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I and II, respectively. However, Group I had significantly higher and lower conversion rates in stages 1 and 3, respectively (both P<0.05).Conclusion: Conservative treatment may be preferable in stage 1 hips. In addition, concentrated autologous bone marrow aspirate transplantation may prevent further collapse in stage 3.