PURPOSE: There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH. MATERIALS AND METHODS: Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis. RESULTS: At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results. CONCLUSION: The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures.
Autografts/radiography ; *Bone Transplantation ; Femur Head Necrosis/radiography/*therapy ; Humans ; Ilium/transplantation ; *Mesenchymal Stem Cell Transplantation ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo evaluate the clinical efficacy and safety of the treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell (BMCs) infusion.

METHODS44 hips in 28 patients with avascular necrosis at early stage were treated by percutaneous multiple holes decompression followed by autologous BMCs infusion. Autologous BMCs were concentrated from bone marrow that was taken from the posterior iliac crest of the patient. Patients were followed up at least 2 years. The results were determined by the changes in the Harris hip score and the progression in the radiograghic stages.

RESULTSNo complications were observed after the operation. Before operation, there were stage I of femoral head necrosis in 8 hips, stage II in 15 hips, stage III in 14 hips, stage IV in 7 hips, and the postoperative stages at the most recent follow-up were stage O in 1 hip, stage I in 6 hips, stage II in 13 hips, stage III in 13 hips, stage IV in 7 hips, stage V in 4 hips. The mean preoperative Harris hip score was 58 (46-89), and improved to 86 (70-94) postoperatively. All the femoral head collapsed preoperatively showed that the necrotic size was at least more than 30%.

CONCLUSIONSPercutaneous multiple holes decompression combined with autologous BMCs is a new way to treat avascular necrosis of the femoral head. The earlier the stage, the better the result. A randomized prospective study needed to compare with routine core decompression in the future.

Adolescent ; Adult ; Bone Marrow Transplantation ; Combined Modality Therapy ; Decompression, Surgical ; Female ; Femur Head Necrosis ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged ; Radiography ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo introduce a new method using calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of the femoral head and evaluate its curative effect.

METHODSFrom May 2000 to June 2005, 48 adult patients (54 hips) with ischemic necrosis of the femoral head at Stages I, II and III of antigen reactive cell opsonization (ARCO) were treated with implantation of calcium phosphate cement/Danshen drug delivery system in the involved femoral head. The operation consisted of removal of the necrotic bone under weight-loading cartilage and the implantation of phosphate cement/Danshen drug delivery system, and all manipulations were made percutaneously through a bone tunnel in the trochanter. The functions of the hip joint were evaluated and X-ray films were taken preoperatively and postoperatively.

RESULTSPostoperative follow-up was 45.5 months on average, ranging from 27 to 78 months. According to the evaluation criterion of "Dandong 1995" for therapeutic effect of adult ischemic necrosis of the femoral head, the therapeutic effects were excellent in 33 hips, good in 17, fair in 3 and poor in 1, with the excellent and good rate of 92.6%.

CONCLUSIONSThis method is relatively simple with little invasion. It not only improves the microcirculation of the femoral head by local application of traditional Chinese medicine, but also provides mechanic buttress in the weight-loading area to prevent collapse during repairing, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimal invasion surgery for ischemic necrosis of the femoral head at Stages I, II and III of ARCO.

Adult ; Aged ; Bone Cements ; Calcium Phosphates ; administration & dosage ; Decompression, Surgical ; Drug Delivery Systems ; Female ; Femur Head ; blood supply ; Femur Head Necrosis ; diagnostic imaging ; therapy ; Humans ; Ischemia ; therapy ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Radiography ; Salvia miltiorrhiza

OBJECTIVETo study the clinical effect of interventional therapy with Chinese and Western medicine for avascular necrosis of femoral head (ANFH).

METHODSA total of 168 ANFH patients (285 hips) were subjected to interventional therapy with Chinese and Western medicine (prostaglandin E1 injection, uroki-nase and Compound Danshen Injection) and examined by digital substruction arterography (DSA) before and after treatment. The imaging of DSA and clinical effect were observed and compared.

RESULTSAfter treatment, hip pain and joint dysfunction were alleviated to different degrees, and the blood vessel count shown by DSA significantly increased. The effect was obviously better in patients of Grade III than in those of other grades.

CONCLUSIONInterventional therapy with Chinese and Western medicine could improve the blood circulation of the femoral head, and is an effective method for the treatment of ANFH.

Adolescent ; Adult ; Aged ; Alprostadil ; administration & dosage ; therapeutic use ; Angiography, Digital Subtraction ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Femur Head ; blood supply ; drug effects ; Femur Head Necrosis ; diagnostic imaging ; drug therapy ; Humans ; Injections, Intra-Arterial ; Middle Aged ; Phenanthrolines ; administration & dosage ; therapeutic use ; Radiography, Interventional ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; administration & dosage ; therapeutic use ; Young Adult