Bone Marrow Aspirate Concentrate (BMAC) May Support Bone Decompression Therapy in the Treatment of Osteonecrosis
Osteonecrosis of the femoral head commonly affects patients between the age of 30 to 50 years and can lead to degeneration of the hip joint. A number of risk factors have been identified, including trauma to the hip joint, long-term use of corticosteroids, alcoholism, smoking, and more recently, organ transplantation, HIV infection, and autoimmune disease. 70-90% of cases regarding osteonecrosis of the femoral head have been reported to collapse with five years of a severe diagnosis, thus early-stage intervention is advised. The collapse of the necrotic region leads to joint incongruity and further contributes to degenerative changes.
Since this condition affects a young patient population, alternatives to surgical intervention with the use of less invasive procedures rather than the conventional hip replacement is warranted. However, joint preserving surgeries, such as core decompression has demonstrated low efficacy with poor outcomes. Therefore, researchers Khanna et al. conducted an observational study to demonstrate evidence-based efficacy of using BMAC to support therapeutic outcomes of bone decompression in the treatment of osteonecrosis of the femoral head. Eligibility criteria for patient participation required symptomatic findings with radiographic confirmation of stage I, II, or stage III without collapse. Adult patients over the age of 18 who were mentally alert, medically fit to undergo treatment, and who did not have a previous history of surgical treatment on the affected hip were selected to participate in the study. Osteonecrosis of the femoral head was confirmed by MRI on participants at the onset of the study.
Exclusion criteria included patients over the age of 60 years, osteonecrosis due to trauma, late-stage with collapse of the femoral head, patients with an active infection, patients with a history of a malignant disease within the past five years, neuro-vascular involvement, and those who were mentally challenged. Furthermore, patients who did not complete the 24-month follow-up period were excluded from study results. Researchers measured primary outcomes based on case comparison of pre- and post-operative Modified Harris Hip Score (mHHS) and hip radiographs at 6 months, 12 months, and 24 months. Ultimately, a total of 10 patients completed the study and 13 hips were evaluated. All patients reported a poor pre-operative mHHS score; whereas, over two-thirds of patients who completed the study demonstrated excellent post-operative mHHS scores, and less than 10 percent showed no improvement or their condition worsened. Significant pain relief was reported in 11 of 13 hips evaluated at the conclusion of the study. Objective measurements showed mHHS scores significantly improved within 6 months; however, radiographic findings began to show increased sclerosis and mild hypertrophy at the margins of the femoral head at 12 months.
Researchers Khanna et al. concluded that the combination of core decompression and BMAC injections into the necrotic lesion improves clinical efficacy and supports therapeutic outcomes of core decompression in the treatment of osteonecrosis of the femoral head in patients with stage I, II, and early stage III without collapse of the femoral head. Patients were allowed to fully weight-bear as tolerated at eight weeks post-op, thereby encouraging an early return to activities of daily living. More research is needed to investigate optimal cell characterization for repair and regeneration of various tissue types.
Read Full-text article Khanna et al.