THA conversion rate comparing decompression alone, with autologous bone graft or stem cells in osteonecrosis

Area of Science:

• Orthopedics
• Regenerative Medicine
• Biomaterials

Background:

• Hip osteonecrosis is a debilitating condition often requiring total hip arthroplasty (THA).
• Core decompression (CD) with or without bone graft (CDBG) are established treatments for pre-collapse osteonecrosis.
• Bone marrow mesenchymal stem cells (CDSC) represent a promising alternative therapy.

Purpose of the Study:

• To compare the total hip arthroplasty (THA) conversion rates for patients treated with CD, CDBG, or CDSC.
• To evaluate the long-term efficacy of these treatments in preventing THA.

Main Methods:

• Retrospective review of 97 cases in 72 patients (1996-2012) with pre-collapse hip osteonecrosis.
• Treatment groups included CD (47 cases), CDBG (34 cases), and CDSC (16 cases).
• Survivorship analysis using Log Rank test and assessment of risk factors.

Main Results:

• No significant difference in THA conversion rates between CD (44%), CDBG (50%), and CDSC (50%) groups (p=0.619).
• Survivorship analysis showed no significant difference (p=0.2011).
• Immunodeficiency, corticosteroid use, and trauma were noted but not significantly associated with outcomes.

Conclusions:

• Core decompression (CD), CDBG, and CDSC demonstrated comparable rates of conversion to THA in patients with pre-collapse osteonecrosis.
• These findings suggest that current treatment options have similar long-term outcomes regarding the need for hip replacement.
• Further investigation is warranted to optimize treatment strategies for hip osteonecrosis.