Core decompression combined with autologous bone marrow stem cells versus core decompression alone for patients with osteonecrosis of the femoral head: A meta-analysis. (September 2019)

• Record Type: Journal Article
• Authors: Wang, Zhan; Sun, Qi-meng; Zhang, Fu-qiang; Zhang, Qun-li; Wang, Li-guo; Wang, Wen-ji
• Is Part Of: International journal of surgery. Volume 69(2019)
• Page Start: 23
• Page End: 31
• Publication Date: 2019-09
• Subjects: Osteonecrosis of the femoral head -- Core decompression -- Autologous bone marrow cells -- Implantation -- Meta-analysis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2019.06.016
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: The efficacy of core decompression plus autologous bone mesenchymal stem cells (BMSCs) for the treatment of osteonecrosis of the femoral head (ONFH) remains controversial. We conducted a systematic review and meta-analysis to explore the efficacy of core decompression combined with BMSCs for OFNH patients. Methods: We searched PubMed, Embase, Web of Science, and the Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of core decompression combined with BMSCs for OFNH patients. The primary outcome was the visual analog scale (VAS) score at 6 months, 12 months and 24 months. The pooled data were analyzed using Stata 12.0 software. Results: Fourteen studies with 540 patients (core decompression + BMSCs = 275, core decompression alone = 265) were included in our meta-analysis. Compared with the core decompression alone group, the core decompression + BMSCs group showed a significant decrease in the VAS score at 6 months, 12 months and 24 months, and a decrease in the number of hips undergoing total hip arthroplasty (THA), the Western Ontario and McMaster Universities (WOMAC) score and the volume of the postoperative necrotic zone. Core decompression + autologous BMSCs was associated with an increase in HHS postoperatively. No significant difference existed in adverse events. Conclusions: Compared with core decompression alone in the treatment of ONFH, the combined utilization of core decompression and autologous BMSCs has better pain relief and clinical outcomes and can delay the collapse of the femoral head more effectively. Highlights: We conducted a meta-analysis to compare the BMSCs combined core decompression for osteonecrosis of the femoral head. This meta-analysis contains only RCT studies. Combined CD with BMSCs can delay the collapse of the femoral head more effectively.