Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years pReportar como inadecuado




Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years p - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Musculoskeletal Disorders

, 18:292

Pathophysiology of musculoskeletal disorders

Abstract

BackgroundWe had previously established concentrated autologous bone marrow aspirate transplantation CABMAT, a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head ONFH. The present study aimed to evaluate the effects of CABMAT as a hip preserving surgical approach, preventing femoral head collapse in asymptomatic ONFH.

MethodsIn total, 222 patients 341 hips with ONFH were treated with CABMAT between April 2003 and March 2013. Based on magnetic resonance imaging, we determined that 119 of these patients had bilateral asymptomatic ONFH 238 hips, and 38 further patients had unilateral asymptomatic ONFH 38 hips. In this series, we retrospectively examined 31 hips in 31 patients with unilateral asymptomatic ONFH treated surgically between 2003 and 2012 and followed up for more than 2 years. Clinical and radiological evaluation were performed immediately before the procedure and at the final follow-up. The two-year follow-up rate among patients with unilateral ONFH was 82% 31-38. Therefore, the present study included 31 patients 19 males and 12 females, with a mean age and follow-up period of 40 and 5.8 years, respectively. Of the 31 asymptomatic hips, 5, 6, 10, and 10 had osteonecrosis of types A, B, C1, and C2, respectively. The diagnosis, classification, and staging of ONFH were based on the 2001 Japanese Orthopaedic Association JOA classification.

ResultsSecondary collapse of the femoral head was observed in 6-10 hips and 5-10 hips with osteonecrosis of types C1 and C2, respectively. Total hip arthroplasty was performed in 9.6% of patients 3-31 hips, at an average of 33 months after surgery. Clinical symptoms improved after surgery, and the secondary collapse rate at a mean of 5.8 years after CABMAT was lower than that reported in several previous studies on the natural course of asymptomatic ONFH.

ConclusionsEarly diagnosis of ONFH i.e., before femoral head collapse and early intervention with CABMAT could improve the clinical outcome of corticosteroid and alcohol-induced ONFH.

KeywordsOsteonecrosis of the femoral head Femoral head collapse Low-invasive surgery Bone marrow aspirate Autologous transplantation AbbreviationsADLActivities of daily living

BMABone marrow aspirate

CABMATConcentrated autologous bone marrow aspirate transplantation

JOAJapanese Orthopaedic Association

ONFHOsteonecrosis of femoral head

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Autor: Yohei Tomaru - Tomokazu Yoshioka - Hisashi Sugaya - Katsuya Aoto - Hiroshi Wada - Hiroshi Akaogi - Masashi Yamazaki - Hajim

Fuente: https://link.springer.com/



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