Mid-term results of concentrated autologous bone marrow aspirate transplantation for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus

Int Orthop. 2018 Jul;42(7):1623-1630. doi: 10.1007/s00264-018-3959-y. Epub 2018 Apr 28.

Abstract

Purpose: We 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). This study aimed to evaluate the effects of CABMAT as a hip-preserving surgical approach, preventing conversion to total hip arthroplasty (THA) and femoral head collapse in patients with systemic lupus erythematosus (SLE).

Methods: Since 2003, 52 SLE patients (8 male, 44 female, 92 hips, mean age 35.3 (16-77) (years) were treated with CABMAT. The mean follow-up period was 5.5 (0.7-14) years. Conversion rate to THA and its predicting factors were analyzed.

Results: The overall conversion rate to THA was 29% (27/92). Conversion rate to THA was 0% (0/3), 0% (0/4), 22% (9/41), and 41% (18/44) in types A, B, C1, and C2, respectively. Conversion rate to THA was 26% (5/19), 26% (6/23), 28% (11/39), 44% (4/9), and 50% (1/2) in stages 1, 2, 3A, 3B, and 4, respectively. In multivariate logistic regression analysis, sex, body mass index (BMI), pre-operative type, and pre-operative stage were significantly correlated with conversion to THA.

Conclusion: The conversion rate to THA was lower than that in the natural course and core decompression, but was higher than that seen in other bone marrow transplantation and osteotomy. Since sex, pre-operative type, and pre-operative stage were significantly correlated with conversion to THA, it is suggested that the higher proportion of women, advanced stage (stage 3A or above), and advanced type (type C or above) in this study affected the THA conversion rate.

Keywords: Concentrated autologous bone marrow aspirate transplantation; Growth factors; Joint preserving surgery; Mesenchymal stem cells; Osteonecrosis of the femoral head; Systemic lupus erythematosus.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / statistics & numerical data
  • Bone Marrow Transplantation / adverse effects
  • Bone Marrow Transplantation / methods*
  • Conversion to Open Surgery / statistics & numerical data
  • Female
  • Femur Head Necrosis / chemically induced
  • Femur Head Necrosis / therapy*
  • Glucocorticoids / adverse effects*
  • Glucocorticoids / therapeutic use
  • Hip Joint / pathology
  • Hip Joint / surgery
  • Humans
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / drug therapy
  • Male
  • Middle Aged
  • Retrospective Studies
  • Transplantation, Autologous
  • Treatment Outcome
  • Young Adult

Substances

  • Glucocorticoids