Clinical efficacy of mesenchymal stem cells in the treatment of patients with avascular necrosis of the femoral head
https://doi.org/10.17238/2072-3180-2025-1-178-184
Abstract
Introduction. Avascular necrosis of the femoral head (ANFH) is a common problem that occurs in 10-18 % of patients with a trauma profile. Extensive research has recently explored the potential of treating ANFH using mesenchymal stem cells and has shown results convincing of the effectiveness and safety of the method.
The purpose of the study. To study the clinical efficacy of mesenchymal stem cells in the treatment of patients with avascular necrosis of the femoral head.
Materials and methods. The data is reviewed in PubMed, CochraneLibrary, ScienceDirect, eLibrary. A clinical case of treatment of a patient with avascular necrosis of the femoral head using mesenchymal stem cells is described.
Results. MSCs are best suited for early therapy of ANFH, as a stage of conservative treatment of patients in order to improve the results of complex treatment and to obtain the possibility of stabilization and regression of necrotic changes in bone tissue. If patients have advanced stages, the use of MSCs can reduce pain and increase limb functionality, improve quality of life, and delay the need for total hip replacement.
Conclusion. Extensive research over the past decade has explored the potential of the MSC and shown promising results. Despite the existing controversies, it seems that the overall results of using MSC for the treatment of avascular necrosis of the femoral head are positive not only in terms of efficacy, but also safety. However, for reliable interpretation of the results, they need to be determined over time.
About the Authors
A. V. ChernykhRussian Federation
Chernykh Alexander Vasilyevich, Doctor of Medical Sciences, Professor, Head of the Department of Operative Surgery with Topographic Anatomy
394036, Studentskaya str., 10, Voronezh
D. S. Plotnikov
Russian Federation
Plotnikov Denis Sergeevich, Traumatologist, Surgical Department
398046, Peter Smorodina str., 13, Lipetsk
S. I. Geydarova
Russian Federation
Geydarova Sofia Igorevna, student
394036, Studentskaya str., 10, Voronezh
A. P. Ostroushko
Russian Federation
OstroushkoAnton Petrovich, Candidate of Medical Sciences, Associate Professor of the Department of General and Outpatient Medicine
394036, Studentskaya str., 10, Voronezh
A. Yu. Laptiyova
Russian Federation
Laptiyova Anastasia Yurievna, Candidate of Medical Sciences, Assistant of the Department of General and Outpatient Surgery
394036, Studentskaya str., 10, Voronezh
References
1. Rui Li, Qiu-Xia Lin, Xue-Zhen Liang, Guang-Bo Liu, He Tang, Yu Wang, Shi-Bi Lu. Stem cell therapy for treating osteonecrosis of the femoral head: From clinical applications to related basic research. Stem Cell Research & Therapy, 2018, v. 9, pp. 291–92. https://doi.org/10.1186/s13287-018-1018-7
2. Mir Sadat-Ali, Abdallah S, Al-Omran, Khalid Al Tabash, Sadananda Acharya, Tarek M. Hegazi, Mona I. Al Muhaish. The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD). J Exp Orthop, 2022, v. 17, № 9(1), pp. 18–19.
3. Virzì F.,Bianca P.,Giammona A.,Apuzzo T.,Di Franco S., Mangiapane L.,Colorito M.,Catalano D., Scavo E.,Nicotra A., Benfante A.,Pistone G.,Caputo V.,Dieli F., Pirrello R.,Stassi G. Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients. Stem Cell Res Ther, 2021, v. 23, № 8(1), pp. 236–237.
4. Mardones R., Camacho D., Monsalvo F., Zulch N., Jofre C., Minguell J.J. Treatment of osteonecrosis of the femoral head by core decompression and implantation of fully functional ex vivo-expanded bone marrow-derived mesenchymal stem cells: a proof-of-concept study. Stem Cells Cloning, 2019, v. 1, № 12, pp. 11–16.
5. Zhan Yu Wu, Qi Sun, Ming Liu, Brian E Grottkau, Zhi Xu He, Qiang Zou, Chuan Ye. Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability. BMC Musculoskelet Disord, 2020, v. 29,№ 21(1), pp. 55–56.
6. Elgaz S., Bonig H. & Bader P. Mesenchymal stromal cells for osteonecrosis. J Transl Med, 2020, v. 18(1), pp. 399–400.
7. Xu Y., Jiang Y., Xia C., Wang Y., Zhao Z., Li T. Stem cell therapy for osteonecrosis of femoral head: Opportunities and challenges. Regen Ther, 2020, v. 15, pp. 295–304.
8. Wang Y., Ma X., Chai W., Tian J. Multiscale Stem Cell Technologies for Osteonecrosis of the Femoral Head. Stem Cells Int. 2019, pp. 891–969. https://doi.org/10.1155/2019/8914569
9. Xiaolin Liu, Qing Li, Xin Niu, Bin Hu, Shengbao Chen, Wenqi Song, Jian Ding, Changqing Zhang, Yang Wang. Exosomes Secreted from Human-Induced Pluripotent Stem Cell-Derived Mesenchymal Stem Cells Prevent Osteonecrosis of the Femoral Head by Promoting Angiogenesis. Int J Biol Sci, 2021, v. 13(2), pp. 232–244.
10. Guo S.C., Tao S.C., Yin W.J., Qi X., Sheng J.G., Zhang C.Q. Exosomes from Human Synovial-Derived Mesenchymal Stem Cells Prevent Glucocorticoid-Induced Osteonecrosis of the Femoral Head in the Rat. Int J BiolSci, 2023, v. 12(10), pp. 1262–1272.
11. Moya-Angeler J., Gianakos A.L., Villa J.C., Ni A., Lane J.M. Current concepts on osteonecrosis of the femoral head. World J Orthop, 2021, v. 6(8), pp. 590–601.
12. Shah K.N., Racine J., Jones L.C., Aaron R.K. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med, 2021, v. 8(3), pp. 201–209.
13. Philippe Hernigou, Françoise Beaujean. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res, 2022, v. 405, pp. 14–23.
14. Andriolo L., Merli G., Tobar C., Altamura S.A., Kon E., Filardo G. Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis. Int Orthop, 2023, v. 42(7), pp. 1689–1704.
15. Zhao D., Cui D., Wang B., Tian F., Guo L., Yang L. Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells. Bone, 2021, v. 50 (1), 325–330.
16. Sen R.K., Tripathy S.K., Aggarwal S., Marwaha N., Sharma R.R., Khandelwal N. Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: a randomized control study. J Arthroplast, 2021, v. 27(5), pp. 679–686.
17. Yuanchen Ma, Tao Wang, Junxing Liao, Honglin Gu, Xinpeng Lin, Qing Jiang, Max K Bulsara, Minghao Zheng, Qiujian Zheng. Efficacy of autologous bone marrow buffy coat grafting combined with core decompression in patients with avascular necrosis of femoral head: a prospective, double-blinded, randomized, controlled study. Stem Cell Res Ther, 2024, v. 5 (5), pp. 115–125.
18. Tabatabaee R.M., Saberi S., Parvizi J., Mortazavi S.M., Farzan M. Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with EarlyStage Osteonecrosis of the Femoral Head: A Comparative Study. J Arthroplast, 2021, v. 30(9 Suppl), pp. 11–15.
19. Gangji V., Hauzeur J.P., Matos C., De Maertelaer V., Toungouz M., Lambermont M. Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. J Bone Joint Surg Am, 2024, v. 86-a (6), pp. 1153–1160.
20. Pepke W., Kasten P., Beckmann N.A., Janicki P., Egermann M. Core Decompression and Autologous Bone Marrow Concentrate for Treatment of Femoral Head Osteonecrosis: A Randomized Prospective Study. Orthop Rev (Павия)., 2024, v. 4 (1), pp. 61–62.
21. Gianakos A.L., Moya-Angeler J., Duggal S., Zambrana L., Fields K.G., Mintz D.N. The Efficacy of Bisphosphonates with Core Decompression and Mesenchymal Stem Cells Compared with Bisphosphonates Alone in the Treatment of Osteonecrosis of the Hip: a Retrospective Study. HSS J, 2022, v. 12(2), pp. 137–144.
22. Papakostidis C., Tosounidis T.H., Jones E., Giannoudis P.V. A systematic review of the literature and meta-analysis of 7 studies. Acta Orthop, 2021, v. 87(1), pp. 72–78.
23. Houdek M.T., Wyles C.C., Collins M.S., Howe B.M., Terzic A., Behfar A. Stem Cells Combined With Platelet-rich Plasma Effectively Treat Corticosteroid-induced Osteonecrosis of the Hip: A Prospective Study. Clin Orthop Relat Res, 2023, v. 476(2), pp. 388–397.
24. Wyles C.C., Houdek M.T., Crespo-Diaz R.J., Norambuena G.A., Stalboerger P.G., Terzic A. Adipose-derived Mesenchymal Stem Cells Are Phenotypically Superior for Regeneration in the Setting of Osteonecrosis of the Femoral Head. Clin Orthop Relat Res, 2021, v. 473(10), pp. 3080–3090.
25. Cai J., Wu Z., Huang L., Chen J., Wu C., Wang S., Deng Z., Wu W., Luo F., Tan J. Cotransplantation of bone marrow mononuclear cells and umbilical cord mesenchymal stem cells in avascular necrosis of the femoral head. Transplant Proc, 2024, v. 46(1), pp. 151–155.
26. Chen C., Qu Z., Yin X., Shang C., Ao Q., Gu Y., Lui Y. Efficacy of umbilical cord-derived mesenchymal stem cell-based therapy for osteonecrosis of the femoral head: A three-year follow-up study. Mol Med Rep, 2021, v. 14(5), pp. 4209–4215.
27. Liu Y., Liu S., Su X. Core decompression and implantation of bone marrow mononuclear cells with porous hydroxyl apatite composite filler for the treatment of osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2022, v. 133(1), pp. 125–133.
28. Knight M.N., Hankenson K.D. Mesenchymal Stem Cells in Bone Regeneration. Adv Wound Care (New Rochelle), 2023, v. 2(6), pp. 306 – 316.
Review
For citations:
Chernykh A.V., Plotnikov D.S., Geydarova S.I., Ostroushko A.P., Laptiyova A.Yu. Clinical efficacy of mesenchymal stem cells in the treatment of patients with avascular necrosis of the femoral head. Moscow Surgical Journal. 2025;(1):178-184. (In Russ.) https://doi.org/10.17238/2072-3180-2025-1-178-184