Concentrated autologous bone marrow aspirate transplantation versus conservative treatment for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus

DOI Web Site 参考文献29件
  • Tomaru Yohei
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
  • Yoshioka Tomokazu
    Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
  • Nanakamura Junichi
    Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
  • Sugaya Hisashi
    Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
  • Hagiwara Shigeo
    Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
  • Nawata Kento
    Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
  • Ohtori Seiji
    Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
  • Yamazaki Masashi
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
  • Mishima Hajime
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan

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<p>Objective: To compare the outcomes of steroid-associated osteonecrosis of the femoral head in patients with systemic lupus erythematosus who underwent conservative treatment and concentrated autologous bone marrow aspirate transplantation</p><p>Methods: Osteonecrosis of the femoral head was classified according to the Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate transplantation was performed by aspirating the bone marrow from both iliac crests and then transplanting it to the necrotic area after the core decompression. Patients with >2-year follow-up after the concentrated autologous bone marrow aspirate transplantation in our institution (Group I) and those with >2-year follow-up after the first hospital visit in a cooperative institution (Group II) were included in this study. After a randomized matching based on age, sex, type, stage, and etiology, the collapse rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were compared between the two groups.</p><p>Results: After the matching adjustment, 33 pairs of hips were included. Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2, respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B, respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I and II, respectively. However, Group I had significantly higher and lower conversion rates in stages 1 and 3, respectively (both P<0.05).</p><p>Conclusion: Conservative treatment may be preferable in stage 1 hips. In addition, concentrated autologous bone marrow aspirate transplantation may prevent further collapse in stage 3.</p>

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