AUTOLOGOUS BONE MARROW-DERIVED MESENCHYMAL STEM CELL THERAPY COMBINED WITH CORE DECOMPRESSION HAS BETTER OUTCOME THAN CORE DECOMPRESSION ALONE FOR EARLY-STAGE OSTEONECROSIS OF FEMORAL HEAD

Osteonecrosis of femur head is a chronic progressive, debilitating and painful disease of hip joint characterized by the progressive necrosis of osteogenic cells. Disease progression commonly leads to collapse of the affected femur head and ultimately development of osteoarthritis. Improved understanding of healing logistics and orthobiologics has provided a ray of hope for treating osteonecrosis of femoral head. Purpose was to evaluate efficacy of autologous bone marrow derived mesenchymal cells (BM-MSC) augmentation during core decompression vis–a–vis core decompression in early stages of osteonecrosis. 38 (50 hips) were randomized into Group A BM-MSC with core decompression (18/26 hips) and group B (core decompression only (20/24 hips). Bone marrow aspirated from the posterior superior iliac spine was centrifuged. Mean 153.91 million (SD= 91.30) number of BM-MSC harvested were instilled into the core decompression tracts of patients in group A. Outcome was evaluated in terms of VAS, Harris Hip score (HHS) and modified Kerboul angle for quantification of necrotic area using magnetic resonance imaging. Follow up ranged from 4-14 (mean: 8.8) months. Aetiology of osteonecrosis was alcohol consumption (47.3%), steroid use (34.2%) and idiopathic(18.4%). The patients were predominantly male (94.7%) with age ranging from 18–65 years (average age 37.01 years). VAS scores improved from pre-operative levels of 5.45±1.46 to 1.33±.97 in group A. VAS scores in group B increased from 5.45±0.51 to 2.88±.69. The HHS in group A had a final mean value of 80.9±14.5 from a baseline score of 61.3±16.9. In group B the HHS changed from a baseline score of 67.6±9.3 to 72.4±7.4. Statistically significant improvement in VAS (p value 0.017), HHS (p value 0.00) and modified Kerboul angle was observed in group A as compared to group B. Modified Kerboul angle changed by a mean of 4.1±15.4 in group A and 21.0±23.8 in group B. There was statistically significant change and progression of disease in group B. There was progression of disease in 3 hips of group A and 5 hips of group B. Negative correlation between change in angle and HHS was observed at final follow up.No intraoperative and postoperative complications were observed. Addition of autologous bone marrow derived mesenchymal stem cells have better clinical improvement than isolated core decompression for early stages of osteonecrosis of femur head.