Pravastatin combined with fibrin sealant-embedded BMSCs enhances recovery in steroid-induced avascular necrosis of the femoral head

Steroid-induced avascular necrosis of the femoral head (SANFH) significantly impairs patients' quality of life, with long-term steroid use being a major contributing factor. The pathogenesis of SANFH remains complex and poorly understood. Bone marrow mesenchymal stem cells (BMSCs) possess multidirectional differentiation potential and are crucial for bone repair and regeneration, yet their precise mechanisms in SANFH treatment are not fully elucidated. In this study, 48 rabbits with early-stage SANFH were randomly assigned to four groups: control (Group A), core decompression (Group B), BMSCs embedded in fibrin sealant (FS) after decompression (Group C), and pravastatin administration combined with BMSCs in FS post-decompression (Group D). Blood lipid levels were monitored throughout the experiment, and femoral heads were assessed via MRI, HE staining, and VEGF immunohistochemical staining. Group C demonstrated reduced femoral head necrosis and increased new bone formation compared to the control. Group D showed significantly lower serum lipid content and femoral head necrosis than other groups, with HE staining revealing fewer empty lacunae and increased trabecular bone density. Additionally, VEGF expression was markedly elevated in Group D. These findings indicate that BMSCs embedded in biomaterials enhance the therapeutic efficacy for early SANFH, and the combination with pravastatin significantly improves outcomes, suggesting a promising new approach for clinical management of femoral head necrosis.