Core decompression combined with autologous bone marrow mesenchymal stem cells for femoral head necrosis: a meta-analysis of safety and efficacy / 中国组织工程研究

ABSTRACT

BACKGROUND: Femoral head necrosis is a multifactorial disease, and has the youth oriented tendency. It often results in femoral head collapse and leads to total hip arthroplasty. Thus, finding a secure and effective treatment is of clinical benefits to relieve patients' suffering and to reduce social economic burden. Bone marrow mesenchymal stem cells (BMSCs) transplantation has been used in the clinical practice of femoral head necrosis. However, the conclusion remains controversial. OBJECTIVE: To access the safety and efficacy of the core decompression combined with autologous BMSCs transplantation in patients with femoral head necrosis by using meta-analysis approach. METHODS: Randomized clinical controlled trials (RCTs) which compared the therapeutic effects between core decompression combined with autologous BMSCs and core decompression were systematically retrieved from inception to June 20, 2017 in PubMed, The Cochrane Library (Issue 5, 2017), Embase, CNKI, CBM, VIP and WanFang databases. After extraction of the information and evaluation of the study quality, a meta-analysis was performed by RevMan software. RESULTS AND CONCLUSION: Eight RCTs with 323 patients (395 hips), 193 hips in BMSCs group and 202 in conventional therapeutic group, were ultimately included. The revisit time was 12-60 months. The overall quality of the trials was considered moderate-high. The results of meta-analysis show that compared with core decompression alone, autologous BMSCs transplantation combined with core decompression could alleviate the pain [Visual Analogue Scale mean difference ( MD)=-0.39, 95% confidence interval (CI) (-0.76,-0.01)], enhance the joint function [Harris score 12 months MD=7.16, 95%CI (3.88, 10.44) and 24 months MD=11.16, 95%CI (8.32, 14.00)], decrease the rate of disease progression in radiography [odds ratio=0.23, 95%CI (0.09, 0.55)]. Although there was no statistical significance between two groups, BMSCs transplantation had trend to reduce the rate of total hip arthroplasty [risk ratio=0.44, 95%CI (0.19, 1.03)]. No obvious complications were found in the course of BMSCs therapy. Given the above, autologous BMSCs transplantation combined with core decompression is a secure and effective therapeutic method for femoral head necrosis.