Efficacy of the Mesenchymal Stem Cells Therapy Combined with Core Decompression in Avascular Necrosis of the Femoral Head. A Systematic Review and Meta-Analysis of Clinical Trials

摘要

Introduction: The potential use of mesenchymal stem cells (MSCs) to revert the initial events of avascular necrosis of the femoral head (ANFH) at the cellular level is gaining reliability. This study aims to find out if mesenchymal stem cell (MSC) therapy has a significant impact on avascular necrosis of the femoral head (AVN) despite surgical treatments. Methods: The systematic review included 6 randomized clinical trials (RCTs). RCTs compared MSC therapy combined with surgical core decompression and a control group using core decompression alone. The main outcome measures were functional and radiological: Visual Analog Scale (VAS), the Harris Hip Score (HHS), Association Research Circulation Osseous (ARCO) and Ficat classifications. Results: The six RCTs included 381 hips. Patients treated by adding MSCs to surgery disclosed a significant improvement in the HHS (p < 0.00001). MSCs provided better results in the VAS than surgery alone (p < 0.00001). The radiological progression evolved significantly in patients receiving core decompression alone (16.8%) in contrast to the MSC group (4.2%) (p < 0.001). The radiological progression evolved significantly in patients receiving core decompression alone (16.8%) in contrast to the MSC group (4.2%) (p < 0.001). Total hip arthroplasty was only required in 2.9% of MSC-treated cases in contrast to 13.0% of patients treated by surgery alone. Conclusions: The addition of MSC therapy to conventional core decompression provides significant clinical and radiological efficacy. At the early stages, MSC therapy had more clinical and radiological efficacy than in advanced stages.