Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress
Clinics in Orthopedic Surgery
Philippe Hernigou, MD, Matthieu Trousselier, MD, François Roubineau, MD, Charlie Bouthors, MD,Nathalie Chevallier, MD, Helene Rouard, MD, and Charles-Henri Flouzat-Lachaniette, MD
Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis.
In future research, several questions will need to be addressed. For example, is the differentiation potential of MSCs from different sources (bone marrow, fat, and periosteum) the same? Are their functional abilities after repeated culture the same? How different are bones formed by implanted MSCs from normal bones in terms of histology and biomechanics? In addition, the risk of forming cancer at the implanted site should be evaluated. Hernigou and colleagues46,47) found that patients treated with cell therapy do not have a greater incidence of cancer than the rest of the population. They analyzed the occurrence of cancers by follow-up, cell number, sites of cancer, age, gender, and the pathology that was treated, and found that the risk of cancer was not increased in patients with longer follow-ups or in patients who had received a higher number of MSCs. However, this study was performed with autologous MSCs from bone marrow; there are no reports of implantation with allogenic MSCs or expanded MSCs with long-term follow-up.