The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD)
Abstract Purpose Avascular necrosis of the femoral head is a common issue faced by orthopaedic surgeons that ranges between 10 and 18%, but in patients with SCD, the incidence reaches 30%. There is no definite treatment except joint arthroplasty. Regenerative medicine is an option to cure or delay j...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-022-00449-z |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850225453654081536 |
|---|---|
| author | Mir Sadat‐Ali Abdallah S. Al‐Omran Khalid AlTabash Sadananda Acharya Tarek M. Hegazi Mona I. Al Muhaish |
| author_facet | Mir Sadat‐Ali Abdallah S. Al‐Omran Khalid AlTabash Sadananda Acharya Tarek M. Hegazi Mona I. Al Muhaish |
| author_sort | Mir Sadat‐Ali |
| collection | DOAJ |
| description | Abstract Purpose Avascular necrosis of the femoral head is a common issue faced by orthopaedic surgeons that ranges between 10 and 18%, but in patients with SCD, the incidence reaches 30%. There is no definite treatment except joint arthroplasty. Regenerative medicine is an option to cure or delay joint arthroplasty. We report here our experience with the injection of ABMDO to manage ANFH and report our medium‐term results, the progression of the ANFH if any and the delay in total hip arthroplasty. (THA). Methods Sixty‐Three (63) patients with SCD and ANFH were examined and thoroughly investigated, and those who had ANFH < grade II were consented to receive ABMDO. Patients were clinically assessed preoperatively using the Visual analogue scale (VAS), Modified Harris Hips Score (MHHS) and Azam‐Sadat Score (ASS) for Quality of Life Score for Chronic Hip Disease. Ten millilitres of bone marrow were aspirated under local anaesthesia and placed in 20 CC of culture media. Osteoblasts were cultured from the aspirated bone marrow. Under anaesthesia, the osteonecrosed lesion was drilled using a 3‐mm cannulated drill, and 5 million osteoblasts were injected at the lesion site. Patients were evaluated in the outpatient clinic after 2 weeks. At 4 months, a repeat MRI was done, and patients were followed for a minimum of 2 years. Results The average age of patients was 25.93 ± 5.48 years. There were 41 (65%) females and 22 (35%) males. The mean hemoglobin S was 83.2 ± 5.1%. The average follow‐up was 49.05 ± 12.9 (range: 24–60) months. The VAS significantly improved from 7.79 ± 1.06 initially to 4.07 ± 1.08 (p < 0.0001) at 2 weeks and continued to improve for the next 24 months, when it was 2.38 ± 0.55 (p < 0.0001). The MHHS improved from 41.77 ± 5.37 initially to 73.19 ± 6.48 at 4 months (p < 0.001), and at 24 months, it was 88.93 ± 3.6 (p < 0.001). The ASS also significantly improved from 2.76 ± 0.49 preoperatively to 7.92 ± 0.09 (p < 0.0001) at 24 months. A comparison of the MRI’s from before and after the osteoblast implantation revealed new bone formation and amelioration of the avascular lesions. Three patients were unsatisfied with their outcomes. and one patient suffered a repeat attack of the vaso‐occlusive crisis within 6 months of the osteoblast injection. Conclusions The results give credence to our earlier short follow‐up results showing that osteoblast transplantation has great potential in the healing of avascular lesions. Our study fits the criteria of a Phase II clinical trial, and we believe a larger study equivalent to Phase III numbers should be conducted and include patients with not only SCD but also steroid‐induced and idiopathic avascular necrosis. Level of evidence II |
| format | Article |
| id | doaj-art-baa9c8a76d1c4670a46bc74d81b89345 |
| institution | OA Journals |
| issn | 2197-1153 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-baa9c8a76d1c4670a46bc74d81b893452025-08-20T02:05:21ZengWileyJournal of Experimental Orthopaedics2197-11532022-01-0191n/an/a10.1186/s40634-022-00449-zThe clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD)Mir Sadat‐Ali0Abdallah S. Al‐Omran1Khalid AlTabash2Sadananda Acharya3Tarek M. Hegazi4Mona I. Al Muhaish5Department of Orthopaedic SurgeryCollege of MedicineImam AbdulRahman Bin Faisal University Dammam and King Fahd Hospital of the UniversityPOBOX 4007131952AlKhobarSaudi ArabiaDepartment of Orthopaedic SurgeryCollege of MedicineImam AbdulRahman Bin Faisal University Dammam and King Fahd Hospital of the UniversityPOBOX 4007131952AlKhobarSaudi ArabiaDepartment of Orthopaedic SurgeryCollege of MedicineImam AbdulRahman Bin Faisal University Dammam and King Fahd Hospital of the UniversityPOBOX 4007131952AlKhobarSaudi ArabiaStem Cell UnitCollege of Public HealthImam AbdulRahman Bin Faisal University Dammam and King Fahd Hospital of the UniversityAlKhobarSaudi ArabiaDepartment of Radiology College of MedicineImam AbdulRahman Bin Faisal UniversityDammamSaudi ArabiaDepartment of Radiology College of MedicineImam AbdulRahman Bin Faisal UniversityDammamSaudi ArabiaAbstract Purpose Avascular necrosis of the femoral head is a common issue faced by orthopaedic surgeons that ranges between 10 and 18%, but in patients with SCD, the incidence reaches 30%. There is no definite treatment except joint arthroplasty. Regenerative medicine is an option to cure or delay joint arthroplasty. We report here our experience with the injection of ABMDO to manage ANFH and report our medium‐term results, the progression of the ANFH if any and the delay in total hip arthroplasty. (THA). Methods Sixty‐Three (63) patients with SCD and ANFH were examined and thoroughly investigated, and those who had ANFH < grade II were consented to receive ABMDO. Patients were clinically assessed preoperatively using the Visual analogue scale (VAS), Modified Harris Hips Score (MHHS) and Azam‐Sadat Score (ASS) for Quality of Life Score for Chronic Hip Disease. Ten millilitres of bone marrow were aspirated under local anaesthesia and placed in 20 CC of culture media. Osteoblasts were cultured from the aspirated bone marrow. Under anaesthesia, the osteonecrosed lesion was drilled using a 3‐mm cannulated drill, and 5 million osteoblasts were injected at the lesion site. Patients were evaluated in the outpatient clinic after 2 weeks. At 4 months, a repeat MRI was done, and patients were followed for a minimum of 2 years. Results The average age of patients was 25.93 ± 5.48 years. There were 41 (65%) females and 22 (35%) males. The mean hemoglobin S was 83.2 ± 5.1%. The average follow‐up was 49.05 ± 12.9 (range: 24–60) months. The VAS significantly improved from 7.79 ± 1.06 initially to 4.07 ± 1.08 (p < 0.0001) at 2 weeks and continued to improve for the next 24 months, when it was 2.38 ± 0.55 (p < 0.0001). The MHHS improved from 41.77 ± 5.37 initially to 73.19 ± 6.48 at 4 months (p < 0.001), and at 24 months, it was 88.93 ± 3.6 (p < 0.001). The ASS also significantly improved from 2.76 ± 0.49 preoperatively to 7.92 ± 0.09 (p < 0.0001) at 24 months. A comparison of the MRI’s from before and after the osteoblast implantation revealed new bone formation and amelioration of the avascular lesions. Three patients were unsatisfied with their outcomes. and one patient suffered a repeat attack of the vaso‐occlusive crisis within 6 months of the osteoblast injection. Conclusions The results give credence to our earlier short follow‐up results showing that osteoblast transplantation has great potential in the healing of avascular lesions. Our study fits the criteria of a Phase II clinical trial, and we believe a larger study equivalent to Phase III numbers should be conducted and include patients with not only SCD but also steroid‐induced and idiopathic avascular necrosis. Level of evidence IIhttps://doi.org/10.1186/s40634-022-00449-zStem cellOsteoblastsAvascular necrosis of femoral headOsteonecrosis; sickle cell disease |
| spellingShingle | Mir Sadat‐Ali Abdallah S. Al‐Omran Khalid AlTabash Sadananda Acharya Tarek M. Hegazi Mona I. Al Muhaish The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD) Journal of Experimental Orthopaedics Stem cell Osteoblasts Avascular necrosis of femoral head Osteonecrosis; sickle cell disease |
| title | The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD) |
| title_full | The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD) |
| title_fullStr | The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD) |
| title_full_unstemmed | The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD) |
| title_short | The clinical and radiological effectiveness of autologous bone marrow derived osteoblasts (ABMDO) in the management of avascular necrosis of femoral head (ANFH) in sickle cell disease (SCD) |
| title_sort | clinical and radiological effectiveness of autologous bone marrow derived osteoblasts abmdo in the management of avascular necrosis of femoral head anfh in sickle cell disease scd |
| topic | Stem cell Osteoblasts Avascular necrosis of femoral head Osteonecrosis; sickle cell disease |
| url | https://doi.org/10.1186/s40634-022-00449-z |
| work_keys_str_mv | AT mirsadatali theclinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT abdallahsalomran theclinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT khalidaltabash theclinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT sadanandaacharya theclinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT tarekmhegazi theclinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT monaialmuhaish theclinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT mirsadatali clinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT abdallahsalomran clinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT khalidaltabash clinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT sadanandaacharya clinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT tarekmhegazi clinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd AT monaialmuhaish clinicalandradiologicaleffectivenessofautologousbonemarrowderivedosteoblastsabmdointhemanagementofavascularnecrosisoffemoralheadanfhinsicklecelldiseasescd |