Efficacy of autologous stem cell at different doses combined with core decompression in the treatment of osteonecrosis of the femoral head: a systematic review and network meta-analysis.

IF 4.6 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Frontiers in Endocrinology Pub Date : 2026-04-22 eCollection Date: 2026-01-01 DOI:10.3389/fendo.2026.1720437

Mingjie Wei, Libo Yuan, Guocheng Feng, Baochuang Qi, Xiangwen Shi, Yongqing Xu

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引用次数: 0

Abstract

Objective: To compare autologous stem cell (SC) at different doses combined with core decompression (CD) versus CD alone for osteonecrosis of the femoral head (ONFH), using conversion to total hip arthroplasty (THA) as the primary outcome.

Methods: PubMed, Embase, Cochrane Library, Web of Science, and CNKI were systematically searched (from inception to July 2025) to identify studies comparing different SC dosages (low dose: <1×10^7; medium dose: 1×10^7-10×10^8; high dose: >1×10^8). Conventional meta-analyses were performed using Review Manager 5.3, while network meta-analyses (NMA) were conducted with Stata 16.0. Treatment efficacy was ranked using SUCRA curves. Sensitivity analyses and funnel plots were applied to assess the robustness of the findings and potential publication bias.

Results: Eighteen studies involving 1,192 patients were included. Compared with CD alone, evidence from conventional meta-analysis and network meta-analysis suggested that high-dose autologous stem cell therapy (>1×10^8 cells) combined with CD was associated with a lower risk of hip failure (conversion to THA) (OR = 0.24, 95% CI: 0.12 to 0.44). The high-dose group was also associated with a lower rate of femoral head collapse (OR = 0.24, 95% CI: 0.08 to 0.74) and lower VAS score (SMD = -1.93, 95% CI: -3.64 to -0.23). However, no statistically significant advantage of the high-dose group over the low- or medium-dose groups was observed, and no clear differences in incidence of adverse events (AEs) were detected across dose categories.

Conclusions: Preliminary evidence suggests that, compared with CD alone, high-dose autologous stem cell therapy (>1×10^8 cells) combined with CD is associated with a lower risk of hip failure and a lower femoral head collapse rate, with additional improvements in pain in some comparisons. However, the certainty of evidence is limited by heterogeneity in study design, follow-up, and cell dose reporting. Future studies should emphasize standardized cell processing and intervention dosing to validate the dose-response relationship and establish the optimal clinical dosage.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record, identfier CRD420251154025.

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不同剂量自体干细胞联合核心减压治疗股骨头坏死的疗效：系统评价和网络荟萃分析

目的：比较不同剂量的自体干细胞（SC）联合核心减压（CD）与单独CD治疗股骨头骨坏死（ONFH），以全髋关节置换术（THA）为主要结局。方法：系统检索PubMed、Embase、Cochrane Library、Web of Science和CNKI（从成立到2025年7月），以确定比较不同SC剂量（低剂量：1×10^8）的研究。使用Review Manager 5.3进行常规meta分析，使用Stata 16.0进行网络meta分析（NMA）。采用SUCRA曲线对治疗效果进行排序。采用敏感性分析和漏斗图来评估研究结果的稳健性和潜在的发表偏倚。结果：纳入18项研究，涉及1192例患者。与单独CD相比，来自传统荟萃分析和网络荟萃分析的证据表明，高剂量自体干细胞治疗（>1×10^8细胞）联合CD与髋关节衰竭（转化为THA）的风险较低相关（OR = 0.24, 95% CI: 0.12至0.44）。高剂量组股骨头塌陷率较低（OR = 0.24, 95% CI: 0.08 ~ 0.74）， VAS评分较低（SMD = -1.93, 95% CI: -3.64 ~ -0.23）。然而，没有观察到高剂量组比低或中剂量组有统计学上的显著优势，并且在不同剂量类别的不良事件（ae）发生率上没有明显差异。结论：初步证据表明，与单独CD相比，高剂量自体干细胞治疗（>1×10^8细胞）联合CD与髋关节衰竭的风险较低和股骨头塌陷率较低相关，在一些比较中还能进一步改善疼痛。然而，证据的确定性受到研究设计、随访和细胞剂量报告的异质性的限制。未来的研究应强调标准化的细胞处理和干预剂量，以验证剂量-反应关系，建立最佳临床剂量。系统评审注册：https://www.crd.york.ac.uk/prospero/display_record，标识符CRD420251154025。

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来源期刊

Frontiers in Endocrinology Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

5.70

自引率

9.60%

发文量

3023

审稿时长

14 weeks

期刊介绍： Frontiers in Endocrinology is a field journal of the "Frontiers in" journal series. In today’s world, endocrinology is becoming increasingly important as it underlies many of the challenges societies face - from obesity and diabetes to reproduction, population control and aging. Endocrinology covers a broad field from basic molecular and cellular communication through to clinical care and some of the most crucial public health issues. The journal, thus, welcomes outstanding contributions in any domain of endocrinology. Frontiers in Endocrinology publishes articles on the most outstanding discoveries across a wide research spectrum of Endocrinology. The mission of Frontiers in Endocrinology is to bring all relevant Endocrinology areas together on a single platform.