SURGICAL TREATMENT OF FEMORAL HEAD NECROSIS WITH PRE-DIFFERENTIATED MESENCHYMAL STEM CELLS

Abstract

Objective. To study the results of pre-differentiated MSCs application in the treatment of femoral head necrosis in young patients. Methods. The developed high-tech approach included: exfusion of 50-70 ml of patient’s bone marrow 4 weeks prior to implantation; osteogenic differentiation and obtaining a biomedical cell product; surgical decompression and introduction of pre-differentiated MSCs in fibrin gel; postoperative rehabilitation. Surgeries were performed in 25 patients at stages I and II according to the ARCO classification. The average age of patients is 34 [29; 45], men - 20 (80%), women - 5 (20%). Theassessment scaleis avisual analogue scale (VAS), Harris scale, radiography, MRI. Results. Observation period was 41 [19; 59] month. Average Harris score before surgery was 76 [68.8; 79] points, after treatment - 90 [78.9; 92] points. In 15 (60%) cases an excellent results were obtained, in 5 (20%) - good, in 3 (12%) - satisfactory, in 2 (8%) - unsatisfactory (collapse progression). The level of pain syndrome was reduced from 40 [30; 50] to 10 [5; 25] points. There were no complications. Preservation of the femoral head sphericity and the width of the joint space, relief of bone marrow edema, reduction of the necrosis zone size and synovitis according to MRI data were found in 92% of cases. Conclusion. The treatment method of femoral head necrosis with the use of pre-differentiated MSCs in the absence of infectious triggers in the lesion focus made it possible to preserve 95 % of cultured cells in the cell product composition and to introduce it minimally invasively, avoiding the need for bone graft collection. The introduction of the cellular technologies in practice made it possible to obtain positive treatment results in 92% of cases due to an improvement clinical condition by the Harris scale and reduce of pain syndrome compared to the initial state; it did not lead to infectious, allergic or other complications within the 41 [19; 59] month follow-up. What this paper adds A method of cell therapy of femoral head necrosis affected young patients using pre-differentiated mesenchymal stem cells (MSCs) has been firstly developed. The use of a new method of treatment made it possible to obtain positive results and preserve the structures of the hip joints in 92% of cases due to the optimization of the osteoregeneration process has been demonstrated.