Total Hip Arthroplasty After Failed Hip-Preserving Surgery with Concentrated Autologous Bone Marrow Aspirate Transplantation for Osteonecrosis of the Femoral Head: A Retrospective Study

Tomohiro Yoshizawa; Tomokazu Yoshioka; Hisashi Sugaya; Tomofumi Nishino; Yohei Tomaru; Hiroshi Wada; Hiroshi Akaogi; Masashi Yamazaki; Hajime Mishima

doi:10.1007/s43465-022-00603-w

Total Hip Arthroplasty After Failed Hip-Preserving Surgery with Concentrated Autologous Bone Marrow Aspirate Transplantation for Osteonecrosis of the Femoral Head: A Retrospective Study

Indian J Orthop. 2022 Feb 1;56(7):1251-1258. doi: 10.1007/s43465-022-00603-w. eCollection 2022 Jul.

Authors

Tomohiro Yoshizawa¹, Tomokazu Yoshioka², Hisashi Sugaya¹, Tomofumi Nishino¹, Yohei Tomaru¹, Hiroshi Wada¹, Hiroshi Akaogi¹, Masashi Yamazaki¹, Hajime Mishima¹

Affiliations

¹ Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan.
² Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan.

Abstract

Purpose: Since 2003, a hip-preserving technique-concentrated autologous bone marrow aspirate transplantation (CABMAT)-has been applied to treat osteonecrosis of the femoral head (ONFH). We investigated intraoperative and postoperative outcomes of total hip arthroplasty (THA) in patients who underwent CABMAT as hip-preserving surgery for ONFH but developed secondary hip osteoarthritis after progressive femoral head collapse.

Methods: A total of 456 hips in 282 patients underwent CABMAT in our hospital between April 2003 and December 2018; 108 hips required THA (THA conversion rate, 23.7%). We enrolled 60 hips (26 hips in 20 men and 34 in 26 women) with a follow-up of over 2 years. We retrospectively analyzed patient background data, time to THA, surgical procedure, postoperative complications, and clinical outcomes from medical records.

Results: The disease was steroid-related, alcohol-related, and idiopathic in 48, seven, and five hips, respectively. The mean age at THA was 45.7 years, and mean conversion time was 2.7 years. Cementless THA was performed in all cases; the mean operating time and blood loss were 82.7 min and 210 g, respectively. Postoperative complications were observed in four cases; intraoperative fracture, two cases; superficial infection, one case; and dislocation, one case. The mean follow-up period was 5.7 years; no loosening or deep infections occurred. No patients required revision arthroplasty.

Conclusion: We noted no complications related to CABMAT. After a minimum 2-year follow-up, the clinical outcomes were good. CABMAT was found to be an useful hip-preserving surgery, with little effect on conversion to THA, and THA outcomes were good.

Keywords: Bone marrow aspirate; Femoral head; Osteonecrosis; Total hip arthroplasty; Transplantation.