Osteonecrosis repair with bone marrow cell therapies: State of the clinical art

Introduction: Hip osteonecrosis is a pathological condition resulting from cellular impairment due to reduction in osteoblast activity and local mesenchymal stem cell populations. Cell-based therapies might aid in overcoming these deficiencies by providing stem cells and other progenitor cells to potentially improve the local cellular environment in the affected hip. Methods: A PubMed search, using the search terms hip osteonecrosis and mesenchymal stem cells, was conducted in December 2013. A total of 15 publications were identified and reviewed for clinical outcomes. Findings: Clinical studies of patients with osteonecrosis treated with mesenchymal stem cells showed beneficial effects. No unexpected adverse events were identified in these studies. Core decompression was the usual method for autologous bone marrow cell implantation into the femoral head. However, other methods have been used such as arterial or venous delivery. A rationale for the use of cytotherapy, as well as the different descriptions of the techniques of implantation MSCs (autologous vs. allogenic, concentration vs. expansion), is provided in the context of treating hip osteonecrosis. Current problems and future challenges with cytotherapy and associated techniques are discussed. This article is part of a Special Issue entitled Stem Cells and Bones. (C) 2014 Elsevier Inc. All rights reserved.