Could BMMNCs therapy reduce the mid- and long-term rate of total hip arthroplasty of femoral head necrosis?: A systematic review and meta-analysis

Background:Osteonecrosis of the femoral head (ONFH) is a cause of hip pain and early joint lesion in patient. The hip-preserving treatments are especially important for patients in early stage of ONFH. However, it is controversial of the effectiveness and safety of bone marrow mononuclear cells (BMMNCs) in the treatment of ONFH. The aim of the study was to explore the mid- and long-term efficacy (particularly the rate of total hip arthroplasty [THA]) with BMMNCs in treatment of ONFH. Methods:PubMed, Web of Science, Embase, OVID, Cochrane Libriary, CNKI, and Google Scholar databases were searched for relevant randomized controlled trials or non-randomized controlled trials from inception to October 15, 2022. Methodological quality of the trials was assessed, relevant data were extracted, and RevMan 5.3 and Stata 15.0 software were used to perform the meta-analysis of parameters related to the consequences. Results:A total of 22 articles were included, including 1923 patients. Meta-analysis results showed that the treatment of BMMNCs has a significantly lower incidence of THA (odds ratio [OR] = 0.33; 95% confidence interval [CI] = 0.27-0.41, P < .00001), radiographic progression rate (OR = 0.37; 95% CI = 0.21-0.63, P = .0003) and visual analog score at 24 months (mean difference [MD] = -11.84; 95% CI = -14.86 to -8.82, P < .00001), and has higher Harris hip score (MD = 6.90; 95% CI = 4.56-9.24, P < .00001), improvement of visual analog score at 24 months (MD = 6.87; 95% CI = 1.84-11.89, P = .007) and Merle D'Aubigne and Postel hip score (MD = 0.79; 95% CI = 0.14-1.44, P = .02). But there was no significant difference in the Western Ontario and McMaster University Osteoarthritis index (MD = -6.32; 95% CI = -16.76 to 4.12, P = .24) and incidence of complication (OR = 0.86; 95% CI = 0.52-1.42, P = .56). Conclusion:Current evidence supports that BMMNCs therapy could reduce the mid- and long-term rate of THA, improve hip function, alleviated the degree of hip pain, delay the progression of imaging staging and not increase the rate of complication, which maybe serve as a preferred option for treating ONFH.

Automated summary

This study aimed to explore the mid- and long-term efficacy of bone marrow mononuclear cells (BMMNCs) in the treatment of osteonecrosis of the femoral head (ONFH). Meta-analysis of relevant trials showed that BMMNCs treatment significantly reduced the rate of total hip arthroplasty, radiographic progression rate, and visual analog score at 24 months, while improving Harris hip score, improvement of visual analog score at 24 months, and Merle D'Aubigne and Postel hip score. Furthermore, BMMNCs treatment did not increase the incidence of complications. These findings suggest that BMMNCs therapy may be a preferred option for treating ONFH.