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SICOT J. 2018;4:46. doi: 10.1051/sicotj/2018044. Epub 2018 Nov 5.

Unusual indication of Cell therapy for hip osteonecrosis after pregnancy.

Author information

1
Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France.
2
Auregan Jean Charles, Hopital Antoine Beclere, 157 Rue de la Porte de Trivaux, 92140 Clamart, France.

Abstract

PURPOSE:

Osteonecrosis is a rare event during or after pregnancy. Due to the low number of cases, there is no report of long-term results after conservative surgery in this population.

METHOD:

From 1992 to 2010, 145 consecutive female patients with unilateral symptomatic (94 stage I and 51 stage II) left hip osteonecrosis (ON) related to pregnancy were treated between 4 and 16 months after delivery with percutaneous mesenchymal stem cell (MSC) injection obtained from bone marrow concentration. The average total number of MSCs (counted as number of colonies forming units-fibroblast) injected in the hip was 185 000 ± 65 000 cells (range 95 000-240 000 cells).

RESULTS:

At the most recent follow-up (average 15 years after hip surgery, range 8-25 years), among the 145 hips included in the study, 4 hips (2.7%) had collapsed and were treated with total hip arthroplasty (THA). Thirty-two of the 94 stage I had progressed to stage II; and 4 of the 51 stage II had progressed to stage III and collapse. The other 141 hips (97.3%) were without collapse and pain free. On MRI, as percentage of the volume of the femoral head, the osteonecrosis had decreased from 34.5% pre-operatively to 6% at the most recent follow-up. For women who had other children after treatment, a subsequent pregnancy was not associated with osteonecrosis.

CONCLUSION:

Patients with hip osteonecrosis following pregnancy had a low conversion rate to THA when treated early with cell therapy.

PMID:
30394283
DOI:
10.1051/sicotj/2018044
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