Original Full Length Article Autologous bone marrow cell implantation in the treatment of non-traumatic osteonecrosis of the femoral head: Five year follow-up of a prospective controlled study

Objective: To determine the efficacy of bone marrow cell implantation into the necrotic lesion of the femoral head on clinical symptoms and the progression of osteonecrosis of the femoral head in comparison with core decompression. Methods: We studied nineteen patients and twenty four hips with early stage osteonecrosis of the femoral head. The hips were allocated to either core decompression only or core decompression and implantation of bone marrow cells. Both patients and assessors were blind with respect to treatment group assignment. The primary outcomes were clinical symptoms and disease progression. Results: Bone marrow implantation afforded a significant reduction in pain and in joint symptoms and reduced the incidence of fractural stages. At 60 months, eight of the eleven hips in the control group had deteriorated to the fractural stage whereas only three of the thirteen hips in the bone marrow graft group had progressed to that stage. Survival analysis showed a significant difference in the time to failure between the two groups at 60 months. Patients had only minor side-effects after the treatments. Conclusions: This long term follow-up study confirmed that implantation of autologous bone marrow cells in the necrotic lesion might be an effective treatment for patients with early stages of osteonecrosis of the femoral head

What future for mesenchymal stem cells in musculoskeletal diseases?

Regenerative medicine using mesenchymal stem cells (MSC) is developped in several musculoskeletal diseases. The concentration of bone marrow or adipose tissue has been the most common therapeutic method used. The large variability of the cell-productions, however, could be a limitation. Recent biological research concerning MSC has unearthed several new aspects. Firstly, a heterogeneity of the MSC was found following the tissue origin and/or the patient's. Then, the characterisation of MSC was improved by using new combinations of cellular membrane markers. Another important step was the discovery of the paracrine activity of MSC. The MSCs are able to produce a lot of growth factors and cytokines, a production of extra cellular vesicles like exosomes arising an intercellular signaling. MSCs were found to have not only a proliferation and differentiation performance to restore the damages of time, but also immunomodulation and anti-inflammation activities. The field of cell-based therapy with MSC is enlarged with newer and more promising methods than bone marrow concentrate. Expansion culture methods of MSC have been developped, as in vitro differentiation in osteoblasts and chondrocytes or cell manipulations by transfection to produce induced pluripotent stem cells or super MSCs able to produce more growth factors or cytokines, or to modify the membrane signaling for improving MSC homing. The translation of these biological developments in human therapy is the key for the MSC future. After pre-clinical tests to verify the safety, controlled trials are needed to define the true place of this regenerative medicine. © 2020 Société Française de Rhumatologi

Update in non-union treatment

peer reviewe

Osteonecrosis in inflammatory bowel diseases: a review of the literature

INTRODUCTION: Osteonecrosis (ON) of the femoral head can lead to femoral head collapse, necessitating total hip replacement. Reports of patients suffering from both ON and Inflammatory Bowel Diseases (IBD) have prompted us to evaluate the relationship between ON and IBD, especially Crohn's disease and ulcerative colitis. METHODS: A review of the data from three new cases, along with data from all the published cases of patients presenting ON and IBD found through a systematic search of the Pub Med database. RESULTS: We encountered some diagnostic problems: The ON diagnosis could not be confirmed in some patients who did not meet the ON diagnostic criteria. Reviewed data was too weak to assess the exact incidence of ON in IBD. Corticosteroid therapy, especially in high dose regimens, is likely the most important etiological factor. No evidence supporting other physiopathological hypothesis, such as total parenteral nutrition, osteoporosis, or coagulation disorders, was found. Finally, the multifocal form of ON appears particularly common in IBD, with some patients presenting multiple lesions of the hip, shoulder, knee and talus. CONCLUSIONS: ON in IBD, which is frequently multifocal, appears to be a complication of corticosteroid therapy, especially when high doses are used. We recommend regular ON checkups for corticosteroid-treated IBD patients

Comparison between clinical evaluation and ultrasonography in detecting hydrarthrosis of the knee

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis.

To study the clinical presentation of femoral head osteonecrosis (ONFH). Publications dedicated to this aspect of ONFH are rare. Our aim was to systematically collect and describe the clinical data

Sonography detection threshold for knee effusion.

The aim of this study was to determine the threshold for detecting knee effusion by ultrasound (US). Five knee specimens from embalmed cadavers were studied. Intra-articular injection of saline, blood and synovial fluid was performed under ultrasound control and methylene blue dye instillation. The smallest amount of fluid detectable by US in the knee was 7.4 ml for synovial fluid, 10.1 and 10.4 ml for saline solution and 9.7 for blood. The threshold for detecting knee joint effusion by US in cadaver specimens was 10 ml for saline and blood and 7 ml for synovial fluid.Journal Articleinfo:eu-repo/semantics/publishe

Articular aspergillosis: two case reports and review of the literature.

We report two cases of septic arthritis of the knee caused by Aspergillus: one by Aspergillus terreus in a cirrhotic patient and the other by Aspergillus fumigatus after vascular graft infection. The recovery of these organisms in synovial fluid should be considered as pathogenic, particularly in immunocompromised hosts. The pathogenic mechanism is discussed and the literature is reviewed.Case ReportsJournal ArticleReviewinfo:eu-repo/semantics/publishe