{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T03:21:23Z","timestamp":1752981683169,"version":"3.37.3"},"reference-count":41,"publisher":"S.C. JURNALUL PENTRU MEDICINA SI VIATA S.R.L","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMedLife"],"abstract":"<jats:p>The study aimed to assess the effectiveness of autologous hematopoietic bone marrow and concentrated growth factor (CGF) transplantation and core decompression in patients with avascular necrosis of the femoral head (ANFH). We performed a single-center prospective study on 31 patients with non-traumatic early-stage (stage I to III) ANFH based on the 1994 classification of the Association Research Circulation Osseous (ARCO). The patients were subjected to bone marrow aspiration from the posterior iliac crest, separation, and concentration of growth factors from the bone marrow aspirate, core decompression of the femoral head, and injection of hematopoietic bone marrow and CGFs into the necrotic lesion. Patients were evaluated using the visual analogue scale, the WOMAC questionnaire, and X-ray and MRI examinations of the hip joints before, at 2, 4, and 6 months after the intervention. Patients had a mean age of 33 years (range 20\u201344 years), 19 (61%) of them being male and 12 (39%) females. The presentation of the disease was bilateral in 21 patients and unilateral in 10 patients. The main cause of ANFH was steroid treatment. The mean VAS and WOMAC scores were 48.37 (SD: 14.67) out of 100, and the mean VAS pain score was 50.83 out of 100 (SD: 20.46), respectively, before transplant. This value significantly improved to 22.31 (SD 12.12) of 100, and the mean VAS pain score was 21.31 of 100 (SD: 20.46) (P=0.04). MRI showed a significant improvement (P=0.012). Our results suggest that autologous hematopoietic bone marrow and CGFs transplantation with core decompression have a beneficial effect in early-stage ANFH.<\/jats:p>","DOI":"10.25122\/jml-2022-0342","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T05:56:56Z","timestamp":1683525416000},"page":"76-90","source":"Crossref","is-referenced-by-count":4,"title":["Autologous hematopoietic bone marrow and concentrated growth factor transplantation combined with core decompression in patients with avascular necrosis of the femoral head"],"prefix":"10.25122","volume":"16","author":[{"given":"Nasser Ghaly","family":"Yousif","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Medicine, Medical College, Al Muthanna University, Samawah, Iraq","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"* Corresponding Author: Nasser Ghaly Yousif, Department of Medicine, Medical College, Al Muthanna University, Samawah, Iraq. E-mail: Yousif_ghaly@mu.edu.iq","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan Essa Kadhum","family":"Al Kilabi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Surgery, Medical College, Kufa University, Kufa, Iraq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karrar Kareem","family":"Hatem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Surgery, Medical College, Jabir Ibn Hayyan Medical University, Najaf, Iraq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamdullah Hadi","family":"Al-Albaseesee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Surgery, Medical College, Kufa University, Kufa, Iraq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wejdi Abbass Yassin","family":"Al-Fatlawy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Surgery, Medical College, Kufa University, Kufa, Iraq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majid","family":"Alhamadani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Surgery, Ministry of Health, Al Muthanna, Iraq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich Aran","family":"N\u00f6th","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Regenerative Research, College of Medicine, Colorado University, Boulder, Colorado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Altmimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Biology, Ministry of Health, Al Muthanna, Iraq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10755","published-online":{"date-parts":[[2023,1]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"1. Yu X, Zhang D, Chen X, Yang J, et al. Effectiveness of various hip preservation treatments for non-traumatic osteonecrosis of the femoral head: A network meta-analysis of randomized controlled trials. Journal of Orthopaedic Science. 2018; 23(2):356-364. doi: 10.1016\/j.jos.2017.12.004.","DOI":"10.1016\/j.jos.2017.12.004"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"2. Zhang W, Li X, Li H, Lu X, et al. 17\u03b2-estradiol promotes bone marrow Mesenchymal stem cell migration mediated by chemokine upregulation. Biochemical and Biophysical Research Communications. 2020;530(2):381-388. doi: 10.1016\/j.bbrc.2020.07.135.","DOI":"10.1016\/j.bbrc.2020.07.135"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"3. Zhong W, Sumita Y, Ohba S, Kawasaki T, et al. In vivo comparison of the bone regeneration capability of human bone marrow concentrates vs. platelet-rich plasma. PLoS One. 2012; 7: e40833. doi.org\/10.1371\/journal.pone.0040833","DOI":"10.1371\/journal.pone.0040833"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"4. Gangji V, De Maertelaer V, Hauzeur JP. 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. Bone. 2011; 49:1005-1009. doi: 10.1016\/j.bone.2011.07.032.","DOI":"10.1016\/j.bone.2011.07.032"},{"key":"ref5","unstructured":"5. Jacobs B. Alcoholism-induced bone necrosis. NY State J Med. 1992 Aug; 92(8):334-338."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"6. Xu Y, Jiang Y, Xia C, Wang Y, et al. Stem cell therapy for osteonecrosis of femoral head: Opportunities and challenges. Regenerative Therapy. 2020; 15:295-304. doi: 10.1016\/j.reth.2020.11.003","DOI":"10.1016\/j.reth.2020.11.003"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"7. Qian Y, Lin Z, Chen J, Fan Y, et al. Natural bone collagen scaffold combined with autologous enriched bone marrow cells for induction of orthogenesis in an ovine spinal fusion model. Tissue Eng Part A. 2009; 15:3547\u20133558. doi: 10.1089\/ten.TEA.2009.0076.","DOI":"10.1089\/ten.tea.2009.0076"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"8. Aarvold A, Smith JO, Tayton ER, Jones AM, et al. A tissue engineering strategy for the treatment of avascular necrosis of the femoral head. Surgeon. 2013; 11:319-325. doi: 10.1016\/j.surge.2013.02.008","DOI":"10.1016\/j.surge.2013.02.008"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"9. Rastogi S, Sankineani SR, Nag HL, Mohanty S, et al. Intralesional autologous Mesenchymal stem cells in management of osteonecrosis of femur: a preliminary study. Musculoskeletal Surgery. 2013; 97(3): 223-228. doi: 10.1007\/s12306-013-0273-0.","DOI":"10.1007\/s12306-013-0273-0"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"10. Marker DR, Seyler TM, McGrath MS, Delanois RE, et al. Treatment of early-stage osteonecrosis of the femoral head. J Bone Joint Surg Am. 2008; 90:175-187. doi: 10.2106\/JBJS.H.00671.","DOI":"10.2106\/JBJS.H.00671"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"11. Tabatabaee RM, Saberi S, Parvizi J, Mortazavi SMJ, Farzan M. Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with Early-Stage Osteonecrosis of the Femoral Head: A Comparative Study. The Journal of Arthroplasty. 2015;30(9):11-15. doi: 10.1016\/j.arth.2015.06.022.","DOI":"10.1016\/j.arth.2015.06.022"},{"key":"ref12","unstructured":"12. Li Z, Wei J, Xiao H, Zhu L, et al. Bone-strengthening supplement (BSP) promotes bone and cartilage repair, for the treatment of osteonecrosis of femoral head: an MRI-based study. Am J Transl Res 2019;11:7449\u201355"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"13. Yousif NG, Chetterje K, Gupta M, Shankar Manu. Complete remission of Hodgkin Lymphoma after a concurrent infection with COVID-19: systematic review and meta-analysis. Muthanna Medical Journal 2022; 6(1):57-67. http:\/\/dx.doi.org\/10.52113\/1\/1\/2022-57-67","DOI":"10.52113\/1\/1\/2022-57-67"},{"key":"ref14","unstructured":"14. Goujon E. Recherches exp\u00e9rimentales sur les propri\u00e9t\u00e9s du tissu osseux. J Anat Physiol 6: 399-412."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"15. Fayaz HC, Giannoudis PV, Vrahas MS, Smith RM, et al. The role of stem cells in fracture healing and nonunion. Int Orthop. 2011 Nov; 35(11): 1587\u2013 1597. doi: 10.1007\/s00264-011-1338-z.","DOI":"10.1007\/s00264-011-1338-z"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"16. Emadedin M, Karimi S, Karimi A, Labibzadeh N, et al. Autologous bone marrow-derived CD133 cells with core decompression as a novel treatment method for femoral head osteonecrosis: a pilot study. Cytotherapy. 2019; 21:107-12. doi: 10.1016\/j.jcyt.2018.10.005.","DOI":"10.1016\/j.jcyt.2018.10.005"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"17. Oryan A, Kamali A, Moshiri A, Baghaban Eslaminejad M. Role of Mesenchymal stem cells in bone regenerative medicine: what is the evidence? Cells Tissues Organs. 2017; 204:59-83. doi: 10.1159\/000469704.","DOI":"10.1159\/000469704"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"18. Zingoni GMZ, Castillo PD, Aliperti CP, Horst DJ. Role of bone marrowderived Mesenchymal stem cells in treatment avascular necrosis of femoral head. American Journal of BioMedicine. 2022; 10(1):25-34. doi:10.18081\/2333-5106\/2022.10\/25","DOI":"10.18081\/2333-5106\/2022.10\/25"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"19. Wang A, Ren M, Wang J. The pathogenesis of steroid-induced osteonecrosis of the femoral head: a systematic review of the literature. Gene. 2018; 671:103-109. doi: 10.1016\/j.gene.2018.05.091.","DOI":"10.1016\/j.gene.2018.05.091"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"20. Xu S, Zhang L, Jin H, Shan L, et al. Autologous Stem Cells Combined Core Decompression for Treatment of Avascular Necrosis of the Femoral Head: A Systematic Meta-Analysis. Biomed Res Int. 2017; 2017: 6136205, doi: 10.1155\/2017\/6136205, PMCID: PMC5559921","DOI":"10.1155\/2017\/6136205"},{"key":"ref21","unstructured":"21. Liu J. Core decompression combined with bone marrow Mesenchymal stem cell transplantation for treating osteonecrosis of the femoral head. Chinese Journal of Tissue Engineering Research. 2019; 23:4599. doi: 10.3969\/j. issn.2095-4344.1813"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"22. Kang JS, Suh YJ, Moon KH, Park JS, et al. Clinical efficiency of bone marrow Mesenchymal stem cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression. Stem Cell Res Ther. 2018;9(1):274. doi: 10.1186\/s13287-018-1030-y.","DOI":"10.1186\/s13287-018-1030-y"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"23. Ohzono K, Saito M, Sugano N, Takaoka K, Ono K.. The fate of nontraumatic avascular necrosis of the femoral head: a radiologic classification to formulate prognosis. Clin Orthop Relat Res 1992; 277:73-8.","DOI":"10.1097\/00003086-199204000-00009"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"24. V\u00e4\u00e4n\u00e4nen M, Tervonen O, Nevalainen MT. Magnetic resonance imaging of avascular necrosis of the femoral head: predictive findings of total hip arthroplasty. Acta Radiol Open. 2021 Apr 27; 10(4):20584601211008379. doi: 10.1177\/20584601211008379","DOI":"10.1177\/20584601211008379"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"25. Lebouvier A, Poignard A, Cavet M, Amiaud J, et al. Development of a simple procedure for the treatment of femoral head osteonecrosis with intraosseous injection of bone marrow Mesenchymal stromal cells: study of their biodistribution in the early time points after injection. Stem Cell Research & Therapy. 2015; 6(1):68. doi: 10.1186\/s13287-015-0036-y","DOI":"10.1186\/s13287-015-0036-y"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"26. Mahadeo KM, Oyeku S, Taragin B, Rajpathak SN, et al. Increased prevalence of osteonecrosis of the femoral head in children and adolescents with sicklecell disease. Am J Hematol. 2011; 86:806\u20138. doi: 10.1002\/ajh.22103.","DOI":"10.1002\/ajh.22103"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"27. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77:34-41","DOI":"10.1302\/0301-620X.77B1.7822393"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"28. Osunkwo I. An update on the recent literature on sickle cell bone disease. Curr Opin Endocrinol Diabetes Obes. 2013; 20:539-46.","DOI":"10.1097\/01.med.0000436192.25846.0b"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"29. Issa K, Naziri Q, Maheshwari AV, Rasquinha VJ, et al. Excellent results and minimal complications of total hip Arthroplasty in sickle cell hemoglobinopathy at mid-term follow-up using cement less prosthetic components. J Arthroplasty. 2013; 28:1693-8. doi: 10.1016\/j.arth.2013.03.017.","DOI":"10.1016\/j.arth.2013.03.017"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"30. Lieberman JR. Core decompression for osteonecrosis of the hip. Clin Orthop Relat Res. 2004; 418: 29-33. doi: 10.1097\/00003086-200401000-00006.","DOI":"10.1097\/00003086-200401000-00006"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"31. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am. 2006; 88:1117-1132. doi: 10.2106\/JBJS.O.00071.","DOI":"10.2106\/JBJS.E.01041"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"32. Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res. 2007; 465:53-62. doi: 10.1097\/BLO.0b013e3181591c92.","DOI":"10.1097\/BLO.0b013e3181591c92"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"33. Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res. 2002; 405:14-23. doi: 10.1097\/00003086-200212000-00003.","DOI":"10.1097\/00003086-200212000-00003"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"34. Yan Z, Hang D, Guo C, Chen Z. Fate of Mesenchymal stem cells transplanted to osteonecrosis of femoral head. J Orthop Res. 2009; 27: 442-446. doi: 10.1002\/jor.20759.","DOI":"10.1002\/jor.20759"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"35. Gangji V, Hauzeur J, Matos C, De Maertelaer V, et al. Treatment of osteonecrosis of the femoral head with implantation of autologous bonemarrow cells. A pilot study. J Bone Joint Surg Am. 2004; 86: 1153-1160. doi: 10.2106\/00004623-200406000-00006.","DOI":"10.2106\/00004623-200406000-00006"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"36. Gangji V, Toungouz M, Hauzeur J. Stem cell therapy for osteonecrosis of the femoral head. Expert Opin Biol Ther. 2005; 5: 437-442. doi: 10.1517\/14712598.5.4.437.","DOI":"10.1517\/14712598.5.4.437"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"37. Song WS, Yoo JJ, Kim YM, Kim HJ. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res. 2007; 454:139-146. doi: 10.1097\/01.blo.0000229342.96103.73.","DOI":"10.1097\/01.blo.0000229342.96103.73"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"38. Pak J. Autologous adipose tissue-derived stem cells induce persistent bone-like tissue in osteonecrosis femoral heads. Pain Physician. 2012; 15:75-85.","DOI":"10.36076\/ppj.2012\/15\/75"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"39. Kim HJ. Autologous adipose tissue-derived stem cells induce persistent bonelike tissue in osteonecrosis femoral heads: not bone-like, but fat-like tissue. Pain Physician. 2012; 15:E749.","DOI":"10.36076\/ppj.2012\/15\/E749"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"40. Hernigou P, Poignard A, Zilber S, Rouard H. Cell therapy of hip osteonecrosis with autologous bone marrow grafting. Indian J Orthop. 2009; 43:40-45. doi: 10.4103\/0019-5413.45322.","DOI":"10.4103\/0019-5413.45322"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"41. N\u00f6th U, Rackwitz L, Steinert AF, Tuan RS. Cell delivery therapeutics for musculoskeletal regeneration. Adv Drug Deliv Rev. 2010; 62:765-783. doi: 10.1016\/j.addr.2010.04.004.","DOI":"10.1016\/j.addr.2010.04.004"}],"container-title":["Journal of Medicine and Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medandlife.org\/wp-content\/uploads\/14.-jml-2022-0342.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T05:57:18Z","timestamp":1683525438000},"score":1,"resource":{"primary":{"URL":"https:\/\/medandlife.org\/wp-content\/uploads\/14.-jml-2022-0342.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["JMedLife-16-076"],"URL":"https:\/\/doi.org\/10.25122\/jml-2022-0342","relation":{},"ISSN":["1844-122X","1844-3117"],"issn-type":[{"type":"print","value":"1844-122X"},{"type":"electronic","value":"1844-3117"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}