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Year 2022 Vol. 30 No 1

TRAUMATOLOGY AND ORTHOPEDICS

À.E. MURZICH 1, Î.À. SOKOLOVSKY 1, Î.L. EISMONT 1, YA.I. ISAYKINA 2

SURGICAL TREATMENT OF FEMORAL HEAD NECROSIS WITH PRE-DIFFERENTIATED MESENCHYMAL STEM CELLS

Republican Scientific and Practical Centre for Traumatology and Orthopedics1, Minsk,
Belarusian Research Center for Pediatric Oncology and Hematology 2, Borovliany, Minsk Region,
The Republic of Belarus

Objective. To study the results of pre-differentiated MSCs application in the treatment of femoral head necrosis in young patients.
Methods. The developed high-tech approach included: exfusion of 50-70 ml of patient’s bone marrow 4 weeks prior to implantation; osteogenic differentiation and obtaining a biomedical cell product; surgical decompression and introduction of pre-differentiated MSCs in fibrin gel; postoperative rehabilitation. Surgeries were performed in 25 patients at stages I and II according to the ARCO classification. The average age of patients is 34 [29; 45], men – 20 (80%), women – 5 (20%). The assessment scale is a visual analogue scale (VAS), Harris scale, radiography, MRI.
Results. Observation period was 41 [19; 59] month. Average Harris score before surgery was 76 [68.8; 79] points, after treatment – 90 [78.9; 92] points. In 15 (60%) cases an excellent results were obtained, in 5 (20%) – good, in 3 (12%) – satisfactory, in 2 (8%) – unsatisfactory (collapse progression). The level of pain syndrome was reduced from 40 [30; 50] to 10 [5; 25] points. There were no complications. Preservation of the femoral head sphericity and the width of the joint space, relief of bone marrow edema, reduction of the necrosis zone size and synovitis according to MRI data were found in 92% of cases.
Conclusion. The treatment method of femoral head necrosis with the use of pre-differentiated MSCs in the absence of infectious triggers in the lesion focus made it possible to preserve 95 % of cultured cells in the cell product composition and to introduce it minimally invasively, avoiding the need for bone graft collection. The introduction of the cellular technologies in practice made it possible to obtain positive treatment results in 92% of cases due to an improvement clinical condition by the Harris scale and reduce of pain syndrome compared to the initial state; it did not lead to infectious, allergic or other complications within the 41 [19; 59] month follow-up.

Keywords: femoral head, necrosis, mesenchymal stem cells, surgical decompression, fibrin gel
p. 61-73 of the original issue
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Address for correspondence:
220024, Republic of Belarus,
Minsk, Kizhevatov Str., 60/4,
Republican Scientific and Practical Centre
for Traumatology and Orthopedics
tel. +375 17 212 32 88.
e-mail: mae77@list.ru,
Murzich Alyaksandr E.
Information about the authors:
Murzich Alyaksandr E., PhD, Deputy Director for Science, Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1625-7321
Sakalouski Aleh A., MD, Professor, Head of Children and Adolescents Trauma and Orthopedic Laboratory, Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8749-3802
Eismont Oleg L., MD, Associate Professor, Head of the Joint Pathology and Sports Injury Laboratory, Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1002-4132
IsaykinaYanina I., PhD (Biol), Head of the Laboratory of Cell Biotechnology and Cytotherapy, Belarusian Research Center for Pediatric Oncology and Hematology, Borovliany, Minsk Region, Republic of Belarus.
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