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Stem cell therapy in bilateral osteonecrosis: computer-assisted surgery versus conventional fluoroscopic technique on the contralateral side

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Abstract

Purpose

Surgical management of osteonecrosis with core decompression with stem cell therapy is a new procedure. The technique is performed with fluoroscopic guidance. This study attempts to determine if computer-navigated technique can improve the procedure.

Methods

Thirty consecutive patients with bilateral symptomatic osteonecrosis without collapse were included in this study during the year 2011. A prospective, randomized, and controlled study was conducted on 60 hips (bilateral osteonecrosis) using conventional fluoroscopy technique on one side and computer-based navigation on the contralateral side. Bone marrow aspirated from the two iliac crests was mixed before concentration. Each side received the same volume of concentrated bone marrow and the same number of cells 110,000 ± 27,000 cells (counted as CFU-F).

Results

Computer navigation achieved better parallelism to the ideal position of the trocar, with better trocar placement as regards to tip-to-subchondral distance and ideal centre position within the osteonecrosis for injection of stem cells. Using computer navigation took fewer attempts to position the trocar, used less fluoroscopy time, and decreased the radiation exposure as compared with surgery performed with conventional fluoroscopy. At the most recent follow-up (6 years), increasing the precision with computer navigation resulted in less collapse (7 versus 1) and better volume of repair (13.4 versus 8.2 cm3) for hips treated with the computer-assisted technique.

Conclusions

The findings of this study suggest that computer navigation may be safely used in a basic procedure for injection of stem cells.

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Authors and Affiliations

  1. Hôpital Henri Mondor, 94010, Creteil, France

    Philippe Hernigou, Benjamin Thiebaut, Victor Housset, Claire Bastard, Yasuhiro Homma, Younes Chaib & Charles Henri Flouzat Lachaniette

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  1. Philippe Hernigou
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  2. Benjamin Thiebaut
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  3. Victor Housset
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  4. Claire Bastard
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  7. Charles Henri Flouzat Lachaniette
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Correspondence to Philippe Hernigou.

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The authors declare that they have no conflict of interest.

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All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hernigou, P., Thiebaut, B., Housset, V. et al. Stem cell therapy in bilateral osteonecrosis: computer-assisted surgery versus conventional fluoroscopic technique on the contralateral side. International Orthopaedics (SICOT) 42, 1593–1598 (2018). https://doi.org/10.1007/s00264-018-3953-4

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  • DOI: https://doi.org/10.1007/s00264-018-3953-4

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