The Effect of Combined Therapy, Percutaneous Concentrated Autologous Bone Marrow Transplantation, and Low-Intensity Pulsed Ultrasound (LIPUS) in Treatment of Femoral Head Osteonecrosis

Objective: We describe a novel, combined approach to the treatment of osteonecrosis of the femoral head (ONFH) based on concentrated autologous bone marrow aspirates (CABMAT) and low-intensity pulsed ultrasound (LIPUS). Patients and Methods: The 7 male and 7 female patients (mean age: 40 years; 22 hips) underwent CABMAT followed by 6 months of continuous LIPUS. The mean follow-up period was 26 months. All patients were assessed using the visual analogue scale (VAS) for pain and the Japanese Orthopedic Association (JOA) hip score. Clinical and plain radiographic evaluations were performed before transplantation and at the most recent follow-up. Computed tomography (CT) scans were obtained before and 12 months after grafting. Results: The VAS and JOA scores improved in all patients. Collapse progressed in 8 of the 22 hips, but none required total hip arthroplasty. The mean volume of new bone formation 12 months' post-transplantation as seen on CT was 1256 mm 3 . New bone formation was observed in all patients. Discussion: The multiple benefits of LIPUS include improved local blood flow, accelerated production of angiogenesis-inducing cytokines, accelerated differentiation of mesenchymal stem cells to form osteoblasts, and the inhibition of osteoclast production and differentiation. This combined therapy is noninvasive, feasible, and joint-preserving in most ONFH patients.