Cell and Organ Transplantology. 2025; 13(2):e2025132181 (in press).
DOI: 10.22494/cot.v13-2.181

Regenerative interventional treatment of hip and knee aseptic osteonecrosis: evaluation of effectiveness

Holiuk Ye., Strafun S., Melnyk M., Maslova T., Pshenychnyi T., Lushchii O.

• State Institute of Traumatology and Orthopedics, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine

Abstract

The incidence and prevalence of aseptic osteonecrosis of the joints remain insufficiently studied in most countries. According to various authors, it occurs in 1.4-4.7 % of patients with hip joint pathology. Interventional regenerative technologies are becoming the only alternative to hip and knee replacement in aseptic osteonecrosis today.
The aim of the study was to develop a method for treating aseptic osteonecrosis of the hip and knee using regenerative technologies and to analyse the results of its application.
Materials and methods. The overall group analysed for treatment outcomes of aseptic osteonecrosis of the hip and knee included 182 patients (262 joints), of whom 102 were men and 80 were women. The mean age of patients was 42.5 ± 20.8 years. A total of 121 patients (187 joints) had aseptic osteonecrosis of the hip and 61 patients (75 joints) had aseptic osteonecrosis of the knee. For patients with aseptic necrosis of the hip the Harris Hip Score, Oxford Hip Score, and VAS were used, while for patients with aseptic osteonecrosis of the knee, the KOOS, Oxford Knee Score, and VAS were applied. The follow-up period in all groups was 12 ± 0.5 months.
Results. A regenerative interventional technique for treating aseptic osteonecrosis of the hip and knee was developed. To improve the technology of intramedullary administration of the biotechnological product, a navigation device was designed. The quality of life indicators in the group that underwent preoperative intra-articular administration of autologous peripheral blood concentrates demonstrated better improvement in pain reduction and joint function compared with the group that underwent core decompression with administration of the mononuclear fraction of bone marrow aspirate alone.
In patients with Ficat stage I, positive functional outcomes and pain reduction were observed as early as three months after treatment. Significant positive results were obtained in all patients of this group 12 months after treatment across all scales. Positive outcomes were also observed in patients with stage II and III, although in stage III the improvement progressed much more slowly.
Analysis of clinical indicators over time using KOOS, OKS and VAS scales, depending on the Ficat stage, revealed that positive dynamics in aseptic osteonecrosis of the knee developed more slowly compared with hip necrosis, but by 12 months the quality of life scores were nearly comparable. The improvement in quality of life, pain relief and joint function was significantly more pronounced in patients with stage I and II.
Conclusions. It was established that the two-stage treatment approach (preoperative intra-articular administration of autologous peripheral blood concentrates followed by core decompression and intramedullary administration of the mononuclear fraction of bone marrow aspirate) significantly improves clinical outcomes according to quality of life questionnaires compared with the one-stage treatment group. Analysis of clinical dynamics depending on the Ficat stage demonstrated significant improvement in quality of life, pain relief and joint function in patients with stage I and II 12 months after treatment.

Key words: hip; knee; aseptic osteonecrosis; regenerative interventional technologies; intramedullary injections

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