Transplantation of bone marrow mononuclear cells enables simultaneous treatment with osteotomy for osteonecrosis of the bilateral femoral head

Background: Bone marrow derived mononuclear cells (BMMNCs) have the advantage of promoting both angiogenesis and osteogenesis. In this report, BMMNCs were transplanted into the affected area of one hip using interconnected porous calcium hydroxyapatite (IP-CHA) in two patients, while the other hip was simultaneously treated with transtrochanteric rotational osteotomy (TRO). This case report documents the potential of BMMNCs with IP-CHA for bone repair at the lesion of osteonecrosis of the femoral head. Case Report: Two patients whose progression of osteonecrosis was stage 3 at one hip and stage 2 at the other hip. Firstly, TRO was performed on the collapsed side. Bone marrow aspirates were obtained from the iliac crest and were centrifuged with a cell separator during the procedure of TRO. BMMNCs were seeded into the IP-CHA and were transplanted to the lesion of osteonecrosis. Bone consolidation of transition zone on the cell-seeded femoral head was observed postoperatively at three or six months. The radiographs more than 22 months after surgery demonstrated shrinking of the extent of osteonecrosis, and no progression of collapse was observed. Conclusions: We described two case reports of simultaneous surgical treatment for osteonecrosis of the bilateral femoral head using TRO for one hip in combination with transplantation of BMMNCs for the other hip. Short term results of this procedure are satisfactory without progression of collapse. Transplantation of BMMNCs may be a beneficial treatment for bone repair in the condition of osteonecrosis.