The efficacy of core decompression combined with regenerative therapy in early femoral head necrosis: a systematic review and meta-analysis involving 954 subjects
Notice bibliographique
Résumé
Background The debate continues on whether combining core decompression (CD) with regenerative therapy provides a more effective treatment for early femoral head necrosis than CD alone. This systematic review and meta-analysis endeavored to assess its efficacy. Methods We systematically searched PubMed, Web of Science, and Cochrane Library through July 2024 for RCTs and cohort studies evaluating the impact of core decompression (CD) with regenerative therapy versus CD alone in early-stage osteonecrosis (ARCO I, II or IIIa or Ficat I or II) of the femoral head (ONFH). Bias was evaluated using the Cochrane ROB 2.0 for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. The primary outcome was disease progression, measured by the incidence of staging advancement and total hip arthroplasty (THA) conversion. Clinical outcomes, including VAS, HHS, WOMAC, and Lequesne index, were secondary measures. Subgroup analyses were performed for variables such as age, BMI, follow-up period, and dosage in the bone marrow aspirate concentrate (BMAC) group, with results depicted in forest plots. Results This study represented a total of seven RCTs (mean follow-up time 36.57 months) and eight cohort trials (mean follow-up time 74.18 months) involving 954 hips. CD, when combined with agents, exhibited considerably enhanced efficacy over CD alone (risk ratio (RR) = 0.55 (95% CI 0.39–0.77), p < 0.001, I 2 = 54%) and 0.59 (95% CI 0.43–0.81), p = 0.001, I 2 = 51%), respectively). However, a significant difference was exclusive to the CD combined with BMAC group in terms of stage progression outcomes (stage progression, RR = 0.47 (95% CI 0.28–0.78), p = 0.004, I 2 = 67%); THA conversions, RR = 0.41 (95% CI 0.32–0.52), p < 0.001, I 2 = 43%). Secondary outcomes (VAS, HHS, WOMAC score and Lequesne index) showed improved results when CD was combined with other regenerative agents, such as bone mesenchymal stem cells (BMSCs) and bone morphogenetic proteins (BMPs), etc. In the reported data, the regenerative group demonstrated significantly higher rates of subjective improvement in pain and functional outcomes compared to those in the CD group (71.74% (66/92) vs. 56.38% (53/94). Subgroup analysis revealed superior outcomes in the low-dose (less than 20 mL) BMAC group and patients aged under 40 years old in stage progression rate and THA conversion rate. Conclusion CD, when combined with regenerative therapy, can diminish hip pain and enhance functionality, but its ability to slow disease progression remains uncertain. BMAC presents a more substantiated efficacy evidence than other agents, with low-doses of BMAC in patients under 40 years potentially slowing ONFH progression. Nonetheless, the high heterogeneity and relatively short follow-up time of these studies make it difficult to draw accurate conclusions, which necessitates verification through future trials comparing CD versus CD combined with regenerative therapy, with a focus on extended follow-up periods. Systematic Review Registration identifier CRD42023467873.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,010 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».