Analysis of the efficacy of autologous adipose-derived stromal vascular fraction and calcium phosphate bone cement combined with core decompression in patients with femoral head necrosis: A retrospective study

Background Currently, cell therapy has become an effective treatment for Osteonecrosis of the Femoral Head (ONFH). Adipose-derived stromal vascular fraction (SVF) has good proliferation ability and bone differentiation efficiency, and it is easy to obtain without cell culture, making it easy to apply clinically. This study aims to evaluate the efficacy of autologous SVF combined with calcium phosphate bone cement (CPC) and core decompression (CD) in patients with ONFH. Method A retrospective analysis of 148 patients (219 hips) treated at the First Medical Center and the Fourth Medical Center of the PLA General Hospital from 2009 to 2022. Fifty-five patients (85 hips) received simple core decompression (CD group) treatment, while 93 patients (134 hips) received SVF and CPC combined with CD (SVF + CPC + CD group) treatment. During a follow-up period of at least 36 months, the imaging progression rate and hip replacement rate were compared according to the staging system of the Association Research Circulation Osseous (ARCO). Kaplan-Meier survival analysis was used to compare the survival rates of the two groups, and Cox multivariate regression analysis was conducted to explore the influencing factors of the survival process. The clinical outcomes were evaluated using the Harris hip score (HHS), Visual analogue scale (VAS), and quality of life score (SF-36). Results The imaging progression rate of the CD group was 55.29% (47/85), while that of the SVF + CPC + CD group was 33.58% (45/134) ( P  < 0.001). The hip replacement rate in the CD group was 35.29% (30/85), and in the SVF + CPC + CD group it was 20.15% ( P  = 0.013). Kaplan-Meier survival analysis showed that over time, the hip survival rate of the SVF + CPC + CD group was consistently higher than that of the CD group. Cox multivariate regression analysis indicated that smoking and ARCO staging were associated with hip survival rate ( P  < 0.05). At the last follow-up, the VAS score, HHS score, and aspects of bodily pain, health status, emotional function, and health change in the SVF + CPC + CD group were significantly better than those in the CD group ( P  < 0.05). Conclusion The combination of SVF and CPC with CD shows significant advantages in improving symptoms of ONFH and delaying disease progression.