Therapeutic Potential of Bone Marrow Mononuclear Cells in Avascular Necrosis of the Femoral Head: A Clinical Study from Pakistan

Authors

Muhammad Adeel Khan, Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
Sana Tariq, Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
Hamza Yousaf, Department of Regenerative Medicine and Stem Cell Research, University of Health Sciences, Lahore, Pakistan
Ayesha Khalid, Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
Imran Shabbir, Department of Pathology and Laboratory Medicine, King Edward Medical University, Lahore, Pakistan

Article Type

Article

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a progressive orthopedic disorder leading to joint collapse and disability if untreated. Conventional therapies offer limited efficacy in early stages. Bone marrow–derived mononuclear cells (BMMNCs) have demonstrated osteogenic and angiogenic potential, offering a regenerative approach to joint preservation. This study evaluated the clinical, functional, and radiological outcomes of BMMNC implantation in Pakistani patients with early-stage AVN.

Methods: In this prospective, single-center study, patients aged 18–55 years with MRI-confirmed Ficat stage I–II AVN underwent core decompression followed by autologous BMMNC injection into the necrotic lesion. BMMNCs were harvested from the posterior iliac crest, processed via centrifugation, and injected under fluoroscopic guidance. Pain (Visual Analog Scale, VAS), function (Harris Hip Score, HHS), and radiological changes were assessed at baseline, 1, 3, 6, and 12 months.

Results: Twenty patients (28 hips) were included, mean age 36.4 ± 8.2 years. Mean VAS improved from 7.8 ± 0.8 at baseline to 1.9 ± 0.5 at 12 months (p < 0.001). Mean HHS increased from 55.2 ± 4.2 to 89.7 ± 3.9 over the same period (p < 0.001). MRI at 12 months showed lesion size reduction and improved bone marrow signal in 78.6% of hips, with no femoral head collapse in 85.7%. Three hips (10.7%) progressed to stage III. No major complications were observed.

Conclusion: Autologous BMMNC therapy combined with core decompression is a safe and effective joint-preserving option for early-stage AVN of the femoral head. It provides significant pain relief, functional improvement, and radiological stabilization in the short term. These findings support the integration of regenerative cell therapy into the treatment algorithm for AVN in resource-limited settings such as Pakistan.

Keywords

Avascular necrosis, femoral head, bone marrow mononuclear cells, regenerative medicine, stem cell therapy

Recommended Citation

Khan, Muhammad Adeel; Tariq, Sana; Yousaf, Hamza; Khalid, Ayesha; and Shabbir, Imran (2025) "Therapeutic Potential of Bone Marrow Mononuclear Cells in Avascular Necrosis of the Femoral Head: A Clinical Study from Pakistan," Muthanna Medical Journal: Vol. 12: Iss. 2, Article 5.
Available at: https://muthmj.mu.edu.iq/journal/vol12/iss2/5

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This work is licensed under a Creative Commons Attribution 4.0 International License.