Efficacy of cell therapy for osteonecrosis of the hip compared with hip arthroplasty in sickle cell disease: a systematic review

Abstract

Abstract Objective: To evaluate the clinical efficacy and effectiveness of the use of cell therapy in the treatment of osteonecrosis of the hip in people with sickle cell disease (SCD) compared with hip arthroplasty. Methodology: Articles published from 2015 to 2019 in English, Portuguese, or Spanish were screened in the following databases: Cochrane, PubMed, Science Research, CAPES (Coordination for the Improvement of Higher Education Personnel), Virtual Health Library (VHL) and SciELO (Scientific Electronic Library Online). The following keywords were used: cell therapy, osteonecrosis, hip, sickle cell anemia and arthroplasty. People with sickle cell disease who developed osteonecrosis of the hip and underwent treatment using cell therapy or hip arthroplasty were selected as the sample. Results: After refining the searches and organizing the references, seven studies were selected that met the eligibility criteria. Discussion: We found that out of the seven studies evaluated, three presented autologous bone marrow cell implantation and four presented hip arthroplasty (THA) as an intervention procedure in osteonecrosis of the hip in people with SCD. In all studies in which THA was used, there was a higher prevalence of complications such as vaso-occlusive crises, pain, surgical wound infection and reintervention, among others. In most studies using cell therapy, pain was reduced or absent, there were no complications and reintervention was not necessary. All studies with cell therapy indicated a reduction in the progression of osteonecrosis of the hip. Conclusion:Considering the analyzed studies, it was found that autologous bone marrow cell implantation has gained prominence and great relevance in the treatment of osteonecrosis of the hip in people with sickle cell disease, presenting a better clinical outcome and greater efficacy and effectiveness compared with hip arthroplasty. Systematic review record: a study pre-registered in PROSPERO (https://www.crd.york.ac. uk/prospero/display_record.php?ID=CRD42020199505) under the number CDR42020199505, before data collection.