Document Type: CURRENT CONCEPTS REVIEW

Authors

1 Massachusetts General Hospital at Harvard Medical School, Boston, USA Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Science, Mashhad, Iran

2 Rothman Orthopedic at Thomas Jefferson University, Philadelphia, PA, USA

3 Royal London Hospital, London, UK

Abstract

Background: Despite widespread research on non-traumatic femoral head osteonecrosis (FHON), there is no
consensus about preventative treatment options. Insuffici
Despite widespread research on non-traumatic femoral head osteonecrosis (FHON), there is no consensus about
preventative treatment options. Insufficient blood supply and increased intra-osseous pressure are the initiating events
in the majority of cases. BMPs are growth factors that belong to the transforming growth factor β (TGFβ) superfamily.
Two specific formulations of BMPs have already been approved by the FDA: 1. BMP-2 (Infused, Medtronic) for the
treatment of tibial open fractures and spinal fusion; 2. BMP-7 (OP-1, Stryker) in the setting of long bone non-unions. To
our knowledge there is no published work reviewing the utility of BMP-2 in the setting of FHON.
Online databases (EMBASE, Cochrane, MEDLINE and PubMed) for literature relating to the use of BMP-2 in the
treatment of FHON on 2nd June 2017.
Animal studies: A total of 169 animal subjects with induced FHON were treated with BMP-2 in all the included in vivo
studies.
Improved histological parameters, areas of revascularization, areas of new bone formation and osteoid deposition
were seen in all studies. The number of osteoclasts decreased post operatively, in the ibandronate and BMP-2 group.
Human studies: In combination, 96 human hips were treated in two studies utilizing BMP-2 and mean follow-up was at
least five years. Success rate of BMP-2 was above 80 % (based on Harris score and WOMAC score) in both studies.
Both are level III studies.
The present review of animal and clinical studies could not find well-designed prospective comparable studies with
large sample size and preliminary evidence is not sufficient to supports the utilization of BMP-2, and its impact on the
midterm outcomes of FHON.
Level of evidence: III
ent blood supply and increased intra-osseous pressure are
the initiating events in the majority of cases. BMPs are growth factors that belong to the transforming growth factor β
(TGFβ) superfamily. Two specific formulations of BMPs have already been approved by the FDA: 1. BMP-2 (Infused,
Medtronic) for the treatment of tibial open fractures and spinal fusion; 2. BMP-7 (OP-1, Stryker) in the setting of long
bone non-unions. To our knowledge there is no published work reviewing the utility of BMP-2 in the setting of FHON.
Methods: Online databases (EMBASE, Cochrane, MEDLINE and PubMed) for literature relating to the use of BMP-2
in the treatment of FHON on 2nd June 2017.
Results: Animal studies: A total of 169 animal subjects with induced FHON were treated with BMP-2 in all the included
in vivo studies.
Improved histological parameters, areas of revascularization, areas of new bone formation and osteoid deposition
were seen in all studies. The number of osteoclasts decreased post operatively, in the ibandronate and BMP-2 group.
Human studies: In combination, 96 human hips were treated in two studies utilizing BMP-2 and mean follow-up was at
least five years. Success rate of BMP-2 was above 80 % (based on Harris score and WOMAC score) in both studies.
Both are level III studies.
Conclusion: The present review of animal and clinical studies could not find well-designed prospective comparable
studies with large sample size and preliminary evidence is not sufficient to supports the utilization of BMP-2, and its
impact on the midterm outcomes of FHON.
Level of evidence: III

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Main Subjects