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Homma Y, Yamasaki T, Tashiro K, Okada Y, Shirogane Y, Watari T, Hayashi K, Baba T, Nagata K, Yanagisawa N, Ohtsu H, Fujiwara N, Ando J, Yamaji K, Tamura N, Ishijima M. Autologous concentrated bone marrow injection for precollapse osteonecrosis of the femoral head concurrent with contralateral total hip arthroplasty: protocol for a clinical trial. BMJ Open 2024; 14:e082243. [PMID: 38719293 PMCID: PMC11086415 DOI: 10.1136/bmjopen-2023-082243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The femoral head contralateral to the collapsed femoral head requiring total hip arthroplasty (THA) often manifests in the precollapse stage of osteonecrosis of the femoral head (ONFH). It is not yet demonstrated how autologous concentrated bone marrow injection may prevent collapse of the femoral head concurrent with contralateral THA. The primary objective is to evaluate the efficacy of autologous concentrated bone marrow injection for the contralateral, non-collapsed, femoral head in patients with bilateral ONFH, with the ipsilateral collapsed femoral head undergoing THA. METHODS AND ANALYSIS This is a multicentre, prospective, non-randomised, historical-data controlled study. We will recruit patients with ONFH who are scheduled for THA and possess a non-collapsed contralateral femoral head. Autologous bone marrow will be collected using a point-of-care device. After concentration, the bone marrow will be injected into the non-collapsed femoral head following the completion of THA in the contralateral hip. The primary outcome is the percentage of femoral head collapse evaluated by an independent data monitoring committee using plain X-rays in two directions 2 years after autologous concentrated bone marrow injection. Postinjection safety, adverse events, pain and hip function will also be assessed. The patients will be evaluated preoperatively, and at 6 months, 1 year and 2 years postoperatively. ETHICS AND DISSEMINATION This protocol has been approved by the Certified Committee for Regenerative Medicine of Tokyo Medical and Dental University and Japan's Ministry of Healthy, Labour and Welfare and will be performed as a class III regenerative medicine protocol, in accordance with Japan's Act on the Safety of Regenerative Medicine. The results of this study will be submitted to a peer-review journal for publication. The results of this study are expected to provide evidence to support the inclusion of autologous concentrated bone marrow injections in the non-collapsed femoral head in Japan's national insurance coverage. TRIAL REGISTRATION NUMBER jRCTc032200229.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Ken Tashiro
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiki Okada
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazufumi Nagata
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hiroshi Ohtsu
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Naho Fujiwara
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Cell Therapy and Transfusion Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Yamaji
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Everts PA, Panero AJ. Basic Science of Autologous Orthobiologics. Phys Med Rehabil Clin N Am 2023; 34:25-47. [DOI: 10.1016/j.pmr.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Defining the iliac wing osseous fixation pathways: anatomy and implant constriction points. Arch Orthop Trauma Surg 2022; 142:755-761. [PMID: 33389023 DOI: 10.1007/s00402-020-03681-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner-outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor. METHODS Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5 mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured. RESULTS The IOTC is an elliptical area measuring 22.3 cm2. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5 mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3 mm in men and 13.8 mm in women (p < 0.001). The gluteal pillar diameter averaged 5.3 mm in men and 4.3 mm in women (p < 0.001). DISCUSSION All ilia converge to a thin and frequently unicortical central region. A 4.5 mm iliac wing lag screw will not breach the cortex if it remains within 20 mm or 14 mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5 mm implants. CONCLUSION This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.
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Hernigou J, Verdonk P, Homma Y, Verdonk R, Goodman SB, Hernigou P. Nonoperative and Operative Bone and Cartilage Regeneration and Orthopaedic Biologics of the Hip: An Orthoregeneration Network (ON) Foundation Hip Review. Arthroscopy 2022; 38:643-656. [PMID: 34506886 DOI: 10.1016/j.arthro.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the hip, including osteonecrosis (aseptic necrosis) involving bone marrow, bone, and cartilage, and chondral injuries involving articular cartilage, synovium, and bone marrow. Promising and established treatment modalities for osteonecrosis include nonweightbearing; pharmacological treatments including low molecular-weight heparin, prostacyclin, statins, bisphosphonates, and denosumab, a receptor activator of nuclear factor-kB ligand inhibitor; extracorporeal shock wave therapy; pulsed electromagnetic fields; core decompression surgery; cellular therapies including bone marrow aspirate comprising mesenchymal stromal cells (MSCs aka mesenchymal stem cells) and bone marrow autologous concentrate, with or without expanded or cultured cells, and possible addition of bone morphogenetic protein-2, vascular endothelial growth factor, and basic fibroblast growth factor; and arterial perfusion of MSCs that may be combined with addition of carriers or scaffolds including autologous MSCs cultured with beta-tricalcium phosphate ceramics associated with a free vascularized fibula. Promising and established treatment modalities for chondral lesions include autologous platelet-rich plasma; hyaluronic acid; MSCs (in expanded or nonexpanded form) derived from bone marrow or other sources such as fat, placenta, umbilical cord blood, synovial membrane, and cartilage; microfracture or microfracture augmented with membrane containing MSCs, collagen, HA, or synthetic polymer; mosaicplasty; 1-stage autologous cartilage translation (ACT) or 2-stage ACT using 3-dimensional spheroids; and autologous cartilage grafting; chondral flap repair, or flap fixation with fibrin glue. Hip pain is catastrophic in young patients, and promising therapies offer an alternative to premature arthroplasty. This may address both physical and psychological components of pain; the goal is to avoid or postpone an artificial joint. LEVEL OF EVIDENCE: Level V, expert opinion.
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Affiliation(s)
| | | | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - René Verdonk
- Department of Orthopaedics & Trauma, ULB University Clinic Erasme, Brussels, Belgium
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford, California, U.S.A
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Jeyaraman M, Bingi SK, Muthu S, Jeyaraman N, Packkyarathinam RP, Ranjan R, Sharma S, Jha SK, Khanna M, Rajendran SNS, Rajendran RL, Gangadaran P. Impact of the Process Variables on the Yield of Mesenchymal Stromal Cells from Bone Marrow Aspirate Concentrate. Bioengineering (Basel) 2022; 9:bioengineering9020057. [PMID: 35200410 PMCID: PMC8869489 DOI: 10.3390/bioengineering9020057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
Human bone marrow (BM) has been highlighted as a promising source of mesenchymal stromal cells (MSCs) containing various growth factors and cytokines that can be potentially utilized in regenerative procedures involving cartilage and bone. However, the proportion of MSCs in the nucleated cell population of BM is only around 0.001% to 0.01% thereby making the harvesting and processing technique crucial for obtaining optimal results upon its use in various regenerative processes. Although several studies in the literature have given encouraging results on the utility of BM aspiration concentrate (BMAC) in various regenerative procedures, there is a lack of consensus concerning the harvesting variables such as choice of anesthetic agent to be used, site of harvest, size of the syringe to be used, anticoagulant of choice, and processing variables such as centrifugation time, and speed. In this review article, we aim to discuss the variables in the harvesting and processing technique of BMAC and their impact on the yield of MSCs in the final concentrate obtained from them.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, India;
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
| | - Shiva Kumar Bingi
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Fellow in Orthopaedic Rheumatology, Dr. RML National Law University, Lucknow 226010, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624304, India
- Correspondence: (S.M.); (N.J.); (P.G.)
| | - Naveen Jeyaraman
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Fellow in Orthopaedic Rheumatology, Dr. RML National Law University, Lucknow 226010, India
- Fellow in Joint Replacement, Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli 620002, India
- Correspondence: (S.M.); (N.J.); (P.G.)
| | | | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201310, India;
| | - Shilpa Sharma
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
| | - Manish Khanna
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Department of Orthopaedics, Prasad Institute of Medical Sciences, Lucknow 226401, India
| | - Sree Naga Sowndary Rajendran
- Department of Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry 605102, India;
| | - Ramya Lakshmi Rajendran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Prakash Gangadaran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: (S.M.); (N.J.); (P.G.)
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Henyš P, Vořechovský M, Kuchař M, Heinemann A, Kopal J, Ondruschka B, Hammer N. Bone mineral density modeling via random field: Normality, stationarity, sex and age dependence. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 210:106353. [PMID: 34500142 DOI: 10.1016/j.cmpb.2021.106353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Capturing the population variability of bone properties is of paramount importance to biomedical engineering. The aim of the present paper is to describe variability and correlations in bone mineral density with a spatial random field inferred from routine computed tomography data. METHODS Random fields were simulated by transforming pairwise uncorrelated Gaussian random variables into correlated variables through the spectral decomposition of an age-detrended correlation matrix. The validity of the random field model was demonstrated in the spatiotemporal analysis of bone mineral density. The similarity between the computed tomography samples and those generated via random fields was analyzed with the energy distance metric. RESULTS The random field of bone mineral density was found to be approximately Gaussian/slightly left-skewed/strongly right-skewed at various locations. However, average bone density could be simulated well with the proposed Gaussian random field for which the energy distance, i.e., a measure that quantifies discrepancies between two distribution functions, is convergent with respect to the number of correlation eigenpairs. CONCLUSIONS The proposed random field model allows the enhancement of computational biomechanical models with variability in bone mineral density, which could increase the usability of the model and provides a step forward in in-silico medicine.
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Affiliation(s)
- Petr Henyš
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies, Technical University of Liberec, Studentskí 1402/2, Liberec 461 17, Czech Republic
| | - Miroslav Vořechovský
- Institute of Structural Mechanics, Faculty of Civil Engineering, Brno University of Technology, Veveří 331/95, Brno 602 00, Czech Republic
| | - Michal Kuchař
- Department of Anatomy, Faculty of Medicine in Hradec Králové, Charles University, Šimkova 870, Hradec Králové, 500 03, Czech Republic.
| | - Axel Heinemann
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Jiří Kopal
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies, Technical University of Liberec, Studentskí 1402/2, Liberec 461 17, Czech Republic
| | - Benjamin Ondruschka
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Auenbruggerpl. 2, Graz 8036, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Fraunhofer Institute for Machine Tools and Forming Technology IWU, Nöthnitzer Straße 44, 01187, Dresden, Germany
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D'Souza RS, Li L, Leng S, Hunt C, Law L, Muir C, Eldrige J, Bydon M, Chi M, Shapiro S, Mauck WD, Qu W. A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest. Bosn J Basic Med Sci 2021; 21:370-377. [PMID: 32415820 PMCID: PMC8112562 DOI: 10.17305/bjbms.2020.4744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/10/2020] [Indexed: 11/16/2022] Open
Abstract
Bone marrow aspiration (BMA) through the iliac crest is potentially unsafe due to the vicinity of neurovascular structures in the greater sciatic notch. Our objective was to investigate the safety of a recently described BMA technique, specifically a trajectory from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS). We conducted a chart review of 260 patients, analyzing three-dimensional reconstructed computed tomography images of the pelvis and sacrum to validate that this new approach offers a wide safety margin from the greater sciatic notch. Analysis of three-dimensional computed tomography scans demonstrated that the PSIS to AIIS trajectory never crossed the greater sciatic notch. The trajectory was noted to be at least one cm away from the greater sciatic notch in all measurements. The new trajectory entered the PSIS at 25.29 ± 4.34° (left side) and 24.93 ± 4.15° (right side) cephalad from the transverse plane, and 24.58 ± 4.99° (left side) and 24.56 ± 4.67° (right side) lateral from the mid-sagittal plane. The area of bone marrow encountered with the new approach was approximately 22.5 cm2. Utilizing the same CT scans, the trajectory from the traditional approach crossed the greater sciatic notch in all scans, highlighting the potential for violating the greater sciatic notch boundary and damaging important neurovascular structures. Statistically significant sex-related differences were identified in needle trajectory angles for both approaches. We conclude that based on this three-dimensional computed tomography study, a trajectory from the PSIS to the AIIS for BMA may offer a wide safety margin from the greater sciatic notch.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Langping Li
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA; Department of Anesthesiology, Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai Leng
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine Hunt
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Luke Law
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Casey Muir
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Eldrige
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Meng Chi
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Shane Shapiro
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William D Mauck
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wenchun Qu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA; Department of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Sandler ML, Griffin M, Xing MH, Ansari E, Khorsandi AS, Urken ML. Postoperative Imaging Appearance of Iliac Crest Free Flaps Used for Palatomaxillary Reconstructions. AJNR Am J Neuroradiol 2021; 42:753-758. [PMID: 33632734 PMCID: PMC8040998 DOI: 10.3174/ajnr.a7005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
The osteomyocutaneous iliac crest free flap is a reconstructive option for segmental mandibular or complex palatomaxillary defects. Familiarity with the radiographic appearance of free flaps such as the iliac crest is necessary for the postoperative evaluation of patients after mandibular, maxillary, or palatal reconstructions because it allows radiologists to properly monitor and interpret the appearance of the flap over time. This study presents a retrospective review of 5 patients who underwent palatomaxillary reconstruction with an iliac crest free flap at our institution. The imaging appearances of the 5 patients were analyzed to determine the key radiographic characteristics of a healthy and successful iliac crest free flap. Radiographic fluency with the imaging appearance of the iliac crest free flap, as well as the new anatomy of the region in the postoperative period, will allow for better interpretation of the flap appearance on imaging and will prevent false identification of tumor recurrence.
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Affiliation(s)
- M L Sandler
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
| | - M Griffin
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
| | - M H Xing
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
| | - E Ansari
- Department of Otolaryngology-Head and Neck Surgery (E.A., M.L.U.), Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, New York
| | - A S Khorsandi
- Department of Radiology (A.S.K.), NY Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - M L Urken
- From the Thyroid, Head & Neck Cancer (THANC) Foundation (M.L.S., M.G., M.H.X., M.L.U.), New York, New York
- Department of Otolaryngology-Head and Neck Surgery (E.A., M.L.U.), Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, New York
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Lana JFSD, da Fonseca LF, Macedo RDR, Mosaner T, Murrell W, Kumar A, Purita J, de Andrade MAP. Platelet-rich plasma vs bone marrow aspirate concentrate: An overview of mechanisms of action and orthobiologic synergistic effects. World J Stem Cells 2021; 13:155-167. [PMID: 33708344 PMCID: PMC7933989 DOI: 10.4252/wjsc.v13.i2.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/15/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
The use of orthobiologics as a novel therapy for the treatment of numerous musculoskeletal disorders has increased considerably over the past decade. Currently, there are multiple alternatives available as suitable treatments; however, the use of autologous blood-derived products such as platelet-rich plasma (PRP), bone marrow aspirate (BMA) and BMA concentrate (BMAC), specifically, is expanding. Although many investigations attempted to demonstrate the effectiveness of these therapies, even with positive results, the literature lacks standardized protocols and overall accuracy in study designs, which leads to variance and difficulty in reproducibility of protocols. The efficacy of PRP for the treatment of cartilage, bone and muscle tissues is well known. Although BMAC has generated optimistic results for the same purposes, its applicability in clinical trials is still relatively recent when compared to PRP. Both products demonstrate the potential to set forth reparative processes, each in their own distinct mechanism. The combination of these biological products has been previously proposed, yet little is known about their synergism. Evidence indicates that growth factor, cytokine, and chemokine profiles seen in both PRP and BMAC vary but are likely to work synergistically to enhance musculoskeletal healing. BMAC products seem to work well without PRP; however, the addition of PRP to BMAC has been shown to act as a rich and natural source of culture medium for stem cells located either peripherally or in the bone marrow itself. Nevertheless, additional variables associated with the use of BMAC and PRP in orthopedics must be further evaluated in order to consolidate the efficacy of this therapeutic strategy.
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Affiliation(s)
| | | | - Rafael da Rocha Macedo
- Department of Orthopedics, Rede D’Or Unit IFOR Hospital, São Bernardo do Campo 09715-021, SP, Brazil
| | - Tomas Mosaner
- Department of Orthopedics, The Bone and Cartilage Institute, Indaiatuba 13334-170, SP, Brazil
| | - William Murrell
- Department of Orthopaedics, Healthpoint UAE, Abu Dhabi 00000, United Arab Emirates
| | - Ashok Kumar
- Department of Orthopaedics, My Doc Specialist Medical Centre, Dubai 00000, United Arab Emirates
| | - Joseph Purita
- Department of Orthopedics, Institute of Regenerative Medicine, Boca Raton, FL 33432, United States
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A. Everts P, Flanagan II G, Rothenberg J, Mautner K. The Rationale of Autologously Prepared Bone Marrow Aspirate Concentrate for use in Regenerative Medicine Applications. Regen Med 2020. [DOI: 10.5772/intechopen.91310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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von Glinski A, Frieler S, Yilmaz E, Ishak B, Goodmanson R, Iwanaga J, Schildhauer TA, Chapman JR, Oskouian RJ, Mayo K, Tubbs RS. Osteology of the ilium revised: illuminating the clinical relevance. Eur J Trauma Emerg Surg 2020; 47:1671-1677. [PMID: 32886140 DOI: 10.1007/s00068-020-01482-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies on anterior and posterior pelvic ring fixation have identified a fragile monocortical area located at the iliac wing. However, there are no current studies regarding this structure's dimensions and relation to known anatomic structures. METHODS Eleven human ilia were dissected from 6 specimens. After debulking soft tissue, photoluminescence was used to indicate the fragile area. The size and thickness of the iliac wing were determined and mapped in relation to the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). RESULTS This photoluminescent unicortical area measured 15.57 cm2 with a mean minimal thickness of 1.37 mm at its thinnest part. Its average diameter was 41.15 mm horizontally and 37.45 mm vertically. In all cases, it was located at the middle third of the ilium with a mean distance of 64.58 mm to the AIIS and 62.73 mm to the PSIS. Trajectory angulation above 4.5° from the PSIS lead to violation of this area. CONCLUSION This study provides useful anatomical information regarding a thin unicortical area at the iliac wing that is relevant to anterior and posterior pelvic ring fixation and the potential complications that can arise from iatrogenic perforation of this area.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA
| | - Sven Frieler
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA.
- Seattle Science Foundation, Seattle, WA, USA.
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA.
| | - Emre Yilmaz
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Ryan Goodmanson
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | - Thomas A Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Seattle Science Foundation, Seattle, WA, USA
| | - Keith Mayo
- Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, WA, USA
| | - R Shane Tubbs
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Otto A, Muench LN, Kia C, Baldino JB, Mehl J, Dyrna F, Voss A, McCarthy MB, Nazal MR, Martin SD, Mazzocca AD. Proximal Humerus and Ilium Are Reliable Sources of Bone Marrow Aspirates for Biologic Augmentation During Arthroscopic Surgery. Arthroscopy 2020; 36:2403-2411. [PMID: 32554079 DOI: 10.1016/j.arthro.2020.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the number of colony-forming units (CFUs) derived from concentrated bone marrow aspirates (BMAs) that were processed following arthroscopic harvest from either the proximal humerus or the body of the ilium during biologic augmentation of the rotator cuff and acetabular labral repairs. METHODS Between November 2014 and January 2019, BMA was harvested from the proximal humerus (n = 89) and the body of the ilium (n = 30) during arthroscopic surgery. Following concentration of the aspirate, a 0.5-mL aliquot was further processed and the number of nucleated cells (NC) was counted. Each aliquot was cultured until CFUs were quantifiable. Fluorescence-activated cell sorting analysis and quantitative polymerase chain reaction was performed to confirm presence of mesenchymal stem cells. BMA harvest sites were prospectively assessed and evaluated for differences in age, sex, volume of aspirated BM, and CFUs per milliliter of BMA. RESULTS The prevalence (38.57 ± 27.92ilium vs. 56.00 ± 25.60humerus CFUs per 106 nucleated cells) and concentration (979.17 ± 740.31ilium vs. 1,516.62 ± 763.63humerus CFUs per 1.0 mL BMA) of CFUs was significantly higher (P < .001, respectively) for BMA harvested from the proximal humerus. Additionally, the estimated total number of cells was significantly higher (P = .013) in BMA from the proximal humerus (97,529.00 ± 91,064.01ilium vs. 130,552.4 ± 85,294.2humerus). There was no significant difference between groups regarding BMA volume (91.67 ± 18.77ilium vs. 85.63 ± 35.61humerus mL; P = .286) and NC count (24.01 ± 5.13ilium vs. 27.07 ± 6.28humerus × 106 per mL BMA; P = .061). The mean age was significantly lower (P < .001) in patients with BMA being harvested from the ilium (30.18 ± 7.63ilium vs. 56.82 ± 7.08humerus years). Patient sex and age had no significant influence on cellular measures within groups (P > .05, respectively). CONCLUSION Both proximal humerus and the body of the ilium can be considered reliable sources of bone marrow aspirate for the use in biologic augmentation during their respective arthroscopic surgery. Samples of bone marrow aspirate from the proximal humerus yielded a significantly higher amount of CFUs when compared with samples of BMA obtained from the ilium. LEVEL OF EVIDENCE Level II- prospective laboratorial study.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany.
| | - Lukas N Muench
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Dyrna
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Andreas Voss
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany; Sporthopaedicum, Straubing-Regensburg, Germany
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.; Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, U.S.A
| | - Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, U.S.A
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A
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Yilmaz E, von Glinski A, Schildhauer TA, Iwanaga J, Ishak B, Abdul-Jabbar A, Moisi M, Oskouian RJ, Tubbs RS, Chapman JR. What are the best trajectories for multiple iliac screw placement in spine surgeries? An anatomical, radiographical and morphometric cadaver analysis. Injury 2020; 51:1294-1300. [PMID: 32201116 DOI: 10.1016/j.injury.2020.02.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Affiliation(s)
- E Yilmaz
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1 44789, Bochum, Germany.
| | - A von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1 44789, Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, United States
| | - T A Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1 44789, Bochum, Germany
| | - J Iwanaga
- Seattle Science Foundation, Seattle, Washington, United States
| | - B Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - A Abdul-Jabbar
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - M Moisi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - R J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States
| | - R S Tubbs
- Seattle Science Foundation, Seattle, Washington, United States; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - J R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, Washington, United States
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von Glinski A, Yilmaz E, Ishak B, Hayman E, Ramey W, Jack A, Iwanaga J, Oskouian RJ, Tubbs RS, Chapman JR. The Modified Iliac Screw: An Anatomic Comparison and Technical Guide. World Neurosurg 2020; 136:e608-e613. [DOI: 10.1016/j.wneu.2020.01.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
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Hernigou P. The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:795-808. [PMID: 32060614 DOI: 10.1007/s00264-020-04506-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/07/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40 years that bone marrow aspiration has been used to treat nonunion disorders. MATERIAL AND METHODS These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000 years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. RESULTS Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrow-derived mesenchymal stem cells to improve healing of fractures. CONCLUSION It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.
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D'Amato RD, Memeo A, Fusini F, Panuccio E, Peretti G. Treatment of simple bone cyst with bone marrow concentrate and equine-derived demineralized bone matrix injection versus methylprednisolone acetate injections: A retrospective comparative study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:49-58. [PMID: 32175897 DOI: 10.5152/j.aott.2020.01.371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to compare the outcome of intra-lesional autologous bone marrow concentrate (BMC) and equine derived demineralized bone matrix (EDDBM) injections with methylprednisolone acetate injections in patients with simple bone cyst. METHODS Clinical records and radiographs of 53 consecutive patients (37 females,and 16 males; mean age: 10.6±1.53 years) treated between 2006 and 2016 were retrospectively reviewed. Healing was assessed by an independent radiologist according to Neer scoring system. Functional outcome was assessed with the Activity Scale for Kids (ASK). Thirty-four cysts were in the humerus, 13 in the femur and 6 in other locations. Twenty-nine patients were included in Steroid Group and treated with 3 cycles of injections of methylprednisolone acetate, while 24 patients were treated with injection of autologous bone marrow concentrate and equine derived demineralized bone matrix (BMC+ EDDBM Group). The two groups were homogenous for the mean age, sex distribution, cysts location and their clinical presentation. RESULTS At a minimum follow-up of 24 months, success rate (Neer/Cole score 3 and 4) was higher in EDDBM+BMC group (83.3% vs 58.6%; p=0.047). Female patients had higher healing rates in both groups (p=0.002). No association was found between healing and age (p=0.839), cyst activity (p=0.599), cyst localization (p=0.099) and clinical presentation (p=0.207). BMC+EDDBM group showed higher ASK score (p=0.0007). CONCLUSION Treatment with BMC+EDDBM injections may provide better results with a single procedure than 3 methylprednisolone acetate injections and represent an interesting alternative for the treatment of unicameral bone cysts. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
- Raffaele Dario D'Amato
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy
| | - Antonio Memeo
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Elena Panuccio
- Department of Paediatric Orthopaedics and Traumatology, Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy
| | - Giuseppe Peretti
- Department of Biomedical Sciences for Health, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Nam TW, Oh HM, Lee JE, Kim JH, Hwang JM, Park E, Jung TD. An unusual complication of sacral nerve root injury following bone marrow harvesting: a case report. BMC Cancer 2019; 19:347. [PMID: 30975123 PMCID: PMC6458794 DOI: 10.1186/s12885-019-5567-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) remains an important therapeutic option for many hematologic malignancies. Bone marrow harvesting from an appropriate donor must be conducted for hematopoietic stem cell transplantation (HSCT). Many previous studies show complications of the recipient after hematopoietic stem cell transplantation (HSCT). However, complications of the donor after bone marrow harvesting are rare. We here report a unique case of a patient who developed sacral nerve root injury after bone marrow harvesting. CASE PRESENTATION A 26-year-old man was admitted to our medical center complaining of acute onset painful burning and tingling sensation at the left posterior thigh and calf. He was a bone marrow donor for his brother's bone marrow transplantation. He had underwent a bone marrow harvesting procedure two days before admission as a bone marrow donor, using both posterior superior iliac spine (PSIS) as the puncture site. Pelvic magnetic resonance image (MRI) showed enhancement around the left S2 nerve root in T1 and T2-weighted images. Nerve conduction studies (NCS) revealed normal conduction velocity and amplitude on both lower extremities. Electromyography (EMG) presented abnormal spontaneous activity and neurogenic motor unit potentials on the S2-innervated intrinsic foot muscle and gastrocnemius, soleus muscle on the left. The patient was treated with pregabalin for pain control. The patient was followed up after 3, 6, and 12 months. Neuropathic pain improved to Visual Analogue Scale (VAS) 1, and recovery state was confirmed by re-innervation patterns of motor unit potentials in electromyography. CONCLUSION Bone marrow harvesting is a relatively safe procedure. However, variable complications may occur. Accurate anatomical knowledge and carefulness are required to avoid sacral nerve root injury when performing the bone marrow harvesting procedure.
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Affiliation(s)
- Tae-Woo Nam
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Hyun-Min Oh
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Jae-Eun Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Ju-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, Kyungpook National University Medical Center, Daegu, South Korea.,Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 41404, South Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea. .,Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 41404, South Korea.
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Kola S, Granville M, Jacobson RE. The Association of Iliac and Sacral Insufficiency Fractures and Implications for Treatment: The Role of Bone Scans in Three Different Cases. Cureus 2019; 11:e3861. [PMID: 30899612 PMCID: PMC6414187 DOI: 10.7759/cureus.3861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Iliac wing fractures are under-diagnosed fractures often associated with sacral insufficiency fractures in osteoporotic patients. They are rarely seen alone. Insufficiency fractures of the iliac bone can often be missed on computerized tomography (CT) and magnetic resonance imaging (MRI) yet identified on radioisotope bone scans. Symptomatic iliac fractures present with more lateralized pain in the hip and groin compared to patients with only sacral insufficiency fractures. Since the acetabulum is the key weight-bearing articulation between the sacrum and pelvis and the femoral head and leg, worsening of iliac stress fractures can have major effects on weight bearing and should be a consideration in patients with persistent pain in this area. The anatomy of the ilium and relationship to other pelvic insufficiency fractures is reviewed as well as treatment options. Typical cases are presented where the iliac fractures were found on bone scan either in addition to the more common sacral fracture or due to the persistence of symptoms of hip and thigh pain.
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Affiliation(s)
- Sandeep Kola
- Physical Medicine and Rehabilitation, Larkin Community Hospital, Miami, USA
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Piuzzi NS, Mantripragada VP, Sumski A, Selvam S, Boehm C, Muschler GF. Bone Marrow-Derived Cellular Therapies in Orthopaedics. JBJS Rev 2018; 6:e4. [DOI: 10.2106/jbjs.rvw.18.00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chaput CD, Shar A, Jupiter D, Hubert Z, Clough B, Krause U, Gregory CA. How stem cell composition in bone marrow aspirate relates to clinical outcomes when used for cervical spine fusion. PLoS One 2018; 13:e0203714. [PMID: 30248138 PMCID: PMC6152872 DOI: 10.1371/journal.pone.0203714] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/24/2018] [Indexed: 01/14/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is performed to relieve pain caused by degenerative disk disease and nerve obstruction. As an alternative to bone graft, autologous concentrated bone marrow aspirate (CBMA) is used to achieve vertebral fusion with a satisfactory success rate. This has been attributed in part to bone marrow-resident mesenchymal stromal cells (MSCs) with the capacity to differentiate into osteoblasts and generate bone tissue. To date, there has been no study comparing cellular yields, MSC frequencies and their osteogenic potential with ACDF outcome. Patients (n = 24) received ACDF with CBMA and allograft bone matrix. Colony forming unit fibroblast (CFU-F) and CFU-osteoblasts (CFU-O) assays were performed on CBMA samples to enumerate MSCs (CFU-F) and osteogenic MSCs (CFU-O). CFUs were normalized to CBMA volume to define yield and also to mononuclear cells (MNC) to define frequency. After 1-year, fusion rates were good (86.7%) with pain and disability improved. There was a negative relationship between MNC and CFU-F measurements with age of patient and CFU-Os negatively correlated with age in females but not males. Tobacco use did not affect CBMA but was associated with poorer clinical outcome. Surprisingly, we found that while high-grade fusion was not associated with CFU-O, it correlated strongly (p<0.0067) with CBMA containing the lowest frequencies of CFU-F (3.0x10-6–5.83x10-5 CFU-F/MNC). MNC levels alone were not responsible for the results. These observations suggest that osteogenesis by human bone marrow is controlled by homeostatic ratio of MSCs to other cellular bone marrow components rather than absolute level of osteogenic MSCs, and that a lower ratio of MSCs to other cellular components in marrow tends to predict effective osteogenesis during ACDF. The results presented herein challenge the current dogma surrounding the proposed mechanism of MSCs in bone healing.
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Affiliation(s)
- Christopher D. Chaput
- Department of Orthopedics, University of Texas Health San Antonio, San Antonio, Texas, United States of America
- * E-mail: (CAG); (CC)
| | - Adam Shar
- Department of Orthopedics, University of Texas Health San Antonio, San Antonio, Texas, United States of America
- Medical Education Building, Texas A&M Health Science Center, Temple Campus, Temple, Texas, United States of America
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Zach Hubert
- Medical Education Building, Texas A&M Health Science Center, Temple Campus, Temple, Texas, United States of America
| | - Bret Clough
- Institute for Regenerative Medicine, Texas A&M Health Science Center, College Station, Texas, United States of America
| | - Ulf Krause
- Institute for Transfusion Medicine and Transplant Immunology, University Hospital Muenster, Muenster, Germany
| | - Carl A. Gregory
- Institute for Regenerative Medicine, Texas A&M Health Science Center, College Station, Texas, United States of America
- * E-mail: (CAG); (CC)
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Hernigou P, Guerin G, Homma Y, Dubory A, Chevallier N, Rouard H, Flouzat Lachaniette CH. History of concentrated or expanded mesenchymal stem cells for hip osteonecrosis: is there a target number for osteonecrosis repair? INTERNATIONAL ORTHOPAEDICS 2018; 42:1739-1745. [PMID: 29796764 DOI: 10.1007/s00264-018-4000-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Despite multiple possible treatments, the risk of collapse remains the main problem of osteonecrosis. Heart failure (HF). In an effort to address the reverse this issue, curative strategies with regenerative medicine are increasingly being considered. The aim of this technology is to halt or reverse progression of the disease to collapse. MATERIAL AND METHODS The pioneering report by Hernigou published in 2002 was the first pilot study suggesting that injection of bone marrow stem cells was a safe approach able to improve osteonecrosis in patients with early stages. Since then, an impressive number of studies and trials employing unselected BM-derived cells (1000 the last 2 years) showed that delivery of those cells to the site of osteonecrosis during core decompression was somehow able to ameliorate the patient with osteonecrosis. In order to translate the promise of this cell therapy into better clinical benefit, many questions need to be addressed. In this review, we therefore analyzed current clinical experience of the literature and our experience of 4000 cases to address these questions and particularly the number of cells that should be injected. RESULTS After almost 20 years of clinical research in this field, we are still far from having drawn conclusions on the number of cells we should inject in regenerating hip osteonecrosis. Findings are difficult to interpret due to heterogeneity of causes of osteonecrosis, as well as differences in the cells count, sample quality, and stages of osteonecrosis. The authors address specific issues, as cell quality, cell numbers, volume of osteonecrosis, concentration of cells, and ex vivo expansion. Bone marrow mesenchymal stem cells are supposed to be "functionally competent," but are collected from the bon, marrow of patients with diseases and risk factors of osteonecrosis. The recipient organ (bone osteonecrosis) is a tissue where several alterations have already occurred. These questions are addressed in this review. CONCLUSION In this review, we analyzed current clinical experience regarding cell therapy and address issues that should be a guide for future cell-based therapeutic application in osteonecrosis.
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Hernigou P, Auregan JC, Dubory A, Flouzat-Lachaniette CH, Chevallier N, Rouard H. Subchondral stem cell therapy versus contralateral total knee arthroplasty for osteoarthritis following secondary osteonecrosis of the knee. INTERNATIONAL ORTHOPAEDICS 2018; 42:2563-2571. [PMID: 29589086 DOI: 10.1007/s00264-018-3916-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) implanted in patients with secondary osteonecrosis (ON) related to corticosteroids have relatively poor outcome (20% revision rate) at a mean follow-up of only eight years. With the hypothesis that subchondral bone marrow injection might improve knees in these patients, we evaluated 30 patients who had bilateral knee osteoarthritis with severe joint space narrowing and received TKA in one knee and subchondral bone marrow concentrate injection in the contralateral knee. MATERIAL AND METHODS A prospective randomized controlled clinical trial was carried out in 60 knees of 30 patients (mean age 28 years, 18-41) who presented bilateral osteoarthritis secondary to knee ON related to corticosteroids in relation with different severe medical conditions. During the same anesthesia, one knee received TKA; for the other knee, a bone marrow graft containing an average of 6500 MSCs/mL (counted as CFU-F, range 3420 to 9830) was delivered to the subchondral bone of the femur and tibia. The length of anesthesia related to each procedure (bone marrow aspiration and subchondral injection of concentrated bone marrow versus total knee arthroplasty) was measured. Peri-operative outcomes, morbidity, complications, and safety of the two procedures were compared. Subsequent admissions for revision surgery were identified. At the most recent follow-up (average of 12 years, range 8 to 16 years), clinical outcomes of the patient (Knee Society score) were obtained along with radiological imaging outcomes (MRIs for knees with subchondral bone marrow injection). RESULTS Anesthesia related to the TKA side was longer than for the cell therapy group. Medical and surgical complications were more frequent after TKA. A higher number of thrombophlebitis was observed on the side with TKA (15%) versus none on the side with cell therapy (0%). At the most recent follow-up (average of 12 years, range 8 to 16 years), six (out of 30) TKA knees needed subsequent surgery versus only one with cell therapy. The Knee Score had improved and remained similar in the TKA and cell therapy groups (respectively 80.3 points ± 11 versus 78.3 ± 23); 21 patients preferred the knee with cell therapy and 9 preferred the knee with TKA. Knees with cell therapy had improvement on cartilage and bone marrow lesions observed at the site of bone marrow subchondral injection. CONCLUSIONS Subchondral autologous bone marrow concentrate was an effective procedure for treating young patients with knee osteoarthritis following secondary ON of the knee related to corticosteroids with a lower complication rate and a quicker recovery as compared with TKA.
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Sansone V, Brañes M, Romeo P. A novel bimodal approach for treating atrophic bone non-unions with extracorporeal shockwaves and autologous mesenchymal stem cell transplant. Med Hypotheses 2017; 111:4-7. [PMID: 29406993 DOI: 10.1016/j.mehy.2017.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/07/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
Abstract
We propose a novel approach for the treatment of atrophic bone non-unions via parallel applications of extracorporeal shock wave therapy (ESWT) and an autologous mesenchymal stem cell transplant. The hypothesis resides on the potentiality of shock waves (SWs) to act as a tool for manipulating the patient's mesenchymal stem cells (MSCs). In addition to the conventional physical stimulus achieved by delivering SWs at the site of non-union to stimulate the well-known trophic effects on bone tissue, a series of concomitant ESWT would be administered in tandem at a bone marrow donor site, such as the iliac crest, to precondition resident bone marrow stromal cells (BMSCs) in vivo, priming resident MSCs by enlarging and conditioning their population prior to bone marrow aspiration. The resulting sample could then be treated to further augment cell concentration and injected, under fluoroscopic control, into the non-union site through a percutaneous approach.
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Affiliation(s)
- Valerio Sansone
- Department of Orthopaedics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy; Galeazzi Orthopaedic Institute, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.
| | - Manuel Brañes
- Universidad de Chile, Facultad de Ciencias, Las Palmeras 3425, Ñuñoa, Región Metropolitana, Chile
| | - Pietro Romeo
- Galeazzi Orthopaedic Institute, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
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Shapiro SA, Arthurs JR. Bone marrow aspiration for regenerative orthopedic intervention: technique with ultrasound guidance for needle placement. Regen Med 2017; 12:917-928. [DOI: 10.2217/rme-2017-0109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: We review relevant anatomy of the iliac crest, and describe an interventional technique to maximize harvesting of desired progenitor cells with ultrasound to guide safe trochar placement. Materials & methods: We validated the technique on both sides of the pelvis in four human cadavers. Results: Using ultrasound guidance, 32 BMA needles were placed in a safe zone along various portions of the iliac crest. Conclusion: Ultrasound guidance can improve accuracy of bone marrow aspirations form the iliac crest. Mastery of this procedure will facilitate cell harvest and aid in patient safety when procuring mesenchymal stem cells from a bone marrow source.
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Affiliation(s)
- Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
- Mayo Clinic Center for Regenerative Medicine, Rochester, Minnesota, MN 55902, USA
| | - Jennifer R Arthurs
- Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
- Mayo Clinic Center for Regenerative Medicine, Rochester, Minnesota, MN 55902, USA
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Abstract
Bone marrow aspirate grafting entails mesenchymal stem cell-containing bone marrow harvesting and injection into a fracture site to promote bone formation. Although the use of bone marrow aspirate in orthopedic trauma is not widespread, an increasing number of studies are reporting clinical success. Advantages of using bone marrow aspirate are that it is readily obtainable, has low harvest morbidity, and can be easily and quickly injected. However, no universally accepted role for its use exists. Future studies directly comparing bone marrow aspirate with conventional techniques are needed to define its role in the treatment of orthopedic trauma patients.
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Affiliation(s)
- Patrick C Schottel
- Department of Orthopaedic Surgery and Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive, Burlington, VT 05405, USA.
| | - Stephen J Warner
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, 6400 Fannin Street, Houston, TX 77030, USA
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Impact of individual anatomy on the benefit of cup medialisation in total hip arthroplasty. Hip Int 2016; 26:537-542. [PMID: 27739568 DOI: 10.5301/hipint.5000392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In total hip arthroplasty, cup medialisation with compensatory increase of femoral offset has been proposed to increase the moment arms of abductor muscles. However, this technique is associated with a loss of acetabular bone stock. Previous data indicates that the potential benefit is not constant among patients and is likely related to patient anatomy. METHOD Therefore, to be able to select patients who would benefit most from this technique, we measured several anatomical parameters of the pelvis and femur in 15 patients; and evaluated correlations between them and the changes of moment arms associated with cup medialisation. The anatomical measurements were performed on 3-D reconstructions of preoperative CT scans. The moment arms of the gluteus medius and gluteus minimus were calculated for an abduction and flexion movement using patient-specific finite element models. RESULTS 6 anatomical parameters were correlated with muscle moment arm variations after cup medialisation. This effect was not systematic for either muscles or movements. Among all parameters, femoral anteversion was the most important parameter in explaining the effect of cup medialisation. DISCUSSION Patients with small femoral anteversion or low-riding greater trochanter benefit more from cup medialisation in terms of moment arm increase in abduction motion.
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Hernigou P, Trousselier M, Roubineau F, Bouthors C, Chevallier N, Rouard H, Flouzat-Lachaniette CH. Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect. INTERNATIONAL ORTHOPAEDICS 2016; 40:2331-2338. [PMID: 26928724 DOI: 10.1007/s00264-016-3147-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/16/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE Infected, long bone non-unions present a significant clinical challenge. New and alternative therapies are needed to address this problem. The purposes of this study were to compare the number of circulating granulocyte-macrophage colony-forming units (CFU-GM) in the peripheral blood of polytraumatic patients with infected tibial non-unions and in the peripheral blood of control patients with the hypothesis that their number was decreased in polytraumatic patients; and to treat their infection without antibiotics and with local transplantation of bone marrow concentrated granulocytes precursors. METHODS Thirty (18 atrophic and 12 hyperthrophic ) infected tibial non-unions (without bone defect) that occurred after open fractures in polytraumatic patients were treated without antibiotics and with percutaneous injection of autologous bone marrow concentrate (BMC) containing granulocytes precursors (CFU-GM). CFU-GM progenitors were assessed in the bone marrow aspirate, peripheral blood, and fracture site of these patients. The number of these progenitors was compared with the CFU-GM progenitors of control patient samples (healthy donors matched for age and gender). Outcome measures were: timing of union, callus formation (radiographs and CT scan), and recurrence of clinical infection. RESULTS As compared to control patients, the number of CFU GM derived colonies was lower at peripheral blood in patients with infected nonunions. The bone marrow graft injected in nonunions contained after concentration 42 621 ± 20 350 CFU-GM-derived colonies/cc. Healing and cure of infection was observed at six months for 25 patients and at one year follow up for 30 patients. At the median ten year follow-up (range: 5 to 15), only one patient had clinical recurrent infection after healing (between 6 months and last follow-up). CONCLUSION The peripheral blood of these polytraumatic patients with infected nonunions had a remarkable decrease in CFU-GM-derived colonies as compared with normal controls. Local transplantation of concentrated CFU-GM-derived colonies aspirated from bone marrow allowed cure of infection and healing without antibiotics.
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Affiliation(s)
- Philippe Hernigou
- Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France.
| | - Matthieu Trousselier
- Orthopaedic Surgeon, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France
| | - François Roubineau
- Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France
| | - Charlie Bouthors
- Orthopaedic Surgeon, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France
| | - Nathalie Chevallier
- EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France
| | - Helene Rouard
- EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France
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Hernigou P, Trousselier M, Roubineau F, Bouthors C, Chevallier N, Rouard H, Flouzat-Lachaniette CH. Stem Cell Therapy for the Treatment of Hip Osteonecrosis: A 30-Year Review of Progress. Clin Orthop Surg 2016; 8:1-8. [PMID: 26929793 PMCID: PMC4761591 DOI: 10.4055/cios.2016.8.1.1] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 12/28/2022] Open
Abstract
Avascular necrosis of the femoral head is caused by a multitude of etiologic factors and is associated with collapse with a risk of hip arthroplasty in younger populations. A focus on early disease management with the use of stem cells was proposed as early as 1985 by the senior author (PH). We undertook a systematic review of the medical literature to examine the progress in cell therapy during the last 30 years for the treatment of early stage osteonecrosis.
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Affiliation(s)
- Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Matthieu Trousselier
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - François Roubineau
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Charlie Bouthors
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Nathalie Chevallier
- EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Helene Rouard
- EFS Cell Therapy Facility, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
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Sabharwal S, Nelson SC, Sontich JK. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2015; 97:1375-84. [PMID: 26290092 DOI: 10.2106/jbjs.o.00298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Scott C Nelson
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 214A, Loma Linda, CA 92354
| | - John K Sontich
- MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109
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Bowen JE. Technical Issues in Harvesting and Concentrating Stem Cells (Bone Marrow and Adipose). PM R 2015; 7:S8-S18. [DOI: 10.1016/j.pmrj.2015.01.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 02/07/2023]
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Hernigou J, Alves A, Homma Y, Guissou I, Hernigou P. Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement. INTERNATIONAL ORTHOPAEDICS 2014; 38:2585-90. [PMID: 24781923 DOI: 10.1007/s00264-014-2353-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/06/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE The bony anatomy of the human ilium has been well described from a qualitative perspective; however, there are little quantitative data to help the surgeon to perform bone marrow aspiration from the iliac crest in the thickest part of the ilium. The minimum thickness of the spongiousus bone in an iliac wing (transverse thickness between the two tables) is an important factor in ensuring the safe placement of a trocar between the two tables of the iliac wing. For example, with an 8-gauge (3.26 mm) trocar, one can consider that if the transverse thickness of the spongiousus bone of the iliac wing is <3 mm, it will be difficult to insert the trocar safely between the two tables. METHODS For this study, we measured spongiousus bone thickness on 48 iliac wings to map the ilium in six sectors, which were defined by drawing lines from equidistant points spaced along the rim of the iliac crest to the centre of the hip. These sectors can be transposed in the same manner to any patient. To evaluate the risks to reach vascular or neurologic structures, 410 trocars were introduced in the different sectors of 20 iliac bones of ten cadavers. RESULTS A map was constructed indicating the thickness of the spongiousus bone in each sector. The thickness data was used to create a map that identifies the sites where bone marrow can be obtained with a trocar of 3-mm diameter according to the thickness of the spongiousus bone. Sectors 2, 3 and 6 appear to be more favourable for accommodating a 3-mm diameter trocar. Sectors 1, 4 and 5 comprise the areas with the thinnest parts of the iliac crest, with some areas being thinner than the trocar diameter. The sector system reliably predicted safe and unsafe areas for trocar placement. In cadavers, dissection demonstrated nine vascular or neurologic lesions created when trocars were introduced into sectors 1, 5 and 6. CONCLUSION Using the sector system, trocars can be directed away from neural and vascular structures and towards zones that are likely to contain larger bone marrow stock.
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