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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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Acetabular Bone Marrow Aspiration During Total Hip Arthroplasty. J Am Acad Orthop Surg 2021; 29:e815-e819. [PMID: 34106093 DOI: 10.5435/jaaos-d-21-00085] [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: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Biologically augmented surgical treatments of orthopaedic conditions are increasingly popular. Bone marrow aspirate concentrate is a key orthobiologic tissue source, and the field is moving from the standard iliac crest marrow aspiration toward local aspirations of marrow depots that are accessible during the standard-of-care procedures in an attempt to reduce morbidity, surgery time, and cost. Here, we present the aspiration of the standard iliac marrow depot, but through a novel acetabular approach during total hip arthroplasty. This procedure markedly simplifies biologic augmentation with bone marrow aspirate concentrate in this large patient cohort.
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Hernigou P, Hernigou J, Scarlat M. Mesenchymal stem cell therapy improved outcome of early post-traumatic shoulder osteonecrosis: a prospective randomized clinical study of fifty patients with over ten year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:2643-2652. [PMID: 34351460 DOI: 10.1007/s00264-021-05160-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Post-traumatic osteonecrosis of the humeral head has a risk of progression to collapse in absence of treatment. The purpose of this study was to evaluate the results of mesenchymal stem cell grafting of the pre-collapse humeral head (study group) in adult patients with osteonecrosis and to compare the results with a simple core decompression without cells (control group). Patients After inclusion and randomization of 50 patients, 26 patients were enrolled in a single-blinded study for the cell therapy group. Twenty-four other patients were treated with simple core decompression without cells (control group). MATERIAL AND METHODS After a mean of 12-year (range 10 to 15) follow-up, X-ray and MRI were used to evaluate the radiological results, while the Constant score and the visual analog scale were chosen to assess the clinical results. The cell therapy group was treated with percutaneous mesenchymal cell (MSCs) injection obtained from bone marrow concentration. The average total number of MSCs (counted as the number of colony-forming units-fibroblast) injected in each humeral head was a total injection of average 180,000 ± 35,000 cells (range 74,000 to 460,000). RESULTS Both the treatment and control groups had a significantly improved clinical score (p < 0.01). At the last follow-up, pain on the visual analog scale and Constant score in the study group had significant improvement (respectively p < 0.001 and p < 0.01) as compared to the control group. Collapse was observed more frequently in the control group (87.5% versus 11.5% for cell therapy, p < 0.0001). The survival rates based on the requirement for further shoulder surgery (arthroplasty) as an endpoint were higher in the cell therapy group in comparison to those in the control group (92% versus 25%; p < 0.0001). CONCLUSION Core decompression with cell therapy was a safe and effective procedure for treatment in the pre-collapse stages of posttraumatic shoulder osteonecrosis and improved the outcome of the disease as compared with simple core decompression without cells.
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Affiliation(s)
- Philippe Hernigou
- Orthopedic Department Henri Mondor Hospital, University Paris-Est, Creteil, France
| | - Jacques Hernigou
- Department of Orthopaedic and Traumatology Surgery, EpiCURA Hospita lBaudour/Hornu, Mons, Belgium
| | - Marius Scarlat
- Département Chirurgie Orthopédique, Clinique Chirurgicale St Michel, Groupe ELSAN, Av. Orient, 83100, Toulon, France
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Kruel AVS, Ribeiro LL, Gusmão PD, Huber SC, Lana JFSD. Orthobiologics in the treatment of hip disorders. World J Stem Cells 2021; 13:304-316. [PMID: 33959220 PMCID: PMC8080542 DOI: 10.4252/wjsc.v13.i4.304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/26/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
Orthobiologics are biological materials that are intended for the regeneration or healing of bone, cartilage and soft tissues. In this review we discuss the use of orthobiologics for hip disorders providing an update. The orthobiologics included in this article are hyaluronic acid, platelet rich plasma, bone marrow, adipose tissue and expanded mesenchymal stem cells. We explain the concepts and definitions of each orthobiological product, and the literature regarding its use in the hip joint. The paucity of guidelines for the production and characterization of the biological products leads to uneven results across the literature. Each biologic therapy has indications and benefits; however, noteworthy are the characterization of the orthobiologics, the application method and outcome analysis for further improvement of each technique.
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Affiliation(s)
| | - Lucas Leite Ribeiro
- Department of Orthopedics, Instituto Médico Salus, São Paulo, SP 01308-050, Brazil
| | - Paulo David Gusmão
- Department of Orthopedics, the Bone and Cartilage Institute, Porto Alegre, RS 90570-020, Brazil
| | - Stephany Cares Huber
- Department of Hematology, University of Campinas, Campinas, SP 13334-170, Brazil
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Ruoss S, Walker JT, Nasamran CA, Fisch KM, Paez C, Parekh JN, Ball ST, Chen JL, Ahmed SS, Ward SR. Strategies to Identify Mesenchymal Stromal Cells in Minimally Manipulated Human Bone Marrow Aspirate Concentrate Lack Consensus. Am J Sports Med 2021; 49:1313-1322. [PMID: 33646886 PMCID: PMC8409176 DOI: 10.1177/0363546521993788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a need to identify and quantify mesenchymal stromal cells (MSCs) in human bone marrow aspirate concentrate (BMAC) source tissues, but current methods to do so were established in cultured cell populations. Given that surface marker and gene expression change in cultured cells, it is doubtful that these strategies are valid to quantify MSCs in fresh BMAC. PURPOSE To establish the presence, quantity, and heterogeneity of BMAC-derived MSCs in minimally manipulated BMAC using currently available strategies. STUDY DESIGN Descriptive laboratory study. METHODS Five published strategies to identify MSCs were compared for suitability and efficiency to quantify clinical-grade BMAC-MSCs and cultured MSCs at the single cell transcriptome level on BMAC samples being used clinically from 15 orthopaedic patients and on 1 cultured MSC sample. Strategies included (1) the guidelines by the International Society for Cellular Therapy (ISCT), (2) CD271 expression, (3) the Ghazanfari et al transcriptional profile, (4) the Jia et al transcriptional profile, and (5) the Silva et al transcriptional profile. RESULTS ISCT guidelines did not identify any MSCs in BMAC at the transcriptional level and only 1 in 9 million cells at the protein level. Of 12,850 BMAC cells, 9 expressed the CD271 gene. Only 116 of 396 Ghazanfari genes were detected in BMAC, whereas no cells expressed all of them. No cells expressed all Jia genes, but 25 cells expressed at least 13 of 22. No cells expressed all Silva genes, but 19 cells expressed at least 8 of 23. Most importantly, the liberalized strategies tended to identify different cells and most of them clustered with immune cells. CONCLUSION Currently available methods need to be liberalized to identify any MSCs in fresh human BMAC and lack consensus at the single cell transcriptome and protein expression levels. These different cells should be isolated and challenged to establish phenotypic differences. CLINICAL RELEVANCE This study demonstrated that improved strategies to quantify MSC concentrations in BMAC for clinical applications are urgently needed. Until then, injected minimally manipulated MSC doses should be reported as rough estimates or as unknown.
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Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - J. Todd Walker
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Chanond A. Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, UC San Diego, La Jolla CA, USA
| | - Kathleen M. Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, UC San Diego, La Jolla CA, USA
| | - Conner Paez
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Jesal N. Parekh
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Scott T. Ball
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Jeffrey L. Chen
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Sonya S. Ahmed
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
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Rony L, Chappard D. Necrosis of the femoral head, X-ray microtomography (microCT) and histology of retrieved human femoral heads. Morphologie 2021; 105:134-142. [PMID: 33744124 DOI: 10.1016/j.morpho.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Aseptic osteonecrosis of the hip (AON) is a rare, but well-known pathology in rheumatology and orthopedic surgery that is a necrosis of the articular cartilage secondary to a necrosis of the subchondral bone. The microscopic aspect is well known, but the microCT aspect has never been reported or correlated with histopathological findings. The objective of this study was to improve the knowledge of the pathophysiology of AON using histochemistry and microCT. One hundred and sixty femoral heads with stage 3 or 4 AON were analyzed: one half of the head was sent for microCT analysis after impregnation with phosphotungstic acid (PTA) and the other half was used for histological analysis without decalcification. The microCT analysis provides relevant information on the cracked articular cartilage and the relationship with the necrotic subchondral trabecular bone well illustrated on three videos. In histology, Goldner's trichrome showed that the articular cartilage remains well preserved for a long time. In addition, toluidine blue staining reveals a modeling process, i.e. the apposition of new bone without prior resorption by osteoclasts. Rhodamine B staining (fluorescence analysis) reveals that the osteonecrotic trabeculae and subchondral bone were devoid of osteocytes. Areas of peri-necrotic osteosclerosis are due to direct bone formation on the surface of pre-existing necrotic trabeculae.
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Affiliation(s)
- L Rony
- GEROM - Groupe études remodelage osseux et biomatériaux, LHEA, Université d'Angers, CHU d'Angers, 49933 Angers cedex, France
| | - D Chappard
- GEROM - Groupe études remodelage osseux et biomatériaux, LHEA, Université d'Angers, CHU d'Angers, 49933 Angers cedex, France.
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Guerin G, Habibi A, Hernigou P, Zilber S. Core decompression with autologous bone marrow aspirate injection in humeral head osteonecrosis in adults with sickle cell disease. INTERNATIONAL ORTHOPAEDICS 2021; 45:1257-1261. [PMID: 33547484 DOI: 10.1007/s00264-021-04962-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Sickle cell disease is often associated with osteonecrosis of the humeral head with a risk of progression to humeral head collapse. The aim of this study was to evaluate the clinical outcome and the effect on the necrosis evolution of humeral head core decompression with autologous bone marrow aspirate injection in these patients. METHODS Forty shoulders in 23 patients were treated with core decompression with autologous concentrated iliac crest bone marrow aspirate injection. Patients were followed for a minimum of two years (limits from 2 to 10 years). Functional outcomes metrics included the simple shoulder test (STT) and subjective shoulder value (SSV) as well as assessment of radiographic progression of disease. RESULTS Shoulder function improved significantly at final follow-up. The STT improved by 2.9 points (p = 0.001) and the SVV improved by 15 % (p = 0.001). However, based on radiologic features, the intervention did not halt the radiographic progression of disease nor did it result in healing of the lesion. The benefits were mainly clinical with diminished pain and functional improvement. CONCLUSION Improvement in shoulder function was observed following core decompression and bone marrow aspirate injection in patients with sickle cell disease and early humeral head necrosis stages. The procedure should not be considered for grade 3 or greater disease and for asymptomatic cases whatever the grade. Given the lack of radiographic improvement observed in this study, further study in the context of prospective controlled trials should be undertaken before this intervention can be widely recommended.
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Affiliation(s)
- Gilles Guerin
- Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, 51 avenue du Marechal de Lattre de Tassigny, 94010, Creteil, France
| | - Anoosha Habibi
- Sickle cell referral center, UPEC, Institut Mondor Recherche Biomédical (IMRB), Institut national de la Santé et de la Recherche médicale (INSERM) U955, APHP, Henri Mondor teaching hospital, DHU A-TVB, 94010, Creteil, France
| | - Philippe Hernigou
- Department of orthopedic surgery, APHP, Henri Mondor teaching hospital, Creteil, France
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Tomaru Y, Yoshioka T, Nanakamura J, Sugaya H, Hagiwara S, Nawata K, Ohtori S, Yamazaki M, Mishima H. Concentrated autologous bone marrow aspirate transplantation versus conservative treatment for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus. J Rural Med 2021; 16:1-7. [PMID: 33442428 PMCID: PMC7788297 DOI: 10.2185/jrm.2020-033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: To compare the outcomes of steroid-associated osteonecrosis of
the femoral head in patients with systemic lupus erythematosus who underwent conservative
treatment and concentrated autologous bone marrow aspirate transplantation Methods: Osteonecrosis of the femoral head was classified according to the
Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate
transplantation was performed by aspirating the bone marrow from both iliac crests and
then transplanting it to the necrotic area after the core decompression. Patients with
>2-year follow-up after the concentrated autologous bone marrow aspirate
transplantation in our institution (Group I) and those with >2-year follow-up after the
first hospital visit in a cooperative institution (Group II) were included in this study.
After a randomized matching based on age, sex, type, stage, and etiology, the collapse
rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were
compared between the two groups. Results: After the matching adjustment, 33 pairs of hips were included.
Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2,
respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B,
respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I
and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I
and II, respectively. However, Group I had significantly higher and lower conversion rates
in stages 1 and 3, respectively (both P<0.05). Conclusion: Conservative treatment may be preferable in stage 1 hips. In
addition, concentrated autologous bone marrow aspirate transplantation may prevent further
collapse in stage 3.
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Affiliation(s)
- Yohei Tomaru
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Tomokazu Yoshioka
- Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Junichi Nanakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Hisashi Sugaya
- Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kento Nawata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Hernigou J, Housset V, Dubory A, Flouzat Lachaniette CH, Rouard H, Hernigou P. Cell therapy for post-traumatic hip osteonecrosis in young patients. Morphologie 2020; 105:127-133. [PMID: 33262030 DOI: 10.1016/j.morpho.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the effects of mesenchymal stem cells injections for treatment of post-traumatic osteonecrosis of the femoral head. METHODS A total of 46 patients were eligible and enrolled in the study. Twenty-three patients were treated with cell therapy and 23 patients with hip arthroplasty (control group). During a minimum follow-up duration of 10years, radiographs were used to evaluate the radiological results, and the Harris Hip Score (HHS) and visual analog scale were chosen to assess the clinical results. RESULTS For the cell therapy group, the product obtained by bone marrow aspiration in the iliac crest before concentration had a mean value of 2480 MSCs/mL (range 730 to 3800). The concentration product was containing average 9300 MSCs/mL (range 3930 to 19,800). At the most recent follow-up (average 15years after the first surgery, range 10 to 20years), among the 23 hips treated with cell therapy (concentrate bone marrow), 6 hips (26%) had collapsed and had required total hip arthroplasty (THA) without revision. Among the 23 hips treated with a primary THA, 7 (30.4%) had required one revision (second THA) at a mean follow-up of 6years (range 1 to 12years); two of these 7 hips had a re-revision; principal causes of revision were recurrent dislocations (3 cases) aseptic loosening (3 revisions) and infection (1 revision). As consequence, we observed significant (P<0.01) better survival time before revision for the cell therapy group. Better results with cell therapy were obtained for treatment at early stages before collapse. CONCLUSION The present study has demonstrated encouraging effects of cell therapy in early post-traumatic hip osteonecrosis and provides another choice for treatment in early stages I to II.
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Affiliation(s)
- J Hernigou
- Department of Orthopaedic and Traumatology Surgery, EpiCURA hospital, Baudour/Hornu, Belgium
| | - V Housset
- Department of Orthopaedic and Traumatology Surgery, Hospital Henri-Mondor, University Paris East, Creteil, France
| | - A Dubory
- Department of Orthopaedic and Traumatology Surgery, Hospital Henri-Mondor, University Paris East, Creteil, France
| | - C H Flouzat Lachaniette
- Department of Orthopaedic and Traumatology Surgery, Hospital Henri-Mondor, University Paris East, Creteil, France
| | - H Rouard
- Établissement Français du Sang (EFS) - Île-de-France, University Paris East, Créteil, France
| | - P Hernigou
- Department of Orthopaedic and Traumatology Surgery, Hospital Henri-Mondor, University Paris East, Creteil, France.
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Jones LC, Kaste SC, Karol SE, DeFeo B, Kim HKW, Neel MD, Levin AS. Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28509. [PMID: 32860663 DOI: 10.1002/pbc.28509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.
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Affiliation(s)
- Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian DeFeo
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Harry K W Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, Texas
| | - Michael D Neel
- Division of Orthopaedics, St. Jude Children's Research Hospital, Memphis, TN
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Hernigou P. Bone marrow in orthopaedics (part II): a three hundred and seventy million-year saga from the Devonian to the coronavirus disease 2019 pandemic-osteonecrosis; transplantation; "human chimera"; stem cells, bioreactors, and coronavirus disease. INTERNATIONAL ORTHOPAEDICS 2020; 44:2787-2805. [PMID: 33037446 PMCID: PMC7546933 DOI: 10.1007/s00264-020-04843-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Three hundred seventy million years ago, bone marrow appeared in skeleton of a fish. More than one hundred years ago, the concept of bone marrow transplantation was proposed to treat human diseases. During the last five decades, this concept became a reality first in hematology and later for orthopaedic diseases. MATERIAL AND METHODS These advances were possible due to the comprehension of the three major components of bone marrow: the fat part, the haematologic part, and the stroma part. Each part has a different history, but the three parts are linked in physiology as in history. RESULTS During many centuries, bone marrow was considered just as food; however, one hundred years ago, the concept of bone marrow transplantation to treat humans was proposed by the French physician Brown-Séquard. During the last five decades, this concept became a reality first in haematology and later for orthopaedic diseases. Transferring what was known from experimental animal models to humans was met with many challenges, the atomic bomb research, and many deaths. Yet through the recognition and subsequent understanding of fundamental processes, medical resiliency, and the determination of a few pioneers, local bone marrow transplantation in orthopaedic surgery became a therapeutic option first for a limited number of diseases and patients. Over the last two decades, mesenchymal stromal cells (MSCs) have been the focus of intense research by acadaemia and industry due to their unique features. MSCs can be easily isolated and expanded through in vitro culture by taking full advantage of their self-renewing capacity. In addition, MSCs exert immunomodulatory effects and can be differentiated into various lineages, which makes them highly attractive for clinical applications in cell-based therapies. CONCLUSION In this review, we attempted to provide a historical overview of bone marrow history, MSC discovery, characterization, and the first clinical studies conducted.
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Affiliation(s)
- Philippe Hernigou
- Orthopedic Department Henri Mondor Hospital, University Paris East, Paris, France.
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Massin P. Treatments of avascular osteonecrosis of the hip: Current treatments. Morphologie 2020; 105:120-126. [PMID: 32653168 DOI: 10.1016/j.morpho.2020.06.003] [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: 04/06/2020] [Revised: 05/17/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Abstract
Conservative treatments for aseptic osteonecrosis of the femoral head have their ancestor in the core decompression of the femoral neck, recommended by Ficat. Due to inconsistent results, this treatment has been optimized by either vascularized fibular grafting, or by injecting autologous stem cells into the necrotic zone. The French promoters have published long-term results, showing efficacy in the early stages of the disease, where the femoral head has not yet lost its sphericity. Over the last 10years, comparative studies, sometimes randomized, opposing them to simple core decompression, have been published by non-promoters, confirming the possibility of stabilization or even regression of necrosis area. But these techniques are not easy to implement. Cell therapy requires treatment of marrow samples by centrifugation to obtain a pellet with a high concentration of haematopoietic cells. The now proven long-term efficacy as well as the safety of this technique make it the method of choice for treating young patients detected at the sub-radiological stage by MRI. Unfortunately, many are seen late with detached cephalic cartilage or collapsed femoral head and have no other option than total hip arthroplasty. This technique is very reliable. With alumina ceramics, results of more than 20years show the absence of wear and osteolysis, although other complications such as instability or periprosthetic fractures may occur in these young and active patients.
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Affiliation(s)
- P Massin
- CMC Ambroise-Paré-Hartmann, 3, rue de l'Hôtel-de-Ville, 92200 Neuilly-sur-Seine, France.
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Tomaru Y, Yoshioka T, Sugaya H, Kumagai H, Hyodo K, Aoto K, Wada H, Akaogi H, Yamazaki M, Mishima H. Ten-year results of concentrated autologous bone marrow aspirate transplantation for osteonecrosis of the femoral head: a retrospective study. BMC Musculoskelet Disord 2019; 20:410. [PMID: 31488133 PMCID: PMC6729020 DOI: 10.1186/s12891-019-2797-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Idiopathic osteonecrosis of the femoral head (ONFH) occurs at a relatively younger age. It is therefore important to prevent the resultant femoral head collapse and requirement of total hip arthroplasty in these patients. In 2003, we initiated concentrated autologous bone marrow aspirate transplantation (CABMAT), a joint-preserving treatment for ONFH, at our institution. Here, we report the long-term results of CABMAT treatment. METHODS We retrospectively collated and analyzed the demographic and treatment data of 69 patients (109 hips) with idiopathic ONFH treated with CABMAT between April 2003 and April 2008. RESULTS Totally, 44 patients (21 men, 23 women, 80 hips) completed the 10-year follow-up. The follow-up rate was 73.4%, and the mean follow-up period was 12.0 (range, 10.0-15.4) years. The mean age of the patients was 42.2 (range, 16.3-70.5) years. Using the Association Research Circulation Osseous (ARCO) classification system for preoperative analysis, 12, 31, 32, and 5 hips were classified as stages 1, 2, 3, and 4, respectively. The overall rate of conversion to total hip arthroplasty (THA) was 34% (27/80 hips). In a multivariate regression analysis, the preoperative stage of ONFH and the body mass index were found to correlate significantly with conversion to THA. Totally, 43 hips (of 80) were classified as belonging to the pre-collapse stage (i.e., stages 1 or 2). The overall collapse rate and the THA-conversion rate of these hips were estimated to be 49% (21/43) and 14% (6/43), respectively. CONCLUSIONS On the basis of our long-term findings, the minimally invasive and feasible CABMAT therapy can be utilized as one of a joint-preserving treatment for ONFH.
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Affiliation(s)
- Yohei Tomaru
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomokazu Yoshioka
- Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hisashi Sugaya
- Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kojiro Hyodo
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Katsuya Aoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Wada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Akaogi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Epple C, Haumer A, Ismail T, Lunger A, Scherberich A, Schaefer DJ, Martin I. Prefabrication of a large pedicled bone graft by engineering the germ for de novo vascularization and osteoinduction. Biomaterials 2019; 192:118-127. [DOI: 10.1016/j.biomaterials.2018.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
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Hernigou P, Rigoulot G, Auregan JC, Housset V, Bastard C, Dubory A, Lachaniette CHF. Unusual indication of Cell therapy for hip osteonecrosis after pregnancy. SICOT J 2018; 4:46. [PMID: 30394283 PMCID: PMC6216759 DOI: 10.1051/sicotj/2018044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Osteonecrosis is a rare event during or after pregnancy. Due to the low number of cases, there is no report of long-term results after conservative surgery in this population. METHOD From 1992 to 2010, 145 consecutive female patients with unilateral symptomatic (94 stage I and 51 stage II) left hip osteonecrosis (ON) related to pregnancy were treated between 4 and 16 months after delivery with percutaneous mesenchymal stem cell (MSC) injection obtained from bone marrow concentration. The average total number of MSCs (counted as number of colonies forming units-fibroblast) injected in the hip was 185 000 ± 65 000 cells (range 95 000-240 000 cells). RESULTS At the most recent follow-up (average 15 years after hip surgery, range 8-25 years), among the 145 hips included in the study, 4 hips (2.7%) had collapsed and were treated with total hip arthroplasty (THA). Thirty-two of the 94 stage I had progressed to stage II; and 4 of the 51 stage II had progressed to stage III and collapse. The other 141 hips (97.3%) were without collapse and pain free. On MRI, as percentage of the volume of the femoral head, the osteonecrosis had decreased from 34.5% pre-operatively to 6% at the most recent follow-up. For women who had other children after treatment, a subsequent pregnancy was not associated with osteonecrosis. CONCLUSION Patients with hip osteonecrosis following pregnancy had a low conversion rate to THA when treated early with cell therapy.
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Affiliation(s)
- Philippe Hernigou
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Guillaume Rigoulot
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Jean Charles Auregan
- Auregan Jean Charles, Hopital Antoine Beclere, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Victor Housset
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Claire Bastard
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
| | - Arnaud Dubory
- Hôpital Henri Mondor, 51 avenue du Maréchal de Tassigny, 94000 Creteil, France
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Theruvath AJ, Nejadnik H, Muehe AM, Gassert F, Lacayo NJ, Goodman SB, Daldrup-Link HE. Tracking Cell Transplants in Femoral Osteonecrosis with Magnetic Resonance Imaging: A Proof-of-Concept Study in Patients. Clin Cancer Res 2018; 24:6223-6229. [PMID: 30224340 DOI: 10.1158/1078-0432.ccr-18-1687] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/23/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Osteonecrosis is a devastating complication of high-dose corticosteroid therapy in patients with cancer. Core decompression for prevention of bone collapse has been recently combined with the delivery of autologous concentrated bone marrow aspirates. The purpose of our study was to develop an imaging test for the detection of transplanted bone marrow cells in osteonecrosis lesions. EXPERIMENTAL DESIGN In a prospective proof-of-concept clinical trial (NCT02893293), we performed serial MRI studies of nine hip joints of 7 patients with osteonecrosis before and after core decompression. Twenty-four to 48 hours prior to the surgery, we injected ferumoxytol nanoparticles intravenously to label cells in normal bone marrow with iron oxides. During the surgery, iron-labeled bone marrow cells were aspirated from the iliac crest, concentrated, and then injected into the decompression track. Following surgery, patients received follow-up MRI up to 6 months after bone marrow cell transplantation. RESULTS Iron-labeled cells could be detected in the access canal by a dark (negative) signal on T2-weighted MR images. T2* relaxation times of iron-labeled cell transplants were significantly lower compared with unlabeled cell transplants of control patients who were not injected with ferumoxytol (P = 0.02). Clinical outcomes of patients who received ferumoxytol-labeled or unlabeled cell transplants were not significantly different (P = 1), suggesting that the added ferumoxytol administration did not negatively affect bone repair. CONCLUSIONS This immediately clinically applicable imaging test could become a powerful new tool to monitor the effect of therapeutic cells on bone repair outcomes after corticosteroid-induced osteonecrosis.
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Affiliation(s)
- Ashok J Theruvath
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, California.,Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany.,Pediatric Molecular Imaging Program, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
| | - Hossein Nejadnik
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, California.,Pediatric Molecular Imaging Program, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
| | - Anne M Muehe
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, California.,Pediatric Molecular Imaging Program, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
| | - Felix Gassert
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, California.,Pediatric Molecular Imaging Program, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
| | - Norman J Lacayo
- Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children's Hospital and Stanford Cancer Center, Stanford University, Stanford, California
| | - Stuart B Goodman
- Department of Orthopaedic Surgery and Bioengineering, Stanford Hospital, Stanford University, Stanford, California
| | - Heike E Daldrup-Link
- Department of Radiology, Pediatric Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, California. .,Pediatric Molecular Imaging Program, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California.,Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children's Hospital and Stanford Cancer Center, Stanford University, Stanford, California
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Hip osteonecrosis: stem cells for life or behead and arthroplasty? INTERNATIONAL ORTHOPAEDICS 2018; 42:1425-1428. [PMID: 29934715 DOI: 10.1007/s00264-018-4026-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
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