The biological basis for concentrated iliac crest aspirate to enhance core decompression in the treatment of osteonecrosis
- 105 Downloads
Core decompression is a surgical procedure that is capable of salvaging the patient’s own natural joint, if the operation is performed in the early stages of osteonecrosis, in which the articular surface has not collapsed. The addition of concentrated cells, aspirated from the iliac crest, to the core tract has been shown to enhance the viability of the femoral head, although large, prospective, randomized, blinded multicentre studies are lacking. The rationale for adding these cells to the core decompression tract is to provide osteoprogenitor and vascular progenitor cells to the area of decompressed dead bone, in order to facilitate tissue regeneration and repair. It has become increasingly evident that vast discrepancies exist in different series in regard to the criteria for patient selection, the surgical technique of core decompression, the methods for harvesting, processing, and injecting the cells, and the methodology for determining success or failure in a specific patient cohort. This paper reviews the salient points relevant to the treatment of osteonecrosis by core decompression with addition of concentrated iliac crest aspirates and poses important questions regarding the future successful application of this technique.
KeywordsOsteonecrosis Core decompression Iliac crest aspirate Osteogenesis Bone healing
This work was supported in part by NIH grants R01AR063717-06 and NCATS 1UG3TR002136-01, and the Ellenburg Chair in Surgery at Stanford University.
- 8.Houdek MT, Wyles CC, Martin JR, Sierra RJ (2014) Stem cell treatment for avascular necrosis of the femoral head: current perspectives. Stem Cells Cloning Adv Appl 7:65–70Google Scholar
- 20.Piuzzi NS, Chahla J, Jiandong H, Chughtai M, LaPrade RF, Mont MA, Muschler GF, Pascual-Garrido C (2017) Analysis of cell therapies used in clinical trials for the treatment of osteonecrosis of the femoral head: a systematic review of the literature. J Arthroplast 32(8):2612–2618CrossRefGoogle Scholar
- 24.Hegde V, Shonuga O, Ellis S, Fragomen A, Kennedy J, Kudryashov V, Lane JM (2014) A prospective comparison of 3 approved systems for autologous bone marrow concentration demonstrated nonequivalency in progenitor cell number and concentration. J Orthop Trauma 28(10):591–598CrossRefPubMedGoogle Scholar
- 27.Caralla T, Joshi P, Fleury S, Luangphakdy V, Shinohara K, Pan H, Boehm C, Vasanji A, Hefferan TE, Walker E et al (2013) In vivo transplantation of autogenous marrow-derived cells following rapid intraoperative magnetic separation based on hyaluronan to augment bone regeneration. Tissue Eng A 19(1–2):125–134CrossRefGoogle Scholar
- 30.Luangphakdy V, Boehm C, Pan H, Herrick J, Zaveri P, Muschler GF (2016) Assessment of methods for rapid intraoperative concentration and selection of marrow-derived connective tissue progenitors for bone regeneration using the canine femoral multidefect model. Tissue Eng A 22(1–2):17–30CrossRefGoogle Scholar
- 33.Wuchter P, Bieback K, Schrezenmeier H, Bornhauser M, Muller LP, Bonig H, Wagner W, Meisel R, Pavel P, Tonn T et al (2015) Standardization of good manufacturing practice-compliant production of bone marrow-derived human mesenchymal stromal cells for immunotherapeutic applications. Cytotherapy 17(2):128–139CrossRefPubMedGoogle Scholar
- 36.Arlet J, Ficat P, Sebbag D (1969) The use of measurement of intramedullary pressure in the greater trochanter in man, particularly in the diagnosis of osteonecrosis of the femoral head. Rev Rhum Mal Osteoartic 35(5):250–256Google Scholar
- 37.Mao Q, Wang W, Xu T, Zhang S, Xiao L, Chen D, Jin H, Tong P (2015) Combination treatment of biomechanical support and targeted intra-arterial infusion of peripheral blood stem cells mobilized by granulocyte-colony stimulating factor for the osteonecrosis of the femoral head: a randomized controlled clinical trial. J Bone Miner Res 30(4):647–656CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Connolly JF, Guse R, Tiedeman J, Dehne R (1991) Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res 266:259–270Google Scholar
- 47.Zwingenberger S, Yao Z, Jacobi A, Vater C, Valladares RD, Li C, Nich C, Rao AJ, Christman JE, Antonios JK et al (2014) Enhancement of BMP-2 induced bone regeneration by SDF-1α mediated stem cell recruitment. Tissue Eng A 20(3–4):810–818Google Scholar