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The biological basis for concentrated iliac crest aspirate to enhance core decompression in the treatment of osteonecrosis

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Abstract

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.

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Funding

This work was supported in part by NIH grants R01AR063717-06 and NCATS 1UG3TR002136-01, and the Ellenburg Chair in Surgery at Stanford University.

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Authors and Affiliations

  1. Departments of Orthopaedic Surgery and Bioengineering, Stanford University, Stanford, CA, USA

    Stuart B. Goodman

  2. Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA, 94063, USA

    Stuart B. Goodman

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  1. Stuart B. Goodman
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Correspondence to Stuart B. Goodman.

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Goodman, S.B. The biological basis for concentrated iliac crest aspirate to enhance core decompression in the treatment of osteonecrosis. International Orthopaedics (SICOT) 42, 1705–1709 (2018). https://doi.org/10.1007/s00264-018-3830-1

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  • DOI: https://doi.org/10.1007/s00264-018-3830-1

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