Abstract
Background & purposeSkeletal stem cells (SSCs) and impaction bone grafting (IBG) can be combined to produce a mechanically stable living bone composite. This novel strategy has been translated to the treatment of avascular necrosis of the femoral head. Surgical technique, clinical follow-up and retrieval analysis data of this translational case series is presented. MethodsSSCs and milled allograft were impacted into necrotic bone in five femoral heads of four patients. Cell viability was confirmed by parallel in vitro culture of the cell-graft constructs. Patient follow-up was by serial clinical and radiological examination. Tissue engineered bone was retrieved from two retrieved femoral heads and was analysed by histology, microcomputed tomography (μCT) and mechanical testing. ResultsThree patients remain asymptomatic at 22- to 44-month follow-up. One patient (both hips) required total hip replacement due to widespread residual necrosis. Retrieved tissue engineered bone demonstrated a mature trabecular micro-architecture histologically and on μCT. Bone density and axial compression strength were comparable to trabecular bone. ConclusionsClinical follow-up shows this to be an effective new treatment for focal early stage avascular necrosis of the femoral head. Unique retrieval analysis of clinically translated tissue engineered bone has demonstrated regeneration of tissue that is both structurally and functionally analogous to normal trabecular bone.
Highlights
AVN of the femoral head is a disease that usually affects young adults, progressing to bone collapse and osteoarthritis in over 80% of untreated patients.[1]
Position and distribution of the necrotic bone in the femoral head have a bearing on prognosis[2,4] the most important predictor remains progression from an intact bony architecture
Milled allograft was prepared from fresh frozen femoral heads according to standard clinical practice
Summary
AVN of the femoral head is a disease that usually affects young adults, progressing to bone collapse and osteoarthritis in over 80% of untreated patients.[1]. Joint preserving therapies are advocated by most authorities to prevent the progression to collapse These include core decompression,[1] electrical stimulation,[6] tantalum trabecular metal rods,[7] vascularised fibular grafts,[8] fibular or tibial strut grafts,[9] concentrated autologous bone marrow[10] or hydroxyapatite rods coated with skeletal stem cells.[11]. Skeletal stem cells (SSCs) and impaction bone grafting (IBG) can be combined to produce a mechanically stable living bone composite. This novel strategy has been translated to the treatment of avascular necrosis of the femoral head. Unique retrieval analysis of clinically translated tissue engineered bone has demonstrated regeneration of tissue that is both structurally and functionally analogous to normal trabecular bone
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