Bone Marrow Concentrate Enriched in Platelet Growth Factors Combined With De-mineralized Bone Matrix for Complex Revision and Complex Lower Limb Arthrodesis

Abstract

Complex arthrodesis procedures in the lower limb present a challenging model for successful outcomes, especially in the face of multiple co-morbidities [1]. Not only is this patient population at risk for delayed union and nonunion, the potential for infection and delay in soft tissue healing is also of great concern [2]. Autolo-gous fusion solutions have been used for decades in bone repair procedures in the form of bone grafts (iliac or rib) or bone marrow (Figure 2) aspirate harvested from the marrow cavities with good results. Bone graft harvest comes with inherent challenges, often resulting in do-nor site morbidity [3]. Bone marrow aspirate (BMA) har-vested from the marrow cavities is a mixture of stromal and peripheral blood and has less inherent risk and still provides a potent osteogenic stimulus. Unfortunately, pure BMA has relatively few osteoprogenitor cells per volume and contains a high proportion of red blood cells that can interfere with bone healing [4] (Figure 1a). Recently, advances in the use of bedside devices have given physicians the option of an autologous concen-trate of therapeutic cells such as white blood cells and platelets as well as adult stem cells known to be instru-mental in osteogenesis, while removing the majority of the red cell fraction (Figure 1b). Additionally, platelet-rich plasma (PRP), which is produced from peripheral blood, contains concentrated growth factors that play a role in the proliferation and differentiation of adult stem cells and the enhancement of tissue healing [5,6]. Both human bone marrow derived mesenchymal stem cells (hMSCs) and platelets have been shown to possess antimicrobial characteristics [7,8].