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A tissue engineering strategy for the treatment of avascular necrosis of the femoral head

A tissue engineering strategy for the treatment of avascular necrosis of the femoral head
A tissue engineering strategy for the treatment of avascular necrosis of the femoral head
BACKGROUND & PURPOSE: 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. Surgical technique, clinical follow-up and retrieval analysis data of this translational case series is presented.

METHODS: SSCs 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 (?CT) and mechanical testing.

RESULTS: Three 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 ?CT. Bone density and axial compression strength were comparable to trabecular bone.

CONCLUSIONS: Clinical 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.
femoral head, avascular necrosis, skeletal stem cells, impaction bone grafting, translation
1479-666X
319-325
Aarvold, A.
cdb23726-6d5e-444a-979a-71ca7af83e3f
Smith, John
8f980673-b037-4ae2-a9a2-84bf039beed0
Tayton, Edward R
96db2df6-e8ca-4709-a13d-16b8f05aff5c
Jones, A.M.H.
ed691057-0714-4466-a207-79ed730c173c
Dawson, Jonathan I.
b220fe76-498d-47be-9995-92da6c289cf3
Lanham, S.A.
28fdbbef-e3b6-4fdf-bd0f-4968eeb614d6
Briscoe, Adam
40a57aa0-be88-47a6-b528-ae8f0914d0e7
Dunlop, Douglas G.
5f8d8b5c-e516-48b8-831f-c6e5529a52cc
Oreffo, Richard O.C.
ff9fff72-6855-4d0f-bfb2-311d0e8f3778
Aarvold, A.
cdb23726-6d5e-444a-979a-71ca7af83e3f
Smith, John
8f980673-b037-4ae2-a9a2-84bf039beed0
Tayton, Edward R
96db2df6-e8ca-4709-a13d-16b8f05aff5c
Jones, A.M.H.
ed691057-0714-4466-a207-79ed730c173c
Dawson, Jonathan I.
b220fe76-498d-47be-9995-92da6c289cf3
Lanham, S.A.
28fdbbef-e3b6-4fdf-bd0f-4968eeb614d6
Briscoe, Adam
40a57aa0-be88-47a6-b528-ae8f0914d0e7
Dunlop, Douglas G.
5f8d8b5c-e516-48b8-831f-c6e5529a52cc
Oreffo, Richard O.C.
ff9fff72-6855-4d0f-bfb2-311d0e8f3778

Aarvold, A., Smith, John, Tayton, Edward R, Jones, A.M.H., Dawson, Jonathan I., Lanham, S.A., Briscoe, Adam, Dunlop, Douglas G. and Oreffo, Richard O.C. (2013) A tissue engineering strategy for the treatment of avascular necrosis of the femoral head. The Surgeon, 11 (6), 319-325. (doi:10.1016/j.surge.2013.02.008). (PMID:23540814)

Record type: Article

Abstract

BACKGROUND & PURPOSE: 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. Surgical technique, clinical follow-up and retrieval analysis data of this translational case series is presented.

METHODS: SSCs 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 (?CT) and mechanical testing.

RESULTS: Three 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 ?CT. Bone density and axial compression strength were comparable to trabecular bone.

CONCLUSIONS: Clinical 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.

Other
1-s2.0-S1479666X13000334-main.pdf__tid=99b4e928-0910-11e4-908a-00000aab0f26&acdnat=1405092943_fe1a07f16defdc6e350e90c3e07d263d - Version of Record
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More information

e-pub ahead of print date: 27 March 2013
Published date: December 2013
Keywords: femoral head, avascular necrosis, skeletal stem cells, impaction bone grafting, translation
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 355826
URI: https://eprints.soton.ac.uk/id/eprint/355826
ISSN: 1479-666X
PURE UUID: d31d429a-4885-4a2b-94c7-b99f85c8ad6b
ORCID for S.A. Lanham: ORCID iD orcid.org/0000-0002-4516-264X
ORCID for Richard O.C. Oreffo: ORCID iD orcid.org/0000-0001-5995-6726

Catalogue record

Date deposited: 05 Sep 2013 15:53
Last modified: 06 Jun 2018 13:02

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