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Autologous chondrocyte implantation to treat femoral condyle and talar lesions
Moises Cohen,Caio Nery,Maria Stella Peccin,Cibele Ramos Réssio
Einstein (S?o Paulo) , 2008,
Abstract: Objective: To show the first Brazilian autologous chondrocyteimplantation. Methods: Young patients with localized lesions infemoral condyle and talus were selected. The clinical evaluationwas complemented with the imaginologic resources. Results: Theneoformed cartilage tissue occupies the defect. The patients showedimprove in the quality life, returning to the daily and sport activities. Conclusions: It was possible to concluded that the autologous chondrocyte implantation is a promising technique for the treatment of femoral condyle and talar condral lesions.
Femoral artery thrombosis after internal fixation of a transverse acetabular fracture in a patient with osteogenesis imperfecta type I
Navid M Ziran, Jeffrey L Johnson, Steven J Morgan, Wade R Smith
Patient Safety in Surgery , 2008, DOI: 10.1186/1754-9493-2-1
Abstract: The ilioinguinal approach is frequently used in orthopaedic pelvic surgery to repair the anterior column, the anterior wall, and transverse fractures of the acetabulum [1]. This approach has a lower incidence of heterotopic ossification and does not violate the abductors – thus, making it an appealing approach for the treatment of these fractures. The inherent risks involved in this approach are damage to the lateral femoral cutaneous nerve, injury to the femoral vessels, bleeding from damage to the corona mortis, inguinal hernia, hematoma, infection, and problems with lymphatic drainage. In this report, we present a patient with Osteogenesis Imperfecta type I who sustained damage to the femoral artery and vein during open reduction internal fixation of a transverse acetabular fracture via the ilioinguinal approach.The patient is a 25 year old female with Osteogenesis Imperfecta type I, and she is a limited household ambulator with numerous orthopaedic procedures in the past. She presented to our Emergency Department after being transferred from a bed to a chair. She heard a pop in her right hemipelvis and complained of right hip pain and left wrist pain. Upon evaluation, she was found to have a significantly comminuted right transverse acetabulum fracture (Figure 1a) and a left distal radius fracture. Two days after presentation, she underwent open reduction internal fixation of the right acetabulum fracture via a standard ilioinguinal approach (Figure 1b). During the initial dissection, the femoral vessels were noted to have minimal perivascular tissue. After exposure, the comminuted fracture was reduced using an offset clamp. A 14-hole reconstruction plate was placed along the pelvic brim along the length of the anterior column. During placement of screws in the pubis with retraction on the femoral vessels, it was noted that there was significant venous bleeding from the vascular bundle. The greater saphenous vein and the femoral vein had been partially lacerated
Treatment of osteonecrosis of the femoral head using autologous cultured osteoblasts: a case report
Seok-Jung Kim, Won-Jong Bahk, Cheong-Ho Chang, Jae-Deog Jang, Kyung-Hwan Suhl
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-58
Abstract: We present the case of a patient with bilateral osteonecrosis of the femoral head treated with autologous cultured osteoblast injection.Although our experience is limited to one patient, autologous cultured osteoblast transplantation appears to be effective for treating the osteonecrosis of femoral head.Osteonecrosis of the femoral head is a progressive disease that leads to femoral head collapse and osteoarthritis [1]. A number of surgical procedures have been developed to preserve the femoral head, however, there is no single treatment method which completely cures this debilitating disease.Bone regeneration by autogenous cell transplantation is one of the most promising treatment concepts currently being developed, as it eliminates the problems of donor site morbidity for autologous grafts, the immunological problems of allogenic grafts, and loosening of implants in total joint arthroplasty.A 31-year old man was admitted with symptoms of acute joint pain of three weeks' duration in both hips. The patient had no specific past history of disease and his laboratory findings were normal. Plain radiographs (Fig. 1A) and MR examination (Fig. 1B) revealed Ficat II osteonecrosis of both femoral heads. The left femoral head was treated by allograft immediately after core decompression, while the right side was treated by injection of autologous cultured osteoblasts for four weeks after the core decompression (Fig. 1C).Follow-up CT obtained one year following treatment, demonstrated that the right femoral head had bone reformation in multiple necrotic areas, that the femoral head was still in optimal condition, and that the left head showed absorption of the grafted bone as well as disease progression.Radiographs obtained five years following surgery showed evidence of remodeling as well as maintenance of the right femoral head, but the left femoral head showed slight irregularity, sclerotic changes, and osteophyte formation (Fig. 1D). On both the MRI (Fig. IE) and the CT
Anti-inflammatory and osteogenesis of complex particles composed of ceric oxide and bioglass on repair of rabbit femoral defects
Medical Journal of Chinese People's Liberation Army , 2011,
Abstract: Objective To observe the anti-inflammatory and osteogenesis of the complex particles composed of ceric oxide and bioglass implanted into rabbit femoral defects.Methods The bilateral penetrating femoral condylar defects of 6mm in diameter were made in 6 adult New Zealand White rabbits,bioglass particles and complex particles composed of ceric oxide and bioglass were randomly implanted into the left or right condylar defect.Animals were sacrificed at 2 and 4 weeks after operation(3 each),specimens from defect sites were harvested for histological examination to observe the inflammatory reaction and calculate the ratio of new bone and grafts on the defect area.Results No inflammatory reaction was found in the defect area filled with bioglass particles or complex particles composed of ceric oxide and bioglass.New bone was observed in the defects 2 weeks after operation,and no significant difference on the bone formation rate existed between the two materials(P > 0.05).The osteogenesis of both materials was more obvious in the 4th week than in the 2nd week(P < 0.05 or 0.01),but the formation rate was similar by the two materials(P > 0.05).No obvious degradation of the grafts implanted into the defect area occurred in the 4th week compared with that in the 2nd week(P > 0.05).Conclusion The complex particles composed of ceric oxide and bioglass has anti-inflammatory activity and similar osteogenesis to normal bioglass particles,and may be used in the repair of bone defects.
Use of irradiated autologous bone in joint sparing endoprosthetic femoral replacement tumor surgery  [cached]
Vijayan Sridhar,Bartlett William,Lee Robert,Ostler Peter
Indian Journal of Orthopaedics , 2011,
Abstract: Background: Joint preservation is usually attempted in cases of bone tumors, though insufficient bone following tumour resection may prevent fixation of conventional joint sparing prosthesis. To preserve the hip joint in skeletally immature patients, we have combined autologous proximal femoral irradiation and intercalary re-implantation with custom made distal femoral replacements. Materials and Methods: A retrospective cohort study of four patients (aged 4-12 years); in whom irradiated autologous bone was combined with an extendable distal femoral endoprostheses was performed. There were three cases of osteosarcoma and one case of Ewing′s sarcoma. Results: At a mean follow-up of 70.5 months (range 26-185 months), all four patients were alive without evidence of local recurrence. There was no evidence of metastatic disease in three patients while one patient showed chest metastatic disease at presentation. In all cases, the irradiated segment of bone united with the proximal femur and demonstrated bone ongrowth at the prosthetic collar. There were no cases of loosening or peri-prosthetic fracture. One implant was revised after 14 years following fracture of the extending component of the endoprosthesis. Conclusions: We report encouraging results utilizing irradiated autologous proximal femoral bone combined with distal femoral replacement in skeletally immature patients.
Scaffold-Based Delivery of Autologous Mesenchymal Stem Cells for Mandibular Distraction Osteogenesis: Preliminary Studies in a Porcine Model  [PDF]
Zongyang Sun, Boon Ching Tee, Kelly S. Kennedy, Patrick M. Kennedy, Do-Gyoon Kim, Susan R. Mallery, Henry W. Fields
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074672
Abstract: Purpose Bone regeneration through distraction osteogenesis (DO) is promising but remarkably slow. To accelerate it, autologous mesenchymal stem cells have been directly injected to the distraction site in a few recent studies. Compared to direct injection, a scaffold-based method can provide earlier cell delivery with potentially better controlled cell distribution and retention. This pilot project investigated a scaffold-based cell-delivery approach in a porcine mandibular DO model. Materials and Methods Eleven adolescent domestic pigs were used for two major sets of studies. The in-vitro set established methodologies to: aspirate bone marrow from the tibia; isolate, characterize and expand bone marrow-derived mesenchymal stem cells (BM-MSCs); enhance BM-MSC osteogenic differentiation using FGF-2; and confirm cell integration with a gelatin-based Gelfoam scaffold. The in-vivo set transplanted autologous stem cells into the mandibular distraction sites using Gelfoam scaffolds; completed a standard DO-course and assessed bone regeneration by macroscopic, radiographic and histological methods. Repeated-measure ANOVAs and t-tests were used for statistical analyses. Results From aspirated bone marrow, multi-potent, heterogeneous BM-MSCs purified from hematopoietic stem cell contamination were obtained. FGF-2 significantly enhanced pig BM-MSC osteogenic differentiation and proliferation, with 5 ng/ml determined as the optimal dosage. Pig BM-MSCs integrated readily with Gelfoam and maintained viability and proliferative ability. After integration with Gelfoam scaffolds, 2.4–5.8×107 autologous BM-MSCs (undifferentiated or differentiated) were transplanted to each experimental DO site. Among 8 evaluable DO sites included in the final analyses, the experimental DO sites demonstrated less interfragmentary mobility, more advanced gap obliteration, higher mineral content and faster mineral apposition than the control sites, and all transplanted scaffolds were completely degraded. Conclusion It is technically feasible and biologically sound to deliver autologous BM-MSCs to the distraction site immediately after osteotomy using a Gelfoam scaffold to enhance mandibular DO.
Successful Treatment of Osteosarcoma Arising in Osteogenesis Imperfecta with High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation Followed-by Limb Sparing Surgery
Selmin Ataergin,Fikret Arpaci,Kaan Erler,Bahtiyar Demiralp
Clinical Medicine : Oncology , 2007,
Abstract: We present a 20-year-old male patient with localized osteosarcoma arising in osteogenesis imperfecta who underwent high-dose chemotherapy together with autologous peripheral blood stem cell transplantation followed-by a successful extremity sparing surgery.
Navigation-Assisted Total Knee Arthroplasty for Osteoarthritis with Extra-Articular Femoral Deformity and/or Retained Hardware  [PDF]
Daisuke Hamada,Hiroshi Egawa,Tomohiro Goto,Tomoya Takasago,Michihiro Takai,Tetsuya Hirano,Yoshiteru Kawasaki,Natsuo Yasui
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/174384
Abstract: Total knee arthroplasty (TKA) for osteoarthritis (OA) patients with extra-articular deformity is still challenging because angular deformity, canal sclerosis, or the retained hardware that precludes the use of the traditional intramedullary guide. In addition, atypical bone cut for intra-articular correction leads to imbalanced soft tissue gap. Furthermore, corrective osteotomy should be considered for severe deformity or para-articular deformity cases. Recently, navigation-assisted TKA has been reported to increase the accuracy of prosthetic positioning and limb alignment. This system can calculate mechanical axis regardless of extra-articular deformity, canal sclerosis, or retained hardware. Accordingly, navigation surgery has been considered to be a powerful option especially in TKAs with extra-articular deformity cases. Here, we report 3 successful navigation-assisted TKAs for osteoarthritis with extra-articular deformities and/or retained hardware. Navigation-assisted TKA is an effective and reliable alternative for patients with extra-articular deformities. 1. Introduction The long-term success of total knee arthroplasty (TKA) is dependent on the accurate positioning of the prosthesis and proper soft tissue balancing. In most TKAs for arthritic knees, proper alignment and ligament balancing can be achieved by the techniques of appropriate bone resection and soft tissue release. On the other hand, TKA for knee arthritis with extra-articular deformity is still challenging based on the following reasons. (1) Altered mechanical axis due to angular deformity, canal sclerosis, or retained hardware which cannot be removed prevents the use of traditional intramedullary guide which is a useful tool for conventional TKAs. (2) Atypical intra-articular bone resection to perform intra-articular correction makes the soft tissue balancing complex. (3) Corrective osteotomy should be considered for severe deformity or para-articular deformity cases. Recently, computer-assisted navigation system has been used for TKA. A couple of studies have demonstrated that computer-assisted TKA provides more accurate, reliable, and reproducible component positioning [1, 2]. This procedure can make accurate bone resection regardless of angular deformity, canal stenosis, or retained hardware. Due to this, navigation surgery has been considered to be an effective option for extra-articular deformity cases. In this paper, we report 3 successful navigation-assisted TKAs for osteoarthritis with extra-articular femoral deformities and/or retained hardware. 2. Methods Long-standing
Gel-type autologous chondrocyte (Chondron?) implantation for treatment of articular cartilage defects of the knee
Nam-Yong Choi, Byoung-Woo Kim, Woo-Jin Yeo, Haeng-Boo Kim, Dong-Sam Suh, Jin-Soo Kim, Yoon-Sik Kim, Yong-Ho Seo, Jea-Yeong Cho, Chung-Woo Chun, Hyun-Shin Park, Asode Shetty, Seok-Jung Kim
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-103
Abstract: Data from 98 patients with articular cartilage injury of the knee joint and who underwent Chondron? implantation at ten Korean hospitals between January 2005 and November 2008, were included and were divided into two groups based on the patient follow-up period, i.e. 13~24-month follow-up and greater than 25-month follow-up. The telephone Knee Society Score obtained during telephone interviews with patients, was used as the evaluation tool.On the tKSS-A (telephone Knee Society Score-A), the score improved from 43.52 ± 20.20 to 89.71 ± 13.69 (P < 0.05), and on the tKSS-B (telephone Knee Society Score-B), the score improved from 50.66 ± 20.05 to 89.38 ± 15.76 (P < 0.05). The total improvement was from 94.18 ± 31.43 to 179.10 ± 24.69 (P < 0.05).Gel-type autologous chondrocyte implantation for chondral knee defects appears to be a safe and effective method for both decreasing pain and improving knee function.As articular cartilage has only limited ability to regenerate, many treatment modalities have been developed during the past several decades to treat symptomatic articular cartilage injuries [1]. Among these treatment modalities, autologous chondrocyte implantation (ACI) has become a standard technique used to repair symptomatic, full-thickness, chondral injuries [2-4].The traditional ACI technique involves injection of cultured autologous cartilage cells into the prepared cartilage defect which is covered by a periosteal flap. The technique requires extensive surgical exposure in order for the sutures to be watertight as well as an additional incision for harvesting the periosteum. In addition, cell leakage, graft detachment, and graft hypertrophy are recognized as potential problems [5].To solve the periosteum-associated problems, many biomaterials have also been used for a new generation of ACI techniques in which cells are combined with bioactive, resorbable biomaterials such as collagen membrance [6], hyaluronan polymer [7], and copolymers of polylactin and pol
Biophysical stimulation in osteonecrosis of the femoral head  [cached]
Massari Leo,Fini Milena,Cadossi Ruggero,Setti Stefania
Indian Journal of Orthopaedics , 2009,
Abstract: Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs) has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary.
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