Autologous Bone Marrow Stem Cells combined with Allograft Cancellous Bone in Treatment of Nonunion

Abstract

Abstract-Autologous cancellous bone graft is currently used as a gold standard method for treatment of bone nonunion. However, there is a limit to the amount of autologous cancellous bone that can be harvested and the donor site morbidity presents a major disadvantage to autologous bone grafting. Embedding viable cells within biological scaffolds appears to be extremely promising. The purpose of this study was to assess the outcome of autologous bone marrow stem cells combined with a cancellous bone allograft as compared to an autologous bone graft in the treatment of bone nonunion. Bone marrow aspiration concentrate (BMAC) was previously produced from bone marrow aspirate via a density gradient centrifugation. Autologous cancellous bone was harvested in 9 patients and applied to the nonunion site. In 18 patients of the clinical trial group after the debridement, the bone gaps were filled with a composite of BMAC and allograft cancellous bone chips (BMAC-ACB). Bone consolidation was obtained in 88.9%, and the mean interval between the cell transplantation and union was 4.6 ± 1.5 months in the autograft group. Bone union rate was 94.4% in group of composite BMAC-ACB implantation. The time to union in BMAC-ACB grafting group was 3.3 ± 0.90 months, and led to faster healing when compared to the autograft. A mean concentration of autologous progenitorcells was found to be 2.43 ± 1.03 (x10 6 ) CD34 + cells/ml, and a mean viability of CD34 + cells was 97.97 ± 1.47 (%). This study shows that the implantation of BMAC has presented the efficacy for treatment of nonunion and may contribute an available alternative to autologous cancellous bone graft. But large clinical application of BM-MSCs requires a more appropriate and profound scientific investigations.

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

“…Nine studies evaluated the use of cBMA in bone healing summarized in Table 4 [ 25 - 33 ]. Eight of nine studies reported on the use of cBMA in either non-union or delayed union.…”

“…All studies reported either lower or similar complication rates post-operatively in groups that received cBMA compared to groups receiving no additional treatment. Bone consolidation and time to bone union was improved in patients receiving cBMA, with faster healing rates when compared to patients in the autograft group[ 33 ]. One study found a significantly lower number of progenitor cells in patients who did not achieve union as well as a negative correlation between the time needed to obtain union and the concentration of colony forming units in the graft[ 30 ].…”

“…However, there is a limit to the amount of bone graft from iliac crest donor site that can be harvested in the reconstruction of large osseous defects. In addition, there are disadvantages of chronic donor site pain, cosmetic concern, and nerve injury, which have been documented in the literature[ 33 ].…”

“…The use of cBMA as an adjunctive procedure has gained attention in the treatment of nonunions[ 30 ]. The current literature demonstrates faster healing with greater than 94% union rate when using cBMA combined with allograft compared with conventional autologous cancellous bone graft[ 33 ]. Ismail et al[ 31 ] reported similar union rates and outcomes when comparing cBMA and iliac crest autograft.…”

Current status of stem cell transplantation in Vietnam

“…Since this time, orthopedic applications of stem cells have expanded significantly; yet, almost all clinical applications make use of autologous bone marrow including treatments for femoral head necrosis (Mai Dac Viet, 2010;Nguyen Thi-Thu Ha, 2013), bone defect and short limb (Nguyen Van Luong, 2010), tibia non-unions (Nguyen Manh Khanh, 2010), long bone non-union (Le Van Doan, 2011;Nguyen Thi-Thu Ha, 2013;Thua et al, 2015a), long bone diaphyseal non-unions (Ngo Ba Toan, 2012, 2014, joint diseases (Duong Dinh Toan, 2013a;Ly Tuan Khai, 2013;Nguyen Thanh Binh, 2012), limb lengthening (Nguyen Thi-Thu Ha, 2013), knee osteoarthritis (Duong Dinh Toan, 2013b;Duong Dinh Toan, 2014) and delayed or non-union bone (Thua et al, 2015b). The common property of these studies is use of non-expanded autologous stem cells; each used concentrated autologous bone marrow generated using a centrifuge-based method.…”