Researchers from University of Missouri School of Medicine suggest that, in biologic joint restoration, treating the donor grafts with bone marrow aspirate concentrate (BMC) before surgery could help improve bone integration and speed recovery.
“Surgeons performing biologic joint restoration surgeries typically only wash the donor bone to remove the marrow as a pretreatment before implanting the graft,” says James Cook, DVM, PhD, OTSC, the William and Kathryn Allen Distinguished Chair in Orthopaedic Surgery at the MU School of Medicine, in a media release.
“Once implanted, the recipient’s bone has to grow into the donor bone for the surgery to be successful. This graft integration involves a long process called ‘creeping substitution’ that can take more than a year to complete. The first 6 months are the most critical for success, so we have been studying ways to make this process better and faster,” adds Cook, who also serves as director of operations and research at MU Health Care’s Mizzou BioJoint Center and director of the Thompson Laboratory for Regenerative Orthopaedics.
In a study published recently in The American Journal of Sports Medicine, Cook and his team compared 17 biologic knee joint grafts implanted without BMC to 29 grafts pretreated with BMC. Post-surgical x-ray images at 6 weeks, 3 months and 6 months were compared for graft integration and healing.
The grafts pretreated with BMC achieved 43% bone integration at 6 weeks, compared to 25% of those not treated. Likewise, at 3 months, pretreated grafts achieved 67% integration, compared to 50% of the untreated grafts. At 6 months, the researchers observed that the pretreated grafts were more than 84% fully integrated, compared to 74% of untreated grafts, the release explains.
“To pretreat a graft with BMC, the patient’s bone marrow is collected at the start of the procedure,” Cook states. “It is processed in the operating room using a centrifuge to make a powerful concentrate containing the patient’s cells and proteins. The resulting BMC is used to saturate the donor bone before it is implanted into the patient’s joint.”
“The use of BMC is approved by the Food and Drug Administration for bone healing therapies,” Cook adds. “It has not been used specifically for biologic joint restoration procedures. I believe this is the first clinical study to directly examine the effects of BMC on bone integration for biologic joint restoration surgeries. Our data show that donor grafts pretreated with BMC were associated with earlier and better bone integration. This means that pretreatment with BMC reduces the risk of bone graft failure and improves the patients’ chances for long term success.”
Cook notes in the release, however, that although the results are favorable, the study has limitations, including the size of the patient sample studied.
“Moving forward, we will verify that similar results can be obtained in a larger patient population,” Cook concludes. “We also want to see if the same positive outcomes can be achieved in other joints, such as hips, shoulders and ankles. However, based on the results of our two studies, we now pretreat all our biologic joint restoration grafts with BMC.”
[Source: University of Missouri School of Medicine]
