Biomedical Engineering Reference
In-Depth Information
presented a construct with potential benefit for osteomyelitis treatment. This
construct was an antibiotic delivery system made of vancomycin alginate beads
embedded in a fibrin gel seeded with bone marrow-derived MSCs. The researchers
have proposed that local delivery of antibiotics by this system would be more
effective than routine systemic delivery in treating bone infections. Furthermore,
the presence of MSCs in the system would assist with regeneration of the bone
defects [
103
].
7.9.4 Osteonecrosis
Osteonecrosis or avascular necrosis of the femoral head is a painful condition that
may result in the collapse of bone end, necessitating total replacement of the hip
joint. Core decompression along with bone graft is often used to treat osteone-
crosis. There are several studies in which whole bone marrow or marrow stromal
cells have been used to treat osteonecrosis.
In a study by Hernigou et al. in 2002, concentrated bone marrow was injected
into the femoral head by a small trocar. The patient was then followed for
5-10 years by Harris hip scoring, radiography, and the need for hip replacement.
According to the results, the individuals who received more CFU-F cells have
more satisfactory outcomes. In this study there was no control group [
104
]. In a
blinded study that treated osteonecrotic bone by bone marrow cell implantation,
Gangji et al. included a control group. In their study, 13 patients (18 hips at stages
I and II of osteonecrosis of the femur head) were included. Two years after
treatment, significant reductions in pain were observed in the marrow cell
implanted patients. Additionally, in this group the numbers of necrotic lesions
reduced by 35 %. According to the findings, osteonecrosis worsened in five out of
eight hips from the control group compared to one hip from the treatment group
[
105
]. Wang et al. have transplanted 30-50 ml of concentrated marrow into 45
patients with avascular necrosis and observed satisfactory results. In their study,
hip replacement was performed for 7 out of 59 femurs [
106
].
In contrast to the three above-mentioned studies that have used marrow cells, Ji
et al. have investigated the transplantation of bone marrow stromal cells along with
decalcified bone matrix in osteonecrosis and reported satisfactory outcomes [
107
].
7.9.5 Nonunion Fractures
Most bone fractures heal spontaneously; the remainder (approximately 15-20 %)
do not heal appropriately, resulting in delayed union or nonunion of the bone
[
108
]. In the past, attempts have been made to apply marrow progenitor cells to
treat nonunion of the bone [
109
,
110
]. In this context, Hernigou et al. have injected
concentrated marrow into 60 noninfected atrophic nonunions of the tibia. Each
