Marcacci - Stem Cells Associated with Macroporous Bioceramics for Long Bone Repair 6 to 7-Year Outcome of a Pilot Clinical Study MAURILIO MARCACCI

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Unformatted text preview: Stem Cells Associated with Macroporous Bioceramics for Long Bone Repair: 6- to 7-Year Outcome of a Pilot Clinical Study MAURILIO MARCACCI, M.D., 1 ELIZAVETA KON, M.D., 1 VLADIMIR MOUKHACHEV, M.D., 2 ANDREI LAVROUKOV, M.D., 2, { SERGEJ KUTEPOV, M.D., 3 RODOLFO QUARTO, M.D., 4,* MADDALENA MASTROGIACOMO, Ph.D., 4 and RANIERI CANCEDDA, M.D. 4 ABSTRACT Extensive bone loss is still a major problem in orthopedics. A number of different therapeutic approaches have been developed and proposed, but so far none have proven to be fully satisfactory. We used a new tissue engineering approach to treat four patients with large bone diaphysis defects and poor therapeutic alternatives. To obtain implantable three-dimensional (3D) living constructs, cells isolated from the pa- tients’ bone marrow stroma were expanded in culture and seeded onto porous hydroxyapatite (HA) ceramic scaffolds designed to match the bone deficit in terms of size and shape. During the surgical session, an Ilizarov apparatus or a monoaxial external fixator was positioned on the patient’s affected limb and the ceramic cylinder seeded with cells was placed in the bone defect. Patients were evaluated at different postsurgery time intervals by conventional radiographs and computed tomography (CT) scans. In one patient, an angiographic evaluation was performed at 6.5 years follow-up. In this study we analyze the long-term outcome of these patients following therapy. No major complications occurred in the early or late postoperative periods, nor were major complaints reported by the patients. No signs of pain, swelling, or infection were observed at the implantation site. Complete fusion between the implant and the host bone occurred 5 to 7 months after surgery. In all patients at the last follow-up (6 to 7 years postsurgery in patients 1 to 3), a good integration of the implants was maintained. No late fractures in the implant zone were observed. The present study shows the long-term durability of bone regeneration achieved by a bone engineering approach. We consider the obtained results very promising and propose the use of culture- expanded osteoprogenitor cells in conjunction with porous bioceramics as a real and significant im- provement in the repair of critical-sized long bone defects. INTRODUCTION E XTENSIVE BONE LOSS OR DESTRUCTION is still a major problem in orthopedics, due in large part to the lack of predictability in obtaining functional bone reconstruction. Present therapeutic approaches to repair large bone defects can be divided into two groups: excluding graft transplant (Ilizarov bone transport) or including graft transplant (auto- logous, homologous, or heterologous bone grafts using dif- ferent biomaterial implants)....
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This note was uploaded on 02/14/2011 for the course ORGANIC CH 341 taught by Professor Idk during the Spring '11 term at Wisconsin.

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Marcacci - Stem Cells Associated with Macroporous Bioceramics for Long Bone Repair 6 to 7-Year Outcome of a Pilot Clinical Study MAURILIO MARCACCI

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