title: Adult mesenchymal stem cells and impaction grafting: a new clinical paradigm shift.
abstract: The demographic challenges of an increasingly aging population emphasize the need for innovative approaches to skeletal reconstruction to augment and repair skeletal tissue lost as a consequence of implant loosening, trauma, degeneration or in situations involving revision surgery requiring bone stock. These clinical imperatives to augment skeletal tissue loss have brought mesenchymal stem cells to the fore in combination with the emerging discipline of tissue engineering. To date, impaction bone grafting for revision hip surgery is a recognized technique to reconstitute bone utilizing morselized allograft to provide a good mechanical scaffold, although with little osteoinductive biological potential. This review details laboratory and clinical examples of a paradigm shift in the application of mesenchymal stem cells with allograft to produce a living composite using the principles of tissue engineering. This step change creates a composite that offers a biological and mechanical advantage over the current gold standard of allograft alone. This translation of tissue engineering concepts into clinical practice offers enormous input into the field of bone regeneration and has implications for translation and future change in skeletal orthopedic practice in an increasingly aging population.
authors.affiliation: Trauma & Orthopaedics, Bone and Joint Research Group, Developmental Origins of Health and Disease, University of Southampton, General Hospital, Southampton, SO16 6YD, UK. bbolland@btopenworld.com
authors.forename: Benjamin J R F
authors.initials: BJ
authors.lastname: Bolland
authors.forename: Simon
authors.initials: S
authors.lastname: Tilley
authors.forename: Andrew M R
authors.initials: AM
authors.lastname: New
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Dunlop
authors.forename: Richard O C
authors.initials: RO
authors.lastname: Oreffo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001861:Bone Regeneration; D001862:Bone Resorption / Q000601:surgery; D018786:Bone Substitutes / Q000600:supply & distribution / Q000627:therapeutic use; D016025:Bone Transplantation; D006801:Humans; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D023822:Tissue Engineering / Q000379:methods*
chemical_list: D018786:Bone Substitutes