title: Augmentation of bone growth onto the acetabular cup surface using bone marrow stromal cells in total hip replacement surgery.
abstract: Aseptic loosening of acetabular components in total hip arthroplasty is the major cause of implant failure. Our hypothesis was that spraying autologous bone marrow-derived stromal cells (BMSCs) in fibrin glue onto the surface of hydroxyapatite-coated uncemented acetabular components would increase bone formation and contact in a caprine model. Ten million BMSCs were sprayed onto the acetabular cup at the time of surgery. Animals in the control group received fibrin glue only. Ground reaction force measurements were taken preoperatively and at 6 and 12 weeks postsurgery. After retrieval at 12 weeks new bone formation, bone-implant contact and fibrous tissue thickness adjacent to the cup were quantified. Viability and proliferation assays showed that the majority of the BMSCs survived spraying in fibrin glue at pressures of up to 1.5 atm. New bone growth adjacent to the bone implant interface in the BMSC-treated group (71.42 +/- 8.97%) was 30% greater than in control (54.22 +/- 16.56%) although this difference was not statistically significant. However, significantly increased new bone formation was measured at the periphery of the cup (zone 5) in the BMSC-treated group (71.97 +/- 10.91%) when compared with control (23.85 +/- 15.13%, p = 0.028). Bone-implant contact was significantly greater in the BMSC-treated group (20.03 +/- 4.64%) (control: 13.71 +/- 8.32%, p = 0.027); correspondingly, the average thickness of the fibrous tissue membrane where present was significantly reduced at the periphery of the cups in the BMSC-treated group (327.49 +/- 20.38 mum) when compared with control (887.21 +/- 158.89 mum) (p = 0.02). This study has clinical applications as greater bone contact at the cup surface will improve fixation and may decrease longer-term aseptic loosening by preventing wear debris-induced bone loss at the implant interface.
authors.affiliation: Division of Surgery and Interventional Science, Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Middlesex, United Kingdom.
authors.forename: Priya
authors.initials: P
authors.lastname: Kalia
authors.forename: Melanie Jean
authors.initials: MJ
authors.lastname: Coathup
authors.forename: Samir
authors.initials: S
authors.lastname: Oussedik
authors.forename: Sujith
authors.initials: S
authors.lastname: Konan
authors.forename: Matthew
authors.initials: M
authors.lastname: Dodd
authors.forename: Fares S
authors.initials: FS
authors.lastname: Haddad
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Blunn
mesh_terms: D000077:Acetabulum / Q000187:drug effects / Q000601:surgery*; D000818:Animals; D019644:Arthroplasty, Replacement, Hip; D001696:Biomechanical Phenomena / Q000187:drug effects; D001846:Bone Development / Q000187:drug effects / Q000502:physiology*; D001854:Bone Marrow Cells / Q000166:cytology*; D049109:Cell Proliferation / Q000187:drug effects; D002470:Cell Survival / Q000187:drug effects; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D006041:Goats; D020007:Implants, Experimental; D011182:Postoperative Care; D011312:Pressure; D017154:Stromal Cells / Q000166:cytology / Q000187:drug effects / Q000378:metabolism / Q000637:transplantation*; D013499:Surface Properties / Q000187:drug effects
chemical_list: D015718:Fibrin Tissue Adhesive