The purpose of this study was to evaluate concentrated autologous bone marrow aspirate transplantation (CABMAT) treatment for corticosteroid-induced osteonecrosis of the femoral head (ONFH) in systemic lupus erythematosus (SLE). Bone marrow was aspirated from iliac crests, concentrated on a conventional manual blood bag centrifugation technique that is used to extract buffy coats and then injected into nine hips with drilling. The mean number of nucleated cells for transplantation was 5.32 × 10⁷ cells/ml. This cell concentration was significantly higher after concentration, and the mean concentration ratio was 5.5. At follow-up (minimum: three years), significant improvement in pain and Harris Hip Score was observed. For eight of nine hips, we successfully preserved the femoral head. However, one hip required total hip arthroplasty 45 months after the operation. CABMAT using our centrifugation technique is an effective, safe and low-cost procedure of therapeutic osteogenesis for corticosteroid-induced ONFH in SLE.

Our objective was to examine the technique of regenerating cartilage tissue from bone marrow‐derived cells by three‐dimensional (3D) culture using the rotating wall vessel (RWV) bioreactor. Three‐dimensional and cylindrical aggregates of allogeneic cartilage with dimensions of 10 × 5 mm (height × diameter) formed by the RWV bioreactor were transplanted into osteochondral defects of Japanese white rabbits (Group T, n = 15). For the control, some osteochondral defects were left empty (Group C, n = 18). At 4, 8, and 12 weeks postimplantation, the reparative tissues were evaluated macroscopically, histologically, and biochemically. In Group T at as early as 4 weeks, histological observation, especially via safranin‐O staining, suggested that the reparative tissues resembled hyaline cartilage. And we observed no fibrous tissues between reparative tissue and adjacent normal tissues. In the deeper portion of the bony compartment, the osseous tissues were well remodeled. At 4 and 8 weeks postimplantation, the mean histological score of Group T was significantly better than that of Group C (p < 0.05). The glycosaminoglycans (GAG)/DNA ratio in both groups increased gradually from 4 to 8 weeks and then decreased from 8 to 12 weeks. We herein report the first successful regeneration of cartilage in osteochondral defects in vivo using allogeneic cartilaginous aggregates derived from bone marrow‐derived cells by 3D culture using the RWV bioreactor. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1291–1298, 2007

The method of constructing cartilage tissue from bone marrow‐derived cells in vitro is considered a valuable technique for hyaline cartilage regenerative medicine. Using a rotating wall vessel (RWV) bioreactor developed in a NASA space experiment, we attempted to efficiently construct hyaline cartilage tissue from human bone marrow‐derived cells without using a scaffold. Bone marrow aspirates were obtained from the iliac crest of nine patients during orthopedic operation. After their proliferation in monolayer culture, the adherent cells were cultured in the RWV bioreactor with chondrogenic medium for 2 weeks. Cells from the same source were cultured in pellet culture as controls. Histological and immunohistological evaluations (collagen type I and II) and quantification of glycosaminoglycan were performed on formed tissues and compared. The engineered constructs obtained using the RWV bioreactor showed strong features of hyaline cartilage in terms of their morphology as determined by histological and immunohistological evaluations. The glycosaminoglycan contents per µg DNA of the tissues were 10.01 ± 3.49 µg/µg DNA in the case of the RWV bioreactor and 6.27 ± 3.41 µg/µg DNA in the case of the pellet culture, and their difference was significant. The RWV bioreactor could provide an excellent environment for three‐dimensional cartilage tissue architecture that can promote the chondrogenic differentiation of adult human bone marrow‐derived cells. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 517–521, 2009

Background: Uncemented fixation of components in joint arthroplasty is achieved primarily through de novo bone formation at the bone-implant interface and establishment of a biological and mechanical interlock. In order to enhance bone-implant integration osteoconductive coatings and the methods of application thereof are continuously being developed and applied to highly porous and roughened implant substrates. In this study the effects of an electrochemically-deposited dicalcium phosphate dihydrate (DCPD) coating of a porous substrate on implant osseointegration was assessed using a standard uncemented implant fixation model in sheep. Methods: Plasma sprayed titanium implants with and without a DCPD coating were inserted into defects drilled into the cancellous and cortical sites of the femur and tibia. Cancellous implants were inserted in a press-fit scenario whilst cortical implants were inserted in a line-to-line fit. Specimens were retrieved at 1, 2, 4, 8 and 12 weeks postoperatively. Interfacial shear-strength of the cortical sites was assessed using a push-out test, whilst bone ingrowth, ongrowth and remodelling were investigated using histologic and histomorphometric endpoints. Results: DCPD coating significantly improved cancellous bone ingrowth at 4 weeks but had no significant effect on mechanical stability in cortical bone up to 12 weeks postoperatively. Whilst a significant reduction in cancellous bone ongrowth was observed from 4 to 12 weeks for the DCPD coating, no other statistically significant differences in ongrowth or ingrowth in either the cancellous or cortical sites were observed between TiPS and DCPD groups. Conclusion: The application of a DCPD coating to porous titanium substrates may improve the extent of cancellous bone ingrowth in the early postoperative phase following uncemented arthroplasty.

Primary stability of the femoral stem is important for the long-term results of cementless total hip arthroplasty. Cementless collared stems have been known to have higher stability than collarless stems when there is a contact between the collar and the calcar. The purpose of this study was to compare the stabilities of collared stem and collarless stem in 2 loading conditions: 1) flat walking and 2) stair climbing. We constructed 3 finite element models. In the first model, the collar had contact with the calcar. The second model had a 1 mm gap between the calcar and the collar. The third model was constructed with a collarless stem. The proximal femur around the stem was divided into 3 zones: the upper zone (Gruen zones 1 and 7), the middle zone (Gruen zones 2 and 6), and the lower zone (Gruen zones 3 and 5). The micromotion at the stem/bone interface was measured at each zone of the 3 models under the 2 loading conditions. The results showed that collared stems were more stable when the collar was in contact with the calcar than when a gap was left between the collar and the calcar. In particular, collar contact was highly effective in suppressing the micromotion proximal to the stem. Compared to the collarless stem, the collared stem had comparable stability when there was a gap at the collar and calcar interface and higher stability when there was contact between the collar and the calcar.