Supercharging allografts with mesenchymal stem cells in the operating room during hip revision.

PURPOSE: Bone marrow derived mesenchymal stem cells (BM-MSCs) have been proposed to improve allografts used during hip revision. However, no study has reported the number of MSCs that could be associated with the allograft and the best technique to load MSCs in allografts. The optimal loading technique should combine methods to increase the initial cell density and create an appropriate environment to accelerate the efficiency of the cell-allograft constructs into clinically applicable grafts. We designed a study to evaluate the number of MSCs in an autograft femoral head considered as the gold standard and to determine the best operating room procedure for loading in allograft with MSCs to approach the same number as in an autograft femoral head. Therefore this study explored a potential of charging whole femoral head allografts with autologous MSCs from iliac crest aspirate for hip revision procedures.

METHODS: First, the study evaluated the total number of mesenchymal stem cells (MSCs) in 1 cc of an average autograft femoral head; this number then serves as a target for loading allografts, in order to achieve the same density of MSCs. For the loading technique itself, several questions were asked and hence several options were investigated. For example, is it better to load the whole allograft or break it up into several fragments? Which way of injecting works best for the whole femoral head allograft (through cartilage or femoral neck)? How concentrated (in terms of MSCs) should the injected iliac crest marrow be? Bone marrow for injection in allografts was obtained from residual marrow from patients undergoing surgical procedures with concentrated bone marrow. With this bone marrow (with and without concentration) we tested different techniques (injection and soaking) to load stem cells in allografts of different sizes: bulk allografts, pieces or blocks (8 or 1 cm(3) blocks) and morselized fragments (from 125 to 8 mm(3)) or particules (1 mm(3)). We also evaluated the release of MSCs from fragments of autografts and allografts loaded with MSCs in cultured medium.

RESULTS: The femoral head autografts contained a lower concentration of MSCs than the iliac crests of the same patient. However, in absence of concentration, with bone marrow aspirated from the iliac crest, we were not able to load in the femoral head allograft the same number of MSCs as the number present in an autograft. The loaded volume of bone marrow (and the corresponding number of MSCs) depended on the technique (injecting, soaking) as well as on the volume and shape of the allografts. The seeding efficiency of loading MSCs in allografts increased with the concentration of MSCs in the bone marrow. With concentrated bone marrow, supercharging the allograft with MSCs (as compared with an autograft) was possible in the operating room, and the number of MSCs supercharged in allografts was predictable.

CONCLUSIONS: The loaded volume of bone marrow depended on the technique (injecting, soaking) as well as on the volume and shape of the allografts. With concentrated bone marrow, the allograft could be charged with a similar or higher number of MSCs than the number present in a femoral head autograft.