Can We Improve Fusion Rates With Bone Marrow Aspirate?

Start Page: 68
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Author(s): 
Lindsay Mae Chandler, DPM, and Bob Baravarian, DPM, FACFAS

   The marrow is concentrated via removal of erythrocytes and plasma from the aspirate. One would directly inject the concentrated bone marrow aspirate into the joint being fused. Usually, this occurs along with subchondral drilling to augment the healing and rate of fusion. Patients are required to be non-weightbearing in a cast for at least eight weeks.

   While there is literature on the use of bone marrow aspirate in spinal fusion, there are currently no published studies on the fusion rate in foot and ankle surgery with bone marrow aspirate. Incidentally, we have found that patients who receive the BMA in conjunction with their fusion generally have shown radiographic signs of fusion at their arthrodesis site approximately two weeks earlier than control patients.

In Conclusion

Bone-marrow-derived mesenchymal stem cells may provide an emerging option for improving fusion rates in foot and ankle arthrodesis procedures. Mesenchymal stem cells make up 2 to 3 percent of the total mononuclear cells in bone marrow. They have the capacity to differentiate into various cell types, including osteoblasts and chondrocytes. Mechanical stimulation, present growth factors and the new environment can all influence the direction in which the stem cells differentiate. These cells regenerate tissue and support angiogenesis.

   Further studies are needed to determine if the role of bone marrow aspiration in foot and ankle surgery is effective over a broader range of patients, and if it augments or speeds up the healing of arthrodesis procedures and/or nonunion/ delayed unions.

   Dr. Chandler is a Fellow at the University Foot and Ankle Institute in Los Angeles.

   Dr. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and is the Director of the University Foot and Ankle Institute in Los Angeles.

References
1. Goujon E. Recherches experimentales sur les proprietes physiologiques de la moelle des os. J Anat Physiol. 1869;6:399-412.
2. Connolly J, Guse R, Lippiello L, Dehne R. Development of an osteogenic bonemarrow preparation. J Bone Joint Surg Am. 1989;71(5):684-91.
3. Hernigou P, Poignard A, Beaujean F, Rouard H. Percutaneous autologous bone-marrow grafting for nonunions influence of the number and concentration of progenitor cells. J Bone Joint Surg Am. 2005;87-A:1430-1437.
4. Tiedeman J, Garvin K, Kile T, Connolly J. The role of a composite, demineralized bone matrix and bone marrow in the treatment of osseous defects. Orthopedics. 1995;18(12):1153-1158.
5. Muschler G, Boehm C, Easley K. Aspiration to obtain osteoblast progenitor cells form human bone marrow: the influence of aspiration volume. J Bone Joint Surg Am. 1997;79(11):1699-1709.

Additional References
6. Jia X, Peters P, Schon L. The use of plateletrich plasma in management of foot and ankle conditions. Oper Tech Sports Med. 2011;19:177-184.
7. Fitzgibbons T, Hawks M, McMullens S, Inda D. Bone grafting in surgery about the foot and ankle: indications and techniques. J Am Academy Orthop Surgeons. 2011;19(2): 112-120.

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