Abstract

Orthoregeneration is defined as a solution for orthopedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include: drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electro-magnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the hip, including osteonecrosis (aseptic necrosis) involving bone marrow, bone, and cartilage, and chondral injuries involving articular cartilage, synovium, and bone marrow. Promising and established treatment modalities for osteonecrosis include non-weight bearing; pharmacological treatments including low molecular-weight heparin, prostacyclin, statins, bisphophonates, and denosumab, a receptor activator of nuclear factor-kB ligand (RANKL) inhibitor; extracorporeal shock wave therapy; pulsed electromagnetic fields; core decompression surgery; cellular therapies including bone marrow aspirate (BMA) comprising mesenchymal stromal cells (MSCs aka mesenchymal stem cells) and bone marrow autologous concentrate (BMAC), with or without expanded or cultured cells, and possible addition of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF); and arterial perfusion of MSCs which may be combined with addition of carriers or scaffolds including autologous MSCs cultured with beta-tricalcium phosphate (b-TCP) ceramics associated with a free vascularized fibula. Promising and established treatment modalities for chondral lesions include autologous platelet-rich plasma (PRP); hyaluronic acid (HA); MSCs (in expanded or non-expanded form) derived from bone marrow or other sources such as fat, placenta, umbilical cord blood, synovial membrane, and cartilage; microfrature or microfracture augmented with membrane containing MSCs, collagen, HA, or synthetic polymer; mosaicpasty; one-stage autologous cartilage translation (ACT) or two-stage ACT using three-dimensional spheroids; and autologous cartilage grafting; chondral flap repair, or flap fixation with fibrin glue. Hip pain is catastrophic in young patients, and promising therapies offer an alternative to premature arthroplasty. This may address both physical and psychological components of pain the goal is to avoid or postpone an artificial joint. LEVEL OF EVIDENCE: Level V, expert opinion. Hip Orthoregeneration for Osteonecrosis and Chondral Defects.

View details for DOI 10.1016/j.arthro.2021.08.032

View details for PubMedID 34506886