Clinical outcome and explant histology after using a cellular bone allograft in two-stage total hip arthroplasty

Abstract

Background Although use of cellular bone allografts (CBA) in orthopedic surgery has become increasingly common, little information is available regarding their short-term clinical performance. In these two case reports of two-stage hip arthroplasties, ViviGen Formable CBA (V-CBA) was used in stage one to fill voids left by previous metal implants. Methods The two patients had distinctly different health profiles, but each of them had previous metal implants due to a hip fracture. In the otherwise healthy 49-year-old male patient, the total hip arthroplasty (THA) was performed 7 weeks after nail removal and V-CBA backfill. In the 64-year-old female patient with Type 1 diabetes and severe osteoporosis, stage 2 was performed after 12 weeks. At the time of THA for each patient, bone containing some V-CBA was removed to accommodate the hip implant. The explants were histologically analyzed for bone matrix, mineralization, and neovascularization. Results Histological staining showed substantial new bone formation and neovascularization in both explants albeit at different levels of maturity. Conclusions Although limited, these results suggest that V-CBA may facilitate new bone formation in healthy as well as in metabolically challenged patients. Level of evidence V, case report

Factors influencing the outcomes of minimally invasive total hip arthroplasty: a systematic review

“…Half of studies were randomised, but, given the overall lack of blinding methods, the risk of detection bias was moderate-high. Furthermore, the different approaches for THA were not considered separately, nor were the different implant designs [ 64 – 81 ]. Given these limitations, data from the present study must be interpreted with caution.…”

Characterization of an advanced viable bone allograft with preserved native bone-forming cells

“…This would be advantageous for complex and high-risk cases, however, previous preclinical research demonstrates that lineagecommitted bone-forming cells are more suitable than the more conventional MSCs in promoting bone formation (Birmingham et al 2012;Ghanaati et al 2011;Tortelli et al 2010), and clinical evidence since its introduction supports the advantage of VBA in this regard. A recent study describing two patients who underwent two-stage total hip arthroplasty with VBA provided a unique opportunity to evaluate the graft histologically after clinical implantation (Shahrdar et al 2020). In one patient, over 100 µm of new bone had formed in and around the VBA bone components after only 7 weeks, suggesting that formation began shortly after implantation.…”

Treatment of Mandibular Non-union Using Patient Specific Crib Cage Plates and Cellular Bone Allograft: A Case Report

“…25 Shahrdar et al looked at bone formation after Vivigen use in hip arthroplasty and noted that Vivigen use led to rapid bone formation that exceeded the rate of usual new bone formation and did not elicit an immune response. 6…”

“…Autografts are the gold standard as they can provide all 3 aspects of bone formation-osteoconduction, osteoinduction and osteogenicity. 6 In contrast, bone allografts typically lose osteogenicity as they undergo decellularization processes, such as irradiation, sonication and chemical treatment to reduce its immunogenicity. 7,8 Cellular bone allograft (CBA), however, is a new alternative to traditional bone allograft in that it retains mesenchymal stem cells (MSC) which have the potential to differentiate into bone, cartilage or fat cells.…”