Overcoming the Limitations of Allograft in Impaction Bone Grafting for Revision Arthroplasty

骨缺损的置换是一个主要的临床和社会经济需求，特别是在翻修关节成形术、脊柱和创伤手术领域。通常，缺乏足够的宿主（自身或自体）骨会阻碍自体骨的普遍使用，而使用供体（异体）骨会带来排斥和感染的风险。骨髓中含有干细胞（骨骼干细胞），这些干细胞可以被分离出来，并且可以很容易地扩增，同时保持它们形成各种组织的能力，如骨骼和脂肪。考虑到人口老龄化带来的人口挑战，利用骨祖细胞产生成骨谱系的潜力的策略的发展，为增加骨形成以取代或恢复创伤或退化骨的功能提供了一种令人信服的方法。我们提出了一个独特的方案来创建一个骨祖细胞和合成支架的活复合材料，以及一个新的创新工艺，将合成聚合物支架和细胞放置在髋关节腔中（一种振动冲击骨移植工艺），可以应用于需要新骨储存的骨科应用。我们将在这项工作中展示骨祖细胞与优化的合成支架和创新的振动嵌塞过程在嵌塞骨移植中增强骨形成的能力。为了证明我们的概念，我们将使用一种标准的临床矫形手术，称为股骨嵌塞移植术，其中需要一个新的假体来取代退化的髋关节植入物并需要骨库存。

The replacement of lost bone is a major clinical and socio-economic need, particularly in the fields of revision arthroplasty, spinal and trauma surgery. Often, a lack of sufficient host (own or autogenous) bone precludes the universal use of autogenous bone while the use of donor (allogeneic) bone carries risks of rejection and infection. Bone marrow contains stem cells (skeletal stem cells), which can be isolated and can be readily expanded, while retaining their ability to form a variety of tissues like bone and fat. Given the demographic challenge of an ageing population, the development of strategies to exploit the potential of bone progenitors which can give rise to cells of the osteogenic lineage, offers a compelling approach to augment bone formation to replace or restore the function of traumatised or degenerated bone. We propose a unique programme to create a living composite of bone progenitor cells and a synthetic scaffold together with a new innovative process for placing the synthetic polymer scaffold and cells in the hip cavity ( a process of vibration impaction bone grafting)that can be applied in orthopaedic applications requiring new bone stock. We will show in this work the ability of bone progenitor cells together with an optimised synthetic scaffold and an innovative vibration impaction process our ability to augment bone formation in impaction bone grafting. To prove our concept, we will use a standard clinical orthopaedic procedure called femoral impaction grafting wherein a new prosthesis is needed to replace a degenerated hip implant and needs bone stock.