Orthobiologics

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ArthroCell es un aloinjerto óseo celular viable que contiene componentes celulares, de andamiaje y de gel derivados de hueso humano. El andamiaje está compuesto por una mezcla patentada de hueso cortical microparticulado, hueso esponjoso y hueso para aloinjerto cortical desmineralizado. El componente de gel derivado de hueso es hidrófobo, resiste la irrigación y permite modelar el aloinjerto óseo ArthroCell para una manipulación óptima. El componente celular consiste en células madre mesenquimales, células osteoprogenitoras y una población celular que incluye células inducibles de multilinaje adultas aisladas de médula ósea (MIAMI, en inglés).

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Human

ArthroCell™ and ArthroCell Plus™ Allografts - Viable Bone Matrices

Spine

ArthroCell™ bone allograft is a non‐immunogenic viable cellular bone allograft intended for use as bone void filler for a variety of bone defects, fusions, and nonunion orthopedic applications. It is cryopreserved for storage up to 2 years at −65°C.

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ArthroCell™ Viable Cellular Bone Allograft

Arthrocell is a viable, moldable cellular allograft that is intended for use as a safe and non-immunogenic cellular bone matrix for bone repair. Arthrocell provides the three key elements necessary for bone healing osteogenic cells, and an osteoconductive scaffold with osteoinductive potential. The osteogenic components of ArthroCell include viable mesenchymal stem cells, osteoprogenitor cells, and a subpopulation that includes marrow isolated adult multilineage inducible, or Miami cells. Arthrocell also contains a blend of micro particulate bone, including a demineralized cortical and cancellous matrix that serves as an osteoconductive scaffold. Osteoinductive growth factors from the scaffold and the defect environment send signals to initiate osteogenic activity that supplements the patient's innate healing processes. Arthrocell provides the three key elements necessary for bone healing osteogenic cells, and an osteoconductive scaffold with osteoinductive potential. Arthrocell is a viable, moldable cellular allograft that is an alternative to autograft, and is intended for use in bone remodeling and repair of bony defects, fusions, and nonunion orthopedic applications.

Thomas Temple, MD, (Miami, FL) and Christopher Adams, MD, (Arthrex® VP of Global Medical Education) discuss ArthroCell™ cellular bone graft and its uses in orthopedic applications.

ArthroCell™ Cellular Bone Grafts

Foot and Ankle

Nicholas W. Todd, DPM (Mountain View, CA), discusses a revision case for a failed 1st metatarsal phalangeal joint implant in which he used a cannulated revision bone dowel, ArthroCell™ viable bone matrix, and the MaxForce™ MTP fusion plate.

1st MTP Revision Using a Cannulated Revision Bone Dowel and Augmented With ArthroCell™ Viable Bone Matrix

Hi, my name is Nicholas Todd. I'm out of the Palo Alto Medical Foundation, and I'm going to be talking about revision of first Metatarsophalangeal joint implants. We've started to see in our practice multiple different implants used for the first Metatarsophalangeal joint. Unfortunately, we've seen many different failures. Our group did a study on hydrogel implants, and what we looked at was the survivability radiographically with hydrogel implants. Unfortunately, at six months, we saw 100% subsidence. Not only was there subsidence, but there was pain associated with the subsidence. This led to many different failures and led to revision surgery. Unfortunately, the surgery is not simple because of the large bone deficits. In these pictures, you can see the large bone deficits seen with taking out a hydrogel implant. With this large deficit, you will need structural support. Without any type of structural support, this patient will have a very poor outcome. Unfortunately, there is a high nonunion rate with large bone grafts with revision first Metatarsophalangeal joint implants. There are many different ways in doing a first metatarsophalangeal joint fusion. The first metatarsophalangeal joint fusion has been around for numerous different years. Today I'm going to present a present a novel approach in treating these very complicated pathologies. This is a 64 year old female with diabetes, rheumatoid arthritis, hypertension, and a BMI of 32. She had chronic pain from previous foot surgery. As you can see, she had an implant that had been failing and IPG fusion and multiple lesser digital surgeries. We decided to take her to surgery because of the chronic pain and swelling of her first metatarsophalangeal joint. As you can see here, it's a double stemmed implant with chronic synovitis and inflammatory tissue surrounding the implant. The first stage is removal of the implant. Inspection of the soft tissue and bony deficit. We ensure that there is no infection. We do a thorough irrigation, and we let down the tourniquet to ensure that there's good, proper bleeding because of the large segmental deficit. We needed some type of bony interface to be placed in this deficit. We decided to use the large bone dowel. The large bone dowel is highly packed cancellous bone that gives us structural support. The cannulation of this implant is beneficial because it allows proper fixation of the graft within the large deficit site. It also gives me structural support to put hardware across this interface, which other implants do not. To augment my fusion, I used ArthroCell, which is a viable cellular graft. I tend to use ArthroCell on my very complicated fusion patients, especially who have multiple comorbidities. I use approximately five cc's of ArthroCell packed around the bone dowel to promote my fusion. The intraoperative images on the left show a large bony deficit within the phalanx as well as the metatarsal. These I packed with ArthroCell. On the right hand side you can see the bone dowel. I correctly fastened the bone dowel to fit within this large deficit. You do not want to overstretch the first metatarsophalangeal joint, so it's important to do this with the tourniquet down to ensure that you have good vascularity throughout your entire surgical case. The intraoperative image on the left shows the cannulated technique for the bone dowel. This allowed me to place the toe in the correct position. It also shows that we had good vascularity to all the digits, especially of the great toe. The intraoperative image on the right shows the revision MaxForce plate. The MaxForce plate gives me enough stability that I feel that will allow the patient to ambulate at an earlier time frame. I also choose to use the KreuLock screws, because these screws not only get the plate down to the bone, but actually lock the plate in place to ensure further stability. These are the final fluoroscopic images of the day. As you can see that on the AP examination, you have excellent compression and alignment through the first metatarsophalangeal joint. On the lateral radiograph, you can see that there is a screw that goes through the bone dowel with revision cases. Before, I was not able to achieve any type of fixation. Her postoperative regimen included a posterior splint for ten days, her sutures removed at ten days as well, and she was non-weight bearing for six weeks. She was back into regular shoes at two months. As you can see, these are her final postoperative images, and she had consolidated nicely across the fusion site. I felt very comfortable walking this patient at six weeks because of the rigidity of the construct and the augmentation of biologics. We are starting to see more and more failures of first metatarsophalangeal joint implants with these new options that I've shown you. I feel much more comfortable addressing these difficult pathologies. The MaxForce plate, the KreuLock screws, and biologics give my patients the best clinical outcome for these very difficult pathologies. Thank you.

Barth B. Riedel, MD (Loma Linda, CA), presents his treatment of nonunion distal radius fractures using Arthrex distal radius plates, augmented with ArthroCell™ viable cellular bone graft.

Distal Radius Malunions and Nonunions Augmented With ArthoCell™ Viable Cellular Bone Graft

I'm Barth Riddell from Loma Linda University Medical Center, here to talk about a case series of distal radius, bowel unions and non-unions augmented with ArthroCell bone graft. The first is a 50 year old male who presented with a distal radius malunion. As you can see, he's in about 30 to 35 degrees of dorsal angulation, which caused a loss of range of motion, specifically with flexion. He was taken to the operating room where a formal volar approach of Henry was performed. Drill holes were made across the distal radius, and then an acetone was in place parallel to the articular surface, which then created our osteotomy. Arthrex distal radius plate was then placed and a good reduction was performed. As you can see in the image on the right, this leaves a gap on the dorsal side of the distal radius, which then ArthroCell bone graft was then used to fill and the patient went on to union. As a final construct can be seen here another malunion case, but actually more severe. This patient came in with a 60 degree dorsal malunion and a severe loss of motion. Again, specifically with flexion as the angle of the malunion mountain precludes again the approach of Henry's performed in a similar technique. An osteotomy is then used to recreate an osteotomy site, and then used to manipulate the distal radius to what can be seen as a more anatomic position. This, however, leaves a very large hole on the dorsal side of the distal radius. Rather than hold the reduction anatomically, a distal radius plate was then placed, fixating the distal row of screws first. The plate can then be used as a lever arm to reduce the distal radius malunion site more anatomically. Again, shaft screws are used to hold down the fracture site and then ArthroCell. Bone graft was then used to fill the void in the back of the wrist. This patient went on to union in three months. Sometimes patients with nonunions present with diaphyseal metaphyseal nonunions, which create a segmental loss. What we have found to offset the stress riser this creates on the distal radius plate is to use an allograft bone wedge along the radial column, and then apply ArthroCell bone graft on the ulnar side. This both increases rigidity and allows the stem cells to help with the healing. Thank you.

Aloinjerto óseo viable

ArthroCell™ - Aloinjerto óseo