Osteogenic potential of reamer irrigator aspirator (RIA) aspirate collected from patients undergoing hip arthroplasty

Authors

  • Ryan M. Porter,

    1. Center for Molecular Orthopedics, Harvard Medical School, 221 Longwood Avenue BLI-152, Boston, Massachusetts 02115
    2. Brigham and Women's Hospital, Boston, Massachusetts
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  • Fangjun Liu,

    1. Center for Molecular Orthopedics, Harvard Medical School, 221 Longwood Avenue BLI-152, Boston, Massachusetts 02115
    2. Brigham and Women's Hospital, Boston, Massachusetts
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  • Carmencita Pilapil,

    1. Center for Molecular Orthopedics, Harvard Medical School, 221 Longwood Avenue BLI-152, Boston, Massachusetts 02115
    2. Brigham and Women's Hospital, Boston, Massachusetts
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  • Oliver B. Betz,

    1. Center for Molecular Orthopedics, Harvard Medical School, 221 Longwood Avenue BLI-152, Boston, Massachusetts 02115
    2. Brigham and Women's Hospital, Boston, Massachusetts
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  • Mark S. Vrahas,

    1. Brigham and Women's Hospital, Boston, Massachusetts
    2. Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
    3. Massachusetts General Hospital, Boston, Massachusetts
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  • Mitchel B. Harris,

    1. Brigham and Women's Hospital, Boston, Massachusetts
    2. Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
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  • Christopher H. Evans

    Corresponding author
    1. Center for Molecular Orthopedics, Harvard Medical School, 221 Longwood Avenue BLI-152, Boston, Massachusetts 02115
    2. Brigham and Women's Hospital, Boston, Massachusetts
    3. Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
    • Center for Molecular Orthopedics, Harvard Medical School, 221 Longwood Avenue BLI-152, Boston, Massachusetts 02115. T: 617-732-8606; F: 617-730-2846.
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Abstract

Intramedullary nailing preceded by canal reaming is the current standard of treatment for long-bone fractures requiring stabilization. However, conventional reaming methods can elevate intramedullary temperature and pressure, potentially resulting in necrotic bone, systemic embolism, and pulmonary complications. To address this problem, a reamer irrigator aspirator (RIA) has been developed that combines irrigation and suction for reduced-pressure reaming with temperature modulation. Osseous particles aspirated by the RIA can be recovered by filtration for use as an autograft, but the flow-through is typically discarded. The purpose of this study was to assess whether this discarded filtrate has osteogenic properties that could be used to enhance the total repair potential of aspirate. RIA aspirate was collected from five patients (ages 71–78) undergoing hip hemiarthroplasty. Osseous particles were removed using an open-pore filter, and the resulting filtrate (230 ± 200 mL) was processed by Ficoll-gradient centrifugation to isolate mononuclear cells (6.2 ± 5.2 × 106 cells/mL). The aqueous supernatant contained FGF-2, IGF-I, and latent TGF-β1, but BMP-2 was below the limit of detection. The cell fraction included culture plastic-adherent, fibroblastic cells that displayed a surface marker profile indicative of mesenchymal stem cells and that could be induced along the osteogenic, adipogenic, and chondrogenic lineages in vitro. When compared to outgrowth cells from the culture of osseous particles, filtrate cells were more sensitive to seeding density during osteogenic culture but had similar capacity for chondrogenesis. These results suggest using RIA aspirate to develop improved, clinically expeditious, cost-effective technologies for accelerating the healing of bone and other musculoskeletal tissues. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:42–49, 2009

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