Recent advances in gene therapy, stem cells and other promising applications are offering new hope for patients and helping orthopaedic surgeons provide state-of-the-art treatment for various frame-related conditions. During a briefing today at the American Academy of Orthopaedic Surgeons' (AAOS) 73rd Annual Meeting, a panel of orthopaedic surgeons and members of the Orthopaedic Research Society (ORS) discussed how these investigational applications may someday treat a variety of bone, joint and muscle-related conditions more readily than many physicians ever imagined possible.
Among the most encouraging techniques is a novel form of adult stem cell therapy for broken bones. Stem cell therapy is performed in lieu of the classic "autograft" technique, used on patients with fractures that are not healing properly. It is not uncommon for bones that are severely injured to heal slowly. Common causes of injury can range from a simple fall to high- energy injuries like car accidents or gunshot wounds. Many patients in these situations undergo multiple reconstructive operations that often require a bone graft, or autograft. Autografts require an incision over the pelvis area to remove some of the patient's own pelvic bone, which is then transferred to the site of the fracture. Such an incision can be quite painful and may be complicated by infection, nerve damage, chronic pain and an unsightly scar. Stem cells offer an effective and less painful alternative to treat simple and complex fractures, particularly those that require additional time to fully heal.
Matthew L. Jimenez, MD, an orthopaedic surgeon at Illinois Bone and Joint Institute, Morton Grove, Ill., is experimenting with adult stem cells to potentially accelerate bone healing and avoid causing patients further discomfort from the self-donation process. Enriching donated bone with a patient's own stem cells, Dr. Jimenez replaces the damaged bone with the stem cell-rich bone. These new cells have the ability to replace the injured portions with new bone.
"The beauty of these adult stem cells is that they can turn into almost any kind of cell, including bone cells and vascular cells," said Dr. Jimenez, one of only a handful of surgeons in the world performing the investigational surgery. "The surgeries we've conducted thus far have had promising results, and to-date, the patients are doing well."
Dr. Jimenez still considers autografts the "gold standard" for bone injuries, but said stem cell therapy -- with continued research -- shows great promise to speed the healing process and avoid the need for additional operations.
Gene therapy is another cutting-edge technique with the potential to mend damaged bones and tissues while sparing patients from undergoing multiple surgeries. Regis J. O'Keefe, MD, PhD, professor of orthopaedics and director of the Center for Musculoskeletal Research at the University of Rochester (NY) Medical Center and treasurer of the ORS, said his laboratory works on methods to introduce genes into bone-forming to improve the cells' function and increase bone formation.
One of the concerns with replacing injured bone with donated bone is that the structural donor bone grafts remain dead, and will fracture in up to 30-40 percent of the cases, Dr. O'Keefe explained. But by placing genes with the ability to induce bone formation onto the surface of a dead bone, the genes provide signals to tissues surrounding the bone and bring it back to life. The resurrected bone is then able to grow and thrive. ...
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