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2. Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes–Patient Operative Delays (ORTHOPOD) study

Author

Stevenson, Iain, Yoong, Andrel, Rankin, Iain, Dixon, James, Lim, Jun Wei, Sattar, Mariam, McDonald, Stephen, Scott, Sharon, Davies, Helen, Jones, Louise, Nolan, Michelle, McGinty, Rebecca, Stevenson, Helene, Bowe, David, Sim, Francis, Vun, James, Strain, Ritchie, Giannoudis, Vasileios, Talbot, Christopher, Gunn, Christopher, Le, Ha Phuong Do, Bradley, Matthew, Lloyd, William, Hanratty, Brian, Lim, Yizhe, Brookes-Fazakerley, Steven, Varasteh, Amir, Francis, Jonathan, Choudhry, Nameer, Malik, Sheraz, Vats, Amit, Evans, Ashish, Garner, Madeleine, King, Stratton, Zbaeda, Mohamed, Diamond, Owen, Baker, Gavin, Napier, Richard, Guy, Stephen, McCauley, Gordon, King, Samuel, Edwards, Gray, Lin, Benjamin, Davoudi, Kaveh, Haines, Samuel, Raghuvanshi, Manav, Buddhdev, Pranai, Karam, Edward, Nimmyel, Enoch, Ekanem, George, Lateef, Razaq, Jayadeep, JS, Crowther, Ian, Mazur, Karolina, Hafiz, Nauman, Khan, Umair, Chettiar, Krissen, Ibrahim, Amr, Gopal, Prasanth, Tse, Shannon, Lakshmipathy, Raj, Towse, Claudia, Al-Musawi, Hashim, Walmsley, Matthew, Aspinall, Will, Metcalfe, James, Moosa, Aliabbas, Crome, George, Abdelmonem, Mohamed, Lakpriya, Sathya, Hawkins, Amanda, Waugh, Dominic, Kennedy, Matthew, Elsagheir, Mohamed, Kieffer, Will, Oyekan, Adekinte, Collis, Justin, Raad, Marjan, Raut, Pramin, Baker, Markus, Gorvett, Alexander, Gleeson, Hannah, Fahmy, John, Walters, Sam, Tinning, Craig, Chaturvedi, Abhishek, Russell, Heather, Alsawada, Osama, Sinnerton, Robert, Crane, Evan, Warwick, Catherine, Dimascio, Lucia, Ha, Taegyeong Tina, King, Thomas, Engelke, Daniel, Chan, Matthew, Gopireddy, Rajesh, Deo, Sunny, Vasarhelyi, Ferenc, Jhaj, Jasmeet, Dogramatzis, Kostas, McCartney, Sarah, Ardolino, Toni, Fraig, Hossam, Hiller-Smith, Ryan, Haughton, Benjamin, Greenwood, Heather, Stephenson, Nicola, Chong, Yuki, Sleat, Graham, Saedi, Farid, Gouda, Joe, Ravi, Sanjeev Musuvathy, Henari, Shwan, Imam, Sam, Howell, Charles, Theobald, Emma, Wright, Jan, Cormack, Jonathan, Borja, Karlou, Wood, Sandy, Khatri, Amulya, Bretherton, Chris, Tunstall, Charlotte, Lowery, Kathryn, Holmes, Benjamin, Nichols, Jennifer, Bashabayev, Beibit, Wildin, Clare, Sofat, Rajesh, Thiagarajan, Aarthi, Abdelghafour, Karim, Nicholl, James, Abdulhameed, Ahmed, Duke, Kathryn, Maling, Lucy, McCann, Matthew, Masud, Saqib, Marshman, James, Moreau, Joshua, Cheema, Kanwalnaini, Rageeb, Peter Morad, Mirza, Yusuf, Kelly, Andrew, Hassan, Abdul, Christie, Alexander, Davies, Angharad, Tang, Cary, Frostick, Rhiannon, Pemmaraju, Gopalakrishna, Handford, Charles, Chauhan, Govind, Dong, Huan, Choudri, Mohammed Junaid, Loveday, David, Bawa, Akshdeep, Baldwick, Cheryl, Roberton, Andrew, Burden, Eleanor, Nagi, Sameer, Johnson-Lynn, Sarah, Guiot, Luke, Kostusiak, Milosz, Appleyard, Thomas, Mundy, Gary, Basha, Amr, Abdeen, Bashar, Robertson-Smith, Bill, Hussainy, Haydar Al, Reed, Mike, Jamalfar, Aral, Flintoft, Emily, McGovern, Julia, Alcock, Liam, Koziara, Michal, Ollivere, Benjamin, Zheng, Amy, Atia, Fady, Goff, Thomas, Slade, Henry, Teoh, Kar, Shah, Nikhil, Al-Obaedi, Ossama, Jamal, Bilal, Bell, Stuart, Macey, Alistair, Brown, Cameron, Simpson, Cameron, Alho, Roberto, Wilson, Victoria, Lewis, Charlotte, Blyth, Daniel, Chapman, Laura, Woods, Lisa, Katmeh, Rateb, Pasapula, Chandra, Youssef, Hesham, Tan, Jerry, Famure, Steven, Grazette, Andrew, Lloyd, Adam, Beaven, Alastair, Jackowski, Anna, Piper, Dani, Lotfi, Naeil, Chakravarthy, Jagannath, Elzawahry, Ahmed, Trew, Christopher, Neo, Chryssa, Elamin-Ahmed, Hussam, Ashwood, Neil, Wembridge, Kevin, Eyre-Brook, Alistair, Greaves, Amy, Watts, Anna, Stedman, Tobias, Ker, Andrew, Wong, Li Siang, Fullarton, Mairi, Phelan, Sean, Choudry, Qaisar, Qureshi, Alham, Moulton, Lawrence, Cadwallader, Craig, Jenvey, Cara, Aqeel, Aqeel, Francis, Daniel, Simpson, Robin, Phillips, Jon, Matthews, Edward, Thomas, Ellen, Williams, Mark, Jones, Robin, White, Tim, Ketchen, Debbie, Bell, Katrina, Swain, Keri, Chitre, Amol, Lum, Joann, Syam, Kevin, Dupley, Leanne, O'Brien, Sarah, Ford, David, Chapman, Taya, Zahra, Wajiha, Guryel, Enis, McLean, Elizabeth, Dhaliwal, Kawaljit, Regan, Nora, Berstock, James, Deano, Krisna, Donovan, Richard, Blythe, Andrew, Salmon, Jennifer, Craig, Julie, Hickland, Patrick, Matthews, Scott, Brown, William, Borland, Steven, Aminat, Akinsemoyin, Stamp, Gregory, Zaheen, Humayoon, Jaibaji, Monketh, Egglestone, Anthony, Sampalli, Sridhar Rao, Goodier, Henry, Gibb, Julia, Islam, Saad, Ranaboldo, Tom, Theivendran, Kanthan, Bond, Georgina, Richards, Joanna, Sanghera, Ranjodh, Robinson, Karen, Fong, Angus, Tsang, Bonita, Dalgleish, James, McGregor-Riley, Jonathan, Barkley, Sarah, Eardley, William, Elhassan, Almutasim, Tyas, Ben, Chandler, Henry, McVie, James, Wei, Nicholas, Negus, Oliver, Baldock, Thomas, Ravi, Kuppuswamy, Qazzaz, Layth, Mohamed, Muawia, Sivayoganthan, Sriharan, Poole, William, Slade, George, Beaumont, Hugo, Beaumont, Oliver, Taha, Rowa, Lever, Caroline, Sood, Abhay, Moss, Maximillian, Khatir, Mohammed, Trompeter, Alex, Jeffers, Aisha, Brookes, Charlotte, Dadabhoy, Maria, Bhattacharya, Rajarshi, Singh, Abhinav, Beer, Alexander, Hodgson, Harry, Rahman, Kashed, Barter, Reece, Mackinnon, Thomas, Frasquet-Garcia, Antonio, Aldarragi, Ameer, Warner, Christian, Pantelides, Christopher, Attwood, Joseph, Al-Uzri, Muntadhir, Qaoud, Qaiys Abu, Green, Stephen, Osborne, Alex, Griffiths, Alexandra, Emmerson, Benjamin, Slater, Duncan, Altahoo, Hasan, Scott, Helen, Rowland, David, O'Donnell, Janine, Edwards, Taff, Hafez, Ahmed, Khan, Basharat, Crane, Emily, Axenciuc, Rostislav, Al-Habsi, Ruqaiya, McAlinden, Gavan, Sterne, Jonathan, Wong, Matthew Lynch, Patil, Sunit, Ridha, Ali, Rasidovic, Damir, Searle, Henry, Choudhry, Jamaal, Farhan-Alanie, Muhamed M, Tanagho, Andy, Sharma, Sidharth, Thomas, Suresh, Smith, Ben, McMullan, Mark, Winstanley, Robert, Mirza, Saqeb, Hamlin, Katharine, Elgayar, Lugman, Larsen, Matthew P, Eissa, Mohamed, Stevens, Samuel, Hopper, Graeme P, Fang Soh, Terrence Chi, Doorgakant, Ashtin, Yogeswaran, Apimaan, Myatt, Darren, Mahon, Joseph, Ward, Nicholas, Reid, Susan, Deierl, Krisztian, Brogan, Declan, Little, Max, Deakin, Sue, Baines, Elliott, Jones, Georgie, Boulton, Helen, Douglas, Trixie, Jeyaseelan, Lucky, Abdale, Abdirizak, Islam, Aminul, Atkinson, Kate V, Mohamedfaris, Khalid, Mmerem, Kingsley, Jamal, Shazil, Wharton, Danielle, Rana, Anurag, McAllister, Ross, Sasi, Sijith, Thomas, Terin, Pillai, Anand, Flaherty, David, Khan, Munir, Akkena, Sudheer, Shandala, Yaseen, Lankester, Benedict, Hainsworth, Louis, Ahmed, Hussam Elamin, Walshaw, Thomas, Walker, Reece, and Eardley, William G.P.

Published
2023
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3. ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom

Author

Stevenson, Iain, Yoong, Andrel, Rankin, Iain, Dixon, James, Lim, Jun Wei, Sattar, Mariam, McDonald, Stephen, Scott, Sharon, Davies, Helen, Jones, Louise, Nolan, Michelle, McGinty, Rebecca, Stevenson, Helene, Bowe, David, Sim, Francis, Vun, James, Strain, Ritchie, Giannoudis, Vasileios, Talbot, Christopher, Gunn, Christopher, Le, Ha Phuong Do, Bradley, Matthew, Lloyd, William, Hanratty, Brian, Lim, Yizhe, Brookes-Fazakerley, Steven, Varasteh, Amir, Francis, Jonathan, Choudhry, Nameer, Malik, Sheraz, Vats, Amit, Evans, Ashish, Garner, Madeleine, King, Stratton, Zbaeda, Mohamed, Diamond, Owen, Baker, Gavin, Napier, Richard, Guy, Stephen, McCauley, Gordon, King, Samuel, Edwards, Gray, Lin, Benjamin, Davoudi, Kaveh, Haines, Samuel, Raghuvanshi, Manav, Buddhdev, Pranai, Karam, Edward, Nimmyel, Enoch, Ekanem, George, Lateef, Razaq, Jayadeep, JS, Crowther, Ian, Mazur, Karolina, Hafiz, Nauman, Khan, Umair, Chettiar, Krissen, Ibrahim, Amr, Gopal, Prasanth, Tse, Shannon, Lakshmipathy, Raj, Towse, Claudia, Al-Musawi, Hashim, Walmsley, Matthew, Aspinall, Will, Metcalfe, James, Moosa, Aliabbas, Crome, George, Abdelmonem, Mohamed, Lakpriya, Sathya, Hawkins, Amanda, Waugh, Dominic, Kennedy, Matthew, Elsagheir, Mohamed, Kieffer, Will, Oyekan, Adekinte, Collis, Justin, Raad, Marjan, Raut, Pramin, Baker, Markus, Gorvett, Alexander, Gleeson, Hannah, Fahmy, John, Walters, Sam, Tinning, Craig, Chaturvedi, Abhishek, Russell, Heather, Alsawada, Osama, Sinnerton, Robert, Crane, Evan, Warwick, Catherine, Dimascio, Lucia, Ha, Taegyeong Tina, King, Thomas, Engelke, Daniel, Chan, Matthew, Gopireddy, Rajesh, Deo, Sunny, Vasarhelyi, Ferenc, Jhaj, Jasmeet, Dogramatzis, Kostas, McCartney, Sarah, Ardolino, Toni, Fraig, Hossam, Hiller-Smith, Ryan, Haughton, Benjamin, Greenwood, Heather, Stephenson, Nicola, Chong, Yuki, Sleat, Graham, Saedi, Farid, Gouda, Joe, Ravi, Sanjeev Musuvathy, Henari, Shwan, Imam, Sam, Howell, Charles, Theobald, Emma, Wright, Jan, Cormack, Jonathan, Borja, Karlou, Wood, Sandy, Khatri, Amulya, Bretherton, Chris, Tunstall, Charlotte, Lowery, Kathryn, Holmes, Benjamin, Nichols, Jennifer, Bashabayev, Beibit, Wildin, Clare, Sofat, Rajesh, Thiagarajan, Aarthi, Abdelghafour, Karim, Nicholl, James, Abdulhameed, Ahmed, Duke, Kathryn, Maling, Lucy, McCann, Matthew, Masud, Saqib, Marshman, James, Moreau, Joshua, Cheema, Kanwalnaini, Rageeb, Peter Morad, Mirza, Yusuf, Kelly, Andrew, Hassan, Abdul, Christie, Alexander, Davies, Angharad, Tang, Cary, Frostick, Rhiannon, Pemmaraju, Gopalakrishna, Handford, Charles, Chauhan, Govind, Dong, Huan, Choudri, Mohammed Junaid, Loveday, David, Bawa, Akshdeep, Baldwick, Cheryl, Roberton, Andrew, Burden, Eleanor, Nagi, Sameer, Johnson-Lynn, Sarah, Guiot, Luke, Kostusiak, Milosz, Appleyard, Thomas, Mundy, Gary, Basha, Amr, Abdeen, Bashar, Robertson-Smith, Bill, Hussainy, Haydar Al, Reed, Mike, Jamalfar, Aral, Flintoft, Emily, McGovern, Julia, Alcock, Liam, Koziara, Michal, Ollivere, Benjamin, Zheng, Amy, Atia, Fady, Goff, Thomas, Slade, Henry, Teoh, Kar, Shah, Nikhil, Al-Obaedi, Ossama, Jamal, Bilal, Bell, Stuart, Macey, Alistair, Brown, Cameron, Simpson, Cameron, Alho, Roberto, Wilson, Victoria, Lewis, Charlotte, Blyth, Daniel, Chapman, Laura, Woods, Lisa, Katmeh, Rateb, Pasapula, Chandra, Youssef, Hesham, Tan, Jerry, Famure, Steven, Grazette, Andrew, Lloyd, Adam, Beaven, Alastair, Jackowski, Anna, Piper, Dani, Lotfi, Naeil, Chakravarthy, Jagannath, Elzawahry, Ahmed, Trew, Christopher, Neo, Chryssa, Elamin-Ahmed, Hussam, Ashwood, Neil, Wembridge, Kevin, Eyre-Brook, Alistair, Greaves, Amy, Watts, Anna, Stedman, Tobias, Ker, Andrew, Wong, Li Siang, Fullarton, Mairi, Phelan, Sean, Choudry, Qaisar, Qureshi, Alham, Moulton, Lawrence, Cadwallader, Craig, Jenvey, Cara, Aqeel, Aqeel, Francis, Daniel, Simpson, Robin, Phillips, Jon, Matthews, Edward, Thomas, Ellen, Williams, Mark, Jones, Robin, White, Tim, Ketchen, Debbie, Bell, Katrina, Swain, Keri, Chitre, Amol, Lum, Joann, Syam, Kevin, Dupley, Leanne, O'Brien, Sarah, Ford, David, Chapman, Taya, Zahra, Wajiha, Guryel, Enis, McLean, Elizabeth, Dhaliwal, Kawaljit, Regan, Nora, Berstock, James, Deano, Krisna, Donovan, Richard, Blythe, Andrew, Salmon, Jennifer, Craig, Julie, Hickland, Patrick, Matthews, Scott, Brown, William, Borland, Steven, Aminat, Akinsemoyin, Stamp, Gregory, Zaheen, Humayoon, Jaibaji, Monketh, Egglestone, Anthony, Sampalli, Sridhar Rao, Goodier, Henry, Gibb, Julia, Islam, Saad, Ranaboldo, Tom, Theivendran, Kanthan, Bond, Georgina, Richards, Joanna, Sanghera, Ranjodh, Robinson, Karen, Fong, Angus, Tsang, Bonita, Dalgleish, James, McGregor-Riley, Jonathan, Barkley, Sarah, Eardley, William, Elhassan, Almutasim, Tyas, Ben, Chandler, Henry, McVie, James, Wei, Nicholas, Negus, Oliver, Baldock, Thomas, Ravi, Kuppuswamy, Qazzaz, Layth, Mohamed, Muawia, Sivayoganthan, Sriharan, Poole, William, Slade, George, Beaumont, Hugo, Beaumont, Oliver, Taha, Rowa, Lever, Caroline, Sood, Abhay, Moss, Maximillian, Khatir, Mohammed, Trompeter, Alex, Jeffers, Aisha, Brookes, Charlotte, Dadabhoy, Maria, Bhattacharya, Rajarshi, Singh, Abhinav, Beer, Alexander, Hodgson, Harry, Rahman, Kashed, Barter, Reece, Mackinnon, Thomas, Frasquet-Garcia, Antonio, Aldarragi, Ameer, Warner, Christian, Pantelides, Christopher, Attwood, Joseph, Al-Uzri, Muntadhir, Qaoud, Qaiys Abu, Green, Stephen, Osborne, Alex, Griffiths, Alexandra, Emmerson, Benjamin, Slater, Duncan, Altahoo, Hasan, Scott, Helen, Rowland, David, O'Donnell, Janine, Edwards, Taff, Hafez, Ahmed, Khan, Basharat, Crane, Emily, Axenciuc, Rostislav, Al-Habsi, Ruqaiya, McAlinden, Gavan, Sterne, Jonathan, Wong, Matthew Lynch, Patil, Sunit, Ridha, Ali, Rasidovic, Damir, Searle, Henry, Choudhry, Jamaal, Farhan-Alanie, Muhamed M, Tanagho, Andy, Sharma, Sidharth, Thomas, Suresh, Smith, Ben, McMullan, Mark, Winstanley, Robert, Mirza, Saqeb, Hamlin, Katharine, Elgayar, Lugman, Larsen, Matthew P, Eissa, Mohamed, Stevens, Samuel, Hopper, Graeme P, Fang Soh, Terrence Chi, Doorgakant, Ashtin, Yogeswaran, Apimaan, Myatt, Darren, Mahon, Joseph, Ward, Nicholas, Reid, Susan, Deierl, Krisztian, Brogan, Declan, Little, Max, Deakin, Sue, Baines, Elliott, Jones, Georgie, Boulton, Helen, Douglas, Trixie, Jeyaseelan, Lucky, Abdale, Abdirizak, Islam, Aminul, Atkinson, Kate V, Mohamedfaris, Khalid, Mmerem, Kingsley, Jamal, Shazil, Wharton, Danielle, Rana, Anurag, McAllister, Ross, Sasi, Sijith, Thomas, Terin, Pillai, Anand, Flaherty, David, Khan, Munir, Akkena, Sudheer, Shandala, Yaseen, Lankester, Benedict, Hainsworth, Louis, Baldock, Thomas E., Walshaw, Thomas, Walker, Reece, and Eardley, William P.G.

Published
2023
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14. Lower limb post-traumatic osteomyelitis: a systematic review of clinical outcomes.

Author

Rodham, Paul, Panteli, Michalis, Vun, James S. H., Harwood, Paul, and Giannoudis, Peter V.

Subjects
ONLINE information services, MEDICAL databases, MEDICAL information storage & retrieval systems, SYSTEMATIC reviews, HEALTH outcome assessment, ACQUISITION of data, LEG, OSTEOMYELITIS, MEDICAL records, TIBIAL fractures, MEDLINE, FEMORAL fractures, DISEASE remission, DISEASE complications
Abstract

Purpose: The aim of this study was to examine the patient-reported outcomes of patients presenting with post-traumatic osteomyelitis (PTOM) of the lower limb over the past 15 years. This period was chosen to reflect modern treatment principles and increased centralisation of care. Methods: An electronic literature search of the relevant databases (PubMed, Ovid Medline, Embase, and the Cochrane library) was conducted to identify studies published between January 2006 and July 2021 reporting series of greater than 10 patients with PTOM of the tibia or femur at the site of a previous fracture. Studies reporting septic non-union were excluded. Results: Sixteen eligible studies were identified and included in the final report. Remission of infection was achieved in 93.2% of cases (range 70–100%), whilst amputation was reported in 1–7% of cases. A variety of patient-reported outcome measures were utilised including the lower extremity functional scale, short musculoskeletal functional assessment, Enneking score, and EQ-5D-3L. Limb-specific functional outcomes returned to levels similar to that of the general population although poorer outcomes were noted in specific cohorts including those with complex anatomic disease and active medical comorbidities. Conclusion: Infection following fracture fixation remains a difficult problem to treat. Regardless, using modern treatments and techniques patients can have comparable functional outcomes to that of the general population. High-quality studies are required to advance our knowledge into which types of treatments offer a benefit and how to further improve outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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17. Blood loss and transfusion risk in intramedullary nailing for subtrochanteric fractures.

Author

Panteli, Michalis, Vun, James S. H., Ahmadi, Milad, West, Robert M., Howard, Anthony J., Chloros, George, Pountos, Ippokratis, and Giannoudis, Peter V.

Subjects
*INTRAMEDULLARY fracture fixation, *HIP fractures, *INTRAMEDULLARY rods, *BLOOD transfusion, *SPONTANEOUS fractures, *OLDER people
Abstract

Background: The incidence of hip fractures and subtrochanteric fractures in particular is increasing, along with the globally expanding aging population. Intramedullary nailing remains the 'gold standard' of their treatment. Blood loss can be a result of the original trauma, but also secondary to the subsequent surgical insult, especially during the reaming of the intramedullary canal. Objectives: The aim of our study was to report on the blood loss and incidence of blood transfusion in patients presenting with a subtrochanteric fracture treated with intramedullary nailing. Most importantly, we aim to identify factors associated with the need for transfusion within the first 48 h post‐operatively. Methods: Following institutional board approval, 431 consecutive patients (131 males; age: 79.03 years old, SD 13.68 years) presenting in a Level 1 Trauma Centre with a subtrochanteric fracture treated with an intramedullary nail were retrospectively identified, over an 8‐year period. Exclusion criteria included patients with high energy injuries, pathological fractures, primary operations at other institutions and patients lost to follow‐up. To identify risk factors leading to increased risk of transfusion, we first compared patients requiring intra‐operative transfusion or transfusion during the first 48 h post‐operatively against those who did not require transfusion. This was then followed by multivariate regression analysis adjusted for confounding factors to identify the most important risk factors associated with need for transfusion within the first 48 h post‐operatively. Results: Incidence of blood transfusion was 6.0% pre‐operatively, compared to 62.7% post‐operatively. A total of 230 patients (52.3%) required either intra‐operative transfusion or transfusion during the first 48 h following surgery. Patients having a transfusion within the first 48 h post‐operatively had a higher incidence of escalation in their care (p = 0.050), LOS (p = 0.015), 30‐day (p = 0.033) and one‐year mortality (p = 0.004). Multivariate regression analysis adjusted for confounding factors identified that the most important association of a need for transfusion within the first 48 post‐operative hours was a pre‐operative Hb <100 g/L (OR 6.64); a nail/canal ratio <70% (OR 3.92), followed by need for open reduction (OR 2.66). Fracture involving the lesser trochanter was also implicated with an increased risk (OR 2.08). Additionally, pre‐operative moderate/severe renal impairment (OR 4.56), as well as hypoalbuminaemia on admission (OR 2.10) were biochemical predictors of an increased risk of transfusion. Most importantly, the need for transfusion was associated with an increase in 30‐day mortality (OR 12.07). Conclusion: Several patient, fracture and surgery related factors are implicated with an increased risk for transfusion within the first 48‐h post‐operatively. Early identification, and where possible correction of these factors can potentially reduce blood loss and risk of transfusion, along with all the associated sequelae and mortality risk. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Published
2023
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26. Evaluation of Human Bone Marrow Mesenchymal Stromal Cell (MSC) Functions on a Biomorphic Rattan-Wood-Derived Scaffold: A Comparison between Cultured and Uncultured MSCs.

Author

Ganguly, Payal, El-Jawhari, Jehan J., Vun, James, Giannoudis, Peter V., and Jones, Elena A.

Subjects
MESENCHYMAL stem cells, BONE growth, BONE regeneration, GENE expression profiling, STROMAL cells, GENE expression, TISSUE scaffolds, ENDOTHELIAL cells
Abstract

The reconstruction of large bone defects requires the use of biocompatible osteoconductive scaffolds. These scaffolds are often loaded with the patient's own bone marrow (BM) cells to facilitate osteoinductivity and biological potency. Scaffolds that are naturally sourced and fabricated through biomorphic transitions of rattan wood (B-HA scaffolds) offer a unique advantage of higher mechanical strength and bioactivity. In this study, we investigated the ability of a biomorphic B-HA scaffold (B-HA) to support the attachment, survival and gene expression profile of human uncultured BM-derived mesenchymal stromal cells (BMSCs, n = 6) and culture expanded MSCs (cMSCs, n = 7) in comparison to a sintered, porous HA scaffold (S-HA). B-HA scaffolds supported BMSC attachment (average 98%) and their survival up to 4 weeks in culture. Flow cytometry confirmed the phenotype of cMSCs on the scaffolds. Gene expression indicated clear segregation between cMSCs and BMSCs with MSC osteogenesis- and adipogenesis-related genes including RUNX2, PPARγ, ALP and FABP4 being higher expressed in BMSCs. These data indicated a unique transcriptional signature of BMSCs that was distinct from that of cMSCs regardless of the type of scaffold or time in culture. There was no statistical difference in the expression of osteogenic genes in BMSCs or cMSCs in B-HA compared to S-HA. VEGF release from cMSCs co-cultured with human endothelial cells (n = 4) on B-HA scaffolds suggested significantly higher supernatant concentration with endothelial cells on day 14. This indicated a potential mechanism for providing vasculature to the repair area when such scaffolds are used for treating large bone defects. [ABSTRACT FROM AUTHOR]

Published
2022
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