Tratamiento de la osteonecrosis de la cabeza femoral con terapia celular avanzada y biomateriales en un modelo experimental en ovejas
- Autores: Victor Manuel Barro Ojeda
- Directores de la Tesis: Enrique Cáceres Palou (dir. tes.), Marius Aguirre Cañadell (codir. tes.), Roberto Vélez Villa (codir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2019
- Idioma: español
- Tribunal Calificador de la Tesis: Lluis Carrera (presid.), Roberto Seijas Vázquez (secret.), Óscar Ares-Rodríguez (voc.)
- Programa de doctorado: Programa de Doctorado en Cirugía y Ciencias Morfológicas por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TESEO
- Resumen
Introduction: Femoral head osteonecrosis (ONCF) mainly affects young and active patients, without treatment, the entity progresses in a few years towards deformity and joint incongruity, presenting at its advanced stage joint degenerative changes, pain and functional disability, generating an important socioeconomic impact. Although there are factors that have been directly related to the ONCF (fractures, corticosteroids, alcohol, irradiation, Caisson's disease), etiology and pathogenesis persist uncertain. The treatment of the ONCF represents a great challenge for the orthopedic surgeon due to the great clinical and radiological variability of this entity. The development of experimental studies represents a very useful tool since it helps us to finish defining the pathogenesis of the disease and at the same time study new options for preclinical treatments.
Materials and Methods: The experimental model consisted of experimentally inducing osteonecrosis in the right femoral head in adult sheep by introducing a percutaneous cryotherapy probe with a helium and argon system. At 6 weeks after the induction of the ONCF, the animals were divided into three therapeutic groups, core decompression was associated with one of the following treatments, except for the control group to which no additional treatment was applied: Group A: Treatment with bone marrow concentrate and βTCP granules, Group B: Treatment with rhBMP-2 and βTCP granules, Group C: Isolated core decompression treatment. After a total 12-week follow-up the femoral heads obtained were studied by computerized microtomography (microCT), biomechanical tests, histological in order to evaluate the regenerative bone potential of each treatment.
Results: Induction of ONCF was performed in 20 sheep. We observed a complication rate of 40% that forced the animals to sacrifice. Finally, 12 sheep (4 per group) were included in the present study. The necrotic lesion was confirmed by the histological study of all the cylinders obtained in the Core Decompression surgery. Bone regeneration was observed in all the studied groups. No statistically significant differences were observed between the treatment groups by histological, biomechanical or MicroCT analysis.
Conclusion: A new modified preclinical model of ONFH using minimally invasive administration of cryotherapy with helium-argon gases induces ONFH in pre-collapse phases in a safe, quantitative and reproducible way. The results of our study do not support the routine use of BMP-2 or bone marrow concentrate associated with β-TCP granules in the treatment of pre-collapse ONFH.
