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Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench

Authors Goodman SB, Maruyama M

Received 15 September 2020

Accepted for publication 22 October 2020

Published 13 November 2020 Volume 2020:13 Pages 913—923


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ning Quan

Stuart B Goodman,1,2 Masahiro Maruyama1

1Departments of Orthopaedic Surgery, Stanford University, Stanford, CA, USA; 2Departments of Bioengineering, Stanford University, Stanford, CA, USA

Correspondence: Stuart B Goodman
Departments of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
Tel +1-650-721-7662
Fax +1-650-721-3470

Abstract: Osteonecrosis of the epiphyseal and metaphyseal regions of major weight-bearing bones of the extremities is a condition that is associated with local death of bone cells and marrow in the afflicted compartment. Chronic inflammation is a prominent feature of osteonecrosis. If the persistent inflammation is not resolved, this process will result in progressive collapse and subsequent degenerative arthritis. In the pre-collapse stage of osteonecrosis, attempt at joint preservation rather than joint replacement in this younger population with osteonecrosis is a major clinical objective. In this regard, core decompression, with/without local injection of bone marrow aspirate concentrate (BMAC), is an accepted and evidence-based method to help arrest the progression and improve the outcome of early-stage osteonecrosis. However, some patients do not respond favorably to this treatment. Thus, it is prudent to consider strategies to mitigate chronic inflammation concurrent with addressing the deficiencies in osteogenesis and vasculogenesis in order to save the affected joint. Interestingly, the processes of inflammation, osteonecrosis, and bone healing are highly inter-related. Therefore, modulating the biological processes and crosstalk among cells of the innate immune system, the mesenchymal stem cell-osteoblast lineage and others are important to providing the local microenvironment for resolution of inflammation and subsequent repair. This review summarizes the clinical and biologic principles associated with osteonecrosis and provides potential cutting-end strategies for modulating chronic inflammation and facilitating osteogenesis and vasculogenesis using local interventions. Although these studies are still in the preclinical stages, it is hoped that safe, efficacious, and cost-effective interventions will be developed to save the host’s natural joint.

Keywords: chronic inflammation, osteonecrosis, osteogenesis, vasculogenesis, bone healing, inflammation

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