Osteoarthritis (OA) is a debilitating condition affecting millions worldwide, often leading to significant pain and disability. For patients with advanced OA, traditional treatments like NSAIDs, physical therapy, and cortisone injections often do not provide adequate relief. Intraosseous injections with bone marrow concentrate (BMC) have emerged as a promising regenerative therapy for these patients and for patients looking to avoid knee replacement. This blog will guide you through the proper procedure for performing intraosseous injections with BMC, including the importance of image guidance, physician expertise, and laboratory techniques for cell purification and concentration.
1. Understanding Bone Marrow Concentrate
Bone marrow concentrate is a rich source of mesenchymal stem cells (MSCs), hematopoietic stem cells, and growth factors that promote cellular tissue repair. These cells can help reduce pain and improve function in patients with osteoarthritis or other musculoskeletal conditions.
2. Pre-Procedure Considerations
Before performing the procedure, it’s crucial to evaluate the patient’s medical history, current medications, and overall health status. Ensure the patient is an appropriate candidate for BMC therapy by considering the severity of their OA and any contraindications, such as active infections or blood disorders.
3. Physician Expertise
Performing intraosseous injections with BMC requires specialized training and experience. Physicians should be well-versed in the anatomy of the joints, the principles of regenerative medicine, and the technical aspects of the procedure. Participation in training programs and hands-on workshops, like the Interventional Orthopedic Foundation, can enhance the physician’s skills and confidence in performing these injections.
4. Image Guidance: Ultrasound and Fluoroscopy
Image guidance is essential for the accuracy and safety of intraosseous injections. Both ultrasound and fluoroscopy play a critical role in ensuring the precise placement of the needle into the bone marrow cavity.
- Ultrasound Guidance: Ultrasound provides real-time visualization of soft tissues, blood vessels, and bony landmarks. It helps the physician avoid neurovascular structures and ensures the needle is correctly positioned before entering the bone.
- Fluoroscopy Guidance: Fluoroscopy offers continuous X-ray imaging, allowing the physician to visualize the needle’s progression through the bone cortex into the marrow cavity. This technique is particularly useful for confirming the final needle placement and assessing the distribution of the injected concentrate with contrast.
5. Harvesting Bone Marrow
The iliac crest (pelvic bone) is the most common site for bone marrow aspiration due to its accessibility and high concentration of stem cells. The procedure involves:
- Patient Positioning: Position the patient prone to expose the iliac crest.
- Sterilization and Anesthesia: Cleanse the area with antiseptic solution and administer local anesthesia to minimize discomfort.
- Aspiration: Insert a bone marrow aspiration needle into the iliac crest and withdraw the bone marrow using a syringe under ultrasound or fluoroscopic guidance. Multiple aspirations from different sites are typically necessary to collect an adequate volume and ensure the highest cell count.
6. Laboratory Techniques for Cell Purification and Concentration
Once the bone marrow is collected, it must be processed to concentrate the stem cells and growth factors. This involves:
- Centrifugation: The bone marrow aspirate is centrifuged to separate the cellular components based on their density. The centrifugation process isolates the mononuclear cell layer, which is rich in MSCs and growth factors.
- Cell Counting and Viability Testing: Assess the concentration and viability of the cells to ensure a therapeutic dose. This step is crucial for the success of the treatment.
7. Performing the Intraosseous Injection
With the BMC prepared, the next step is the intraosseous injection:
- Patient Positioning: Position the patient to allow easy access to the affected joint.
- Sterilization and Anesthesia: Cleanse the injection site and administer local anesthesia.
- Needle Insertion: Under ultrasound and/or fluoroscopic guidance, insert the intraosseous needle into the bone marrow cavity of the affected joint.
- Injection: Slowly inject the BMC into the bone marrow cavity, ensuring even distribution within the targeted area.
8. Post-Procedure Care and Follow-Up
After the injection, monitor the patient for any immediate adverse reactions. Provide post-procedure instructions, including activity restrictions and pain management. Schedule follow-up visits to assess the patient’s response to the treatment and to evaluate any improvements in symptoms and joint function.
Conclusion
Intraosseous injections with bone marrow concentrate offer a promising therapeutic option for patients with advanced osteoarthritis. Proper technique, image guidance, physician expertise, and meticulous laboratory processing are crucial to the success of this procedure. By adhering to these guidelines, healthcare providers can enhance the efficacy of BMC therapy and improve the quality of life for patients suffering from osteoarthritis and other appropriate conditions.
For more detailed information and training opportunities, consider reaching out to professional organizations specializing in regenerative medicine and orthopedic interventions.