Day one of the Interventional Orthopedics Foundation meeting was a great lineup, and we began with a lecture from the father of modern orthobiologics, Philippe Hernigou from Paris, France. He had some game-changing slides that I wanted to go over as the data was remarkable. So let’s dive in this morning.
Hernigou and Bone Marrow
While I was the first guy that started using bone marrow stem cells to treat common orthopedic problems, like knee/hip arthritis and degenerative discs in 2005, Philippe Hernigou began using bone marrow concentrate to treat orthopedic bone disease when I was still in college. As he discussed yesterday at the 2019 IOF meeting in Colorado, he began his first research project in the mid-’80s and published his first papers in the ’90s. Meaning, he was the first guy using bone marrow stem cells to treat orthopedic issues, like osteonecrosis and even knee arthritis, but all through the bone (i.e., not into the joint).
Elderly Patients Who Get Bone Marrow Concentrate to Treat Knee Arthritis Live Longer than Those Who Get Knee Replacement
The first fascinating thing that Dr. Hernigou showed was a slide that reviewed survival in elderly patients who has a knee replacement versus just an “in the bone” injection of their own bone marrow cells. That slide is above, which showed fewer deaths over time in the bone marrow concentrate group and more deaths over time in patients who had a knee replacement. While some of this effect could be selection bias (inadvertently choosing patients who are more likely to die sooner or later), much of this is likely related to the many more severe complications that are common in the elderly who get knee replacements.
The Number of Stem Cells in the Knee with Age Drops More Quickly than the Number in the Pelvis
Why do we take stem cells from the pelvis, concentrate them, and then put them in someone’s knee? Dr. Hernigou shared some data that compared the number of stem cells in both areas with age. Above, you see that the number of stem cells in the knee declines much more rapidly with age (lower line) compared to the drop in the pelvis.
Hence, this slide shows why these bone marrow concentrate procedures make sense. Stem cells in the knee help to maintain the bone and cartilage and other tissues. These decline with age, but this decline is far less in the pelvis. Hence transplanting the more plentiful stem cells in the pelvis to the stem cell-poor knee makes common sense.
The upshot? I just wanted to share these two slides from day one of the IOF conference. I also wanted to recognize what a great mentor we all have in Philippe Hernigou in Paris!