Summary

Usage of bone marrow aspirate concentrate from the body of the ilium and application during hip arthroscopy demonstrates that this is a reliable harvest site and yields low complication rates.

Abstract

Introduction

Bone marrow aspirate concentrate (BMAC) from the ilium has shown to significantly improve mid-term functional outcomes for patients undergoing acetabular labral repair for moderate cartilage damage. However, there are no studies elucidating the complication rates and reliability of harvesting BMAC from the ilium during hip arthroscopy in a large patient population. Therefore, the objectives of this study are to evaluate the safety and reliability of BMAC harvesting and application from the body of the ilium during hip arthroscopy for acetabular labral repair.

Methods

A retrospective chart review was performed of all patients who underwent hip arthroscopy for acetabular labral repair with BMAC from the body of the ilium from August 2016 to April 2023. Under fluoroscopic guidance, a heparin-rinsed Jamshidi bone marrow biopsy needle that was driven through the lateral cortex of the ilium just proximal to the sourcil was used to access the harvest site. BMAC was then combined with platelet rich plasma (PRP), platelet poor plasma (PPP), and thrombin and applied to the repair site. Patients were evaluated for minor (asymptomatic heterotopic ossification, transient neurapraxia, trochanteric bursitis) and major post-operative complications (infection, deep vein thrombosis, pulmonary embolism, avascular necrosis, dislocation, instability, femoral neck facture). Furthermore, intraoperative information including estimated blood loss (EBL) (mL), traction time (min), operative time (min), and bone marrow aspirate (BMA) volume (cc) were collected.

Results

331 patients met inclusion criteria (female, n=127). Patients had a mean age of 31.2±9.5 years and body mass index of 25.7±4.1 kg/m2. 24 patients (7.3%) experienced minor complications including heterotropic ossification (n=14, 4%), transient neurapraxia (n=9, 2.7%), and trochanteric bursitis (n=1, <1%). 2 patients (n=2, <1%) experienced major complications including deep vein thrombosis (n=2, <1%). On average, patients had 26.7±7.1 mL EBL, 74.0±7.2 min traction time, 127.3±32.8 min operative time, and 106.5±25.4 cc of BMA harvested.

Conclusion

Usage of BMAC from the body of the ilium and application during hip arthroscopy demonstrates that this is a reliable harvest site and yields low complication rates. This technique minimizes donor site morbidity by accessing the BMAC through a previously established Dienst portal and operative time by simultaneously harvesting BMA and whole venous blood centrifugation. Patients had minimal blood loss, low traction time, low operative time, and substantial concentration of connective tissue progenitor cells.