Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench

Stuart B Goodman,1,2 Masahiro Maruyama1 1Departments of Orthopaedic Surgery, Stanford University, Stanford, CA, USA; 2Departments of Bioengineering, Stanford University, Stanford, CA, USACorrespondence: Stuart B GoodmanDepartments of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Red...

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Autores principales:	Goodman SB, Maruyama M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	chronic inflammation osteonecrosis osteogenesis vasculogenesis bone healing inflammation Pathology RB1-214 Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/dec0525dca3c412eaed4b922d2703965
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spelling	oai:doaj.org-article:dec0525dca3c412eaed4b922d27039652021-12-02T13:40:27ZInflammation, Bone Healing and Osteonecrosis: From Bedside to Bench1178-7031https://doaj.org/article/dec0525dca3c412eaed4b922d27039652020-11-01T00:00:00Zhttps://www.dovepress.com/inflammation-bone-healing-and-osteonecrosis-from-bedside-to-bench-peer-reviewed-article-JIRhttps://doaj.org/toc/1178-7031Stuart B Goodman,1,2 Masahiro Maruyama1 1Departments of Orthopaedic Surgery, Stanford University, Stanford, CA, USA; 2Departments of Bioengineering, Stanford University, Stanford, CA, USACorrespondence: Stuart B GoodmanDepartments of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USATel +1-650-721-7662Fax +1-650-721-3470Email goodbone@stanford.eduAbstract: 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, inflammationGoodman SBMaruyama MDove Medical Pressarticlechronic inflammationosteonecrosisosteogenesisvasculogenesisbone healinginflammationPathologyRB1-214Therapeutics. PharmacologyRM1-950ENJournal of Inflammation Research, Vol Volume 13, Pp 913-923 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic inflammation osteonecrosis osteogenesis vasculogenesis bone healing inflammation Pathology RB1-214 Therapeutics. Pharmacology RM1-950
spellingShingle	chronic inflammation osteonecrosis osteogenesis vasculogenesis bone healing inflammation Pathology RB1-214 Therapeutics. Pharmacology RM1-950 Goodman SB Maruyama M Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench
description	Stuart B Goodman,1,2 Masahiro Maruyama1 1Departments of Orthopaedic Surgery, Stanford University, Stanford, CA, USA; 2Departments of Bioengineering, Stanford University, Stanford, CA, USACorrespondence: Stuart B GoodmanDepartments of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USATel +1-650-721-7662Fax +1-650-721-3470Email goodbone@stanford.eduAbstract: 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
format	article
author	Goodman SB Maruyama M
author_facet	Goodman SB Maruyama M
author_sort	Goodman SB
title	Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench
title_short	Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench
title_full	Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench
title_fullStr	Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench
title_full_unstemmed	Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench
title_sort	inflammation, bone healing and osteonecrosis: from bedside to bench
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/dec0525dca3c412eaed4b922d2703965
work_keys_str_mv	AT goodmansb inflammationbonehealingandosteonecrosisfrombedsidetobench AT maruyamam inflammationbonehealingandosteonecrosisfrombedsidetobench
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Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench

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