Bone Marrow Aspirate Concentrate Harvest and Delivery With a Neonatal Nasogastric Tube: A Simple Technique in Hip Arthroscopy

Abstract

In the past 10 to 15 years, there has been an increasing interest in using orthobiologics to address pathologies of the hip. The use of bone marrow aspirate concentrate (BMAC) showed greater functional improvement in patients with moderate cartilage injuries who had a labral repair than patients without BMAC injection. In hip arthroscopy and preservation, difficulty is encountered during the bone marrow harvest and administration into the hip joint with distraction. Therefore, orthopaedic surgeons need a reliable and reproducible technique to safely administer BMAC in the hip joint to achieve the best results. With this technique, we want to show that BMAC harvest and administration with a neonatal nasogastric feeding tube is easy, safe, and reproducible.

Fig 1

Anterolateral portal of the pelvis in an 18-year-old patient with femoroacetabular impingement syndrome, a left labral tear, and a chondrolabral delamination.

Fig 2

The bone biopsy trephine Jamshidi needle. Observe the direction of the needle placement, from medial to lateral and from anterior to posterior. Jamshidi needle (left), the Jamshidi needle on a dry bone with its right placement (center), and Jamshidi needle placed in the anterosuperior iliac spine (right).

Fig 3

A 5-8 French neonatal nasogastric feeding tube that is utilized to deliver the bone marrow concentrate into the hip joint.

Fig 4

The bone marrow aspirate DASH APEX 12 centrifuge machine (left). The bone marrow concentrate in 5-mL syringes is ready to be injected into the hip joint (right).

Fig 5

The nasogastric feeding tube delivery through the peritrochanteric space portal with arthroscopic grasping forceps. In total, 30 to 40 cc of bone marrow aspirate concentrate is administered into the right hip joint toward the acetabular fossa. (A, acetabulum; FH, femoral head; FT, feeding tube; L, labrum.)

Fig 6

The nasogastric neonatal feeding tube placed on a dried right hip joint (left) in the modified supine position. The arthroscope is on the anterolateral portal. Observe the right picture with a labral repair with its anchors and sutures in place. (A, acetabulum; AL, anterolateral portal; FH, femoral head; FT, feeding tube; L, labrum.)