ORTHOUNION is a multi-centre, open, comparative, randomized, clinical trial with three parallel arms that aims to compare the efficacy of three treatments to enhance bone healing in patients with long bone non-union.
Bone injuries represent an important world medical problem producing significant healthcare and societal expenditure. While most bone injuries are not severe and are capable of healing through bone regeneration by natural callus formation with standard treatments, severe bone injuries may not heal, becoming an important unmet clinical need. Non-unions, or pseudarthrosis, may occur in 5% to 20% of long-bone fractures that fail to heal properly after more than 6 months, with morbidity, prolonged hospitalization, and increased expenses. The most commonly accepted standard augmentation to procure fracture and non-union healing consists of autologous bone grafting, obtained from the same patient in a different surgical site and transplanted to the reconstruction site. However, autologous bone grafting has some drawbacks (such as persistent pain, scar, late recovery, limited amount of bone, etc) and a limited regeneration efficacy (success rate of about 74%) and high societal cost. Culture-expanded autologous MSCs combined with biphasic calcium phosphate (BCP) biomaterial granules have been claimed as a solid regenerative medicine alternative to autologous bone grafting in non-unions, although current data are limited. In this context, the ORTHOUNION initiative focuses on the opportunity to test the hypothesis of superiority of MSC, the investigational ATMP, versus the currently accepted standard therapy, iliac crest bone autograft to biologically augment surgical treatment of long-bone non-unions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
46
Cultured Mesenchymal Stem Cells obtained from expanded bone marrow
Autologous iliac crest grafting
CHU Clermont-Ferrand
Clermont-Ferrand, France
Bone consolidation
The percentage of bone consolidation in the comparator treatment arm ( iliac crest autograft) and experimental treatment arm (mesenchymal cells).
Time frame: 12 months after treatment
Bone consolidation
To compare bone consolidation between the experimental arms and the comparator
Time frame: 6 and 24 months
Radiological Bone consolidation
To compare bone consolidation, using the REBORNE scale, between the experimental arms and the comparator. The REBORNE scale is an ad-hoc and validated scale, developed by Gomez-Barrena et al. (article currently under preparation) as a modification of the RUST score (Whelan, 2010; Journal of Trauma). In the REBORNE scale, the presence/absence of radiological consolidation is evaluated on a total of 4 cortices. Score range from 0 (no bone callus visible) to 4 (callus present with same density as cortical). The total score will be recorded.
Time frame: 6, 12 and 24 months
Level of Pain
To compare level of pain (by Numeric Rating Scale \[NRS\]) between the experimental arms and the comparator. The NRS is a scale that rates the patient´s pain from 0-10 (0= no pain, 10= worst pain), at the time of the visit.
Time frame: 6, 12 and 24 months
Complications
To compare the rate of complications between the experimental arms and the comparator
Time frame: 6, 12 and 24 months
Health status
To compare the health status (by using the Short Form-36 Health Questionnaire) between treatment arms. The SF-36 questionnaire is a validated, widely used patient-reported health survey which measures their physical and mental health status. It consists of 36 questions organized in 8 dimensions. The total score will be recorded.
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Department of Orthopaedic Surgery, Hospital Henri Mondor
Créteil, France
Department of Orthopaedic Surgery, CHU Nantes
Nantes, France
Department of Orthopaedic Surgery Toulouse University Hospital
Toulouse, France
Department of Orthopaedic Surgery, CHU Tours
Tours, France
Universitätsklinikum Frankfurt, Department of Trauma, Hand and Reconstructive Surgery
Frankfurt, Germany
Universitätsklinikum Freiburg, Klinik für Orthopädie und Unfallchirurgie
Freiburg im Breisgau, Germany
Universitätsklinikum München
Munich, Germany
Department of Orthopaedic Trauma, University of Ulm
Ulm, Germany
Istituto Ortopedico Rizzoli, SSD Fisiopatologia Ortopedica e Medicina Rigenerativa
Bologna, Italy
...and 9 more locations
Time frame: 6, 12 and 24 months