When Total Hip Arthroplasty (THA) is required in a patient with developmental dysplasia of the hip (DDH), bone deficiency in the acetabular roof often remains a problem. The iliac crest (IC) has long been the preferred source of autograft material, but graft harvest is associated with frequent complications and pain. Autologous bone graft can also be obtained from the femoral head (FH) for reconstruction of the acetabulum in hip arthroplasty. However, in certain challenging clinical scenarios, incorporation of the femoral head autograft appears less successful than the iliac crest autograft. The difference in potential for proliferation and osteoblastic differentiation between the two sites has still not been evaluated; therefore, it is not known how to compensate for this difference when it is present. We designed this study to evaluate the number of mesenchymal stem cells (MSCs) in both the iliac crest and femoral head of the same patient. We also determined the best operating room procedure for loading the femoral head with MSCs to achieve equivalent numbers of MSCs as in the IC. Twenty patients (8 men and 16 women) undergoing THA for DDH were enrolled in the study. The mean age was 55.5 years (range 41–65 years). Bone marrow aspirates were obtained from three depths within the femoral head and the aspirates were quantified relative to matched iliac crest aspirates that were obtained from the same patient at the same time. The cell count, progenitor cell concentration (cells/mL marrow), and progenitor cell prevalence (progenitor cells/million nucleated cells) were calculated. Aspirates of FH marrow demonstrated less concentrations of mononuclear cells compared with matched controls from the iliac crest. Progenitor cell concentrations were consistently lower in FH aspirates compared to matched controls from the iliac crest (p = 0.05). The concentration of osteogenic progenitor cells was, on average, 40% lower in the FH aspirates than in the paired iliac crest samples (p = 0.05). However, with bone marrow aspirated from the iliac crest, we were able to load the femoral head autograft with sufficient MSCs to obtain the same number as present in an iliac crest. With concentrated bone marrow from the IC, supercharging the femoral autograft with MSCs to numbers above that present in the IC was possible in the operating room, and the number of MSCs supercharged in the femoral head was predictable. Based on these findings we suggest that FH graft supercharged with BM-MSCs from the IC is comparable to IC graft for osseous graft supplementation especially in THA for patients with DDH.

Introduction: The bone marrow aspirate examination is defined as a quantitative and qualitative study of bone marrow cells obtained by puncture and aspiration. Aim: Our objective was to evaluate the practice of this exam at Andrainjato Fianarantsoa University Hospital in order to improve its diagnostic relevance.Method: This is a prospective and descriptive cross-sectional study of all bone marrow aspirates performed at the Andrainjato Fianarantsoa University Hospital Madagascar, during 18 months, from January 2021 to June 2022.Results: Forty-two bone marrow aspirate examinations were performed during the study period, among the 338 requests for hematological analysis received, representing a percentage of 1.26%. The average age of the patients was 32.17 years, with a sex ratio of 2.5. The prescription was of hospital origin in 83.3% of patients, motivated by the disturbance of the blood count in 78.6% of cases. Thirty-three requests were evaluated as relevant prescriptions. Coupled with the realization of the bone marrow examination, the haemograms were pathological in 78.6% of cases. The result of the bone marrow aspirate showed normal marrow cytology (16.7%), reactive marrow (23.8%), pathological marrow (50.0%), and hemodiluted marrow (9.5%). Dysmyelopoiesis (33.3%), multiple myeloma (23.8%), and acute leukemia (19.0%) were the main pathologies found. The difficulties encountered were related to the poor quality of the equipment and the non-availability of other complementary explorations.Conclusion: The bone marrow aspirate examination is technically feasible at Andrainjato Fianarantsoa University Hospital despite the existence of difficulties. The commitment to the process of continuous improvement of quality would impose the improvement of the technical platform.