SLOB

If the hip socket is visibly damaged but not fully dislocated, the SPMLs cannot prevent what has already happened. Hip damage can be mechanically self promoting. We had already devised a method for some very resistant uses of bone grafting that required speedy and strong bone graft (to fill large cysts and to fuse certain high stress joints). Rather than putting in hard “cortical” bone [feels like hard wood], which often fails, we used cadaver processed soft cancellous bone which is more air than bone. We kneaded a bone morphogenic protein (BMP) gel into that crunchy soft matrix plus bone marrow. BMP tells bone stem cells to “MAKE BONE” and those cells (living in marrow) will transform quickly into bone making tissue. That is why we laced the BMP gel with bone marrow (bone stem cells) that we harvest at the time of surgery. The bone stem cells are driven wild by BMP protein. New bone rapidly forms as driven stem cells consume the surrounding matrix that we molded in place to hold the shape of what is wanted of the new bone. As new bone forms it becomes very quickly visible whereas the initial matrix is not seen on x-ray. Poof, there it is – so it seemed to radiologists who had no idea how the bone had gotten so far so fast (we put it there – just couldn't see it). The fastest area was the superior and lateral near the top of the hip on the side of the pelvis. We noted it on our x ray request forms. This material, as prepared, has a crunchy clay feel. We pack it into a space that we create - a shape where we want bone to be - and seal it closed (sutures). It is similar to stuffing tuna into a pita bread pocket.

So who needs this? Not this person (left) who had the dysplasia prevented (SPMLs with ethanol perineural selective focal injections). Below = 19 yr followup.