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Micronized Dehydrated Human Amnion Chorion Membrane Injection in the Treatment of Knee Osteoarthritis-A Large Retrospective Case Series

Kris J Alden, Stan Harris, Brandon Hubbs, Kimberly Kot, Niki B Istwan, David Mason


  • Department of Surgery, Hinsdale Orthopaedics Associates, Hinsdale, Illinois.
  • Department of Medical Affairs, MiMedx Group Inc., Marietta, Georgia.

PMID: 31779034 DOI: 10.1055/s-0039-3400951


Osteoarthritis (OA) of the knee is a leading cause of chronic pain and disability in the United States. Current treatment options primarily target OA symptoms reserving surgical intervention and knee replacement for those who fail conservative measures. With average age of patients with knee OA decreasing, regenerative treatment approaches to reduce symptoms, increase quality of life, and delay the need for surgical intervention are increasingly sought. Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate metabolic processes leading to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Micronization of the tissue allows for suspension in normal saline and injection. We conducted a retrospective review of 100 knees treated for symptomatic OA with micronized dehydrated human amnion/chorion membrane (mdHACM) and followed for 6 months. Our purpose is to present our experience and patient outcomes. Data were abstracted from electronic medical records of 82 consecutive OA patients (100 knees) injected with 100 mg mdHACM. Patient age, gender, adverse events and routinely collected Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated. Effectiveness of mdHACM treatment was measured by serial KOOS at baseline, and posttreatment at 6 weeks, 3, and 6 months. Overall mean KOOS for the cohort was 40 at baseline, improving to 52, 62, and 65 at 6 weeks, 3 months, and 6 months post-mdHACM injection. Percent increases were 32, 56, and 65%, respectively. Quality of life and sports/recreation domains improved by 111 and 118%, respectively, at 6 months. Pain scores improved by 67% at 6 months. All scores improved throughout the observation period. The most common adverse event was pain after injection lasting 2 to 7 days, observed in 68% of cases. This represents the largest single-physician experience with mdHACM for treatment of knee OA reported to date. Injectable mdHACM appears to be a potentially useful treatment option for knee OA patients. Controlled studies are underway to confirm these observations.

Thieme. All rights reserved.

Conflict of interest statement

K.J.A. reports research support from Mimedx none outside the submitted work. S.H. is an employee of MiMedx and reports stock options and stock grants received from MiMedx. B.H. is an employee of MiMedx and reports personal fees from MiMedx outside the submitted work. K.K. is an employee of MiMedx and reports stock options and stock grants received from MiMedx. N.B.I. reports personal fees from MiMedx outside the submitted work and reports stock options and stock grants received from MiMedx. D.M. is an employee of MiMedx and reports stock options and stock grants received from MiMedx.

Direct Anterior Approach for Revision Total Hip Arthroplasty: Anatomy and Surgical Technique

Ahmed Siddiqi, Kris J Alden, Jonathan G Yerasimides, Atul F Kamath


  • From the Department of Orthopedics, Cleveland Clinic Foundation, Cleveland, OH (Kamath and Siddiqi), the Hinsdale Orthopaedics, Hinsdale, IL (Alden), and the Norton Orthopedic Institute, Louisville, KY (Yerasimides).

PMID: 33351524 DOI: 10.5435/JAAOS-D-20-00334


There has been increased interest and literature on the efficacy of direct anterior approach (DAA) for total hip arthroplasty (THA). Developments in surgical technique and instrumentation, along with exposure earlier in orthopaedic residency training, may augment the adoption of this approach among practicing orthopaedic surgeons. With the increasing number of primary THA performed through the DAA, understanding the indications and techniques associated with revision THA via the DAA has proved increasingly important. Patient positioning, understanding surgical anatomy and extensile maneuvers, and applying key reconstructive methods are essential for obtaining adequate exposure and fixation. Acetabular exposure can be facilitated through capsular and soft-tissue release, along with extensile approaches to the pelvis and acetabulum. Extensile distal extension can be performed for safe access to the femur, including extended femoral osteotomies. The purpose of this review is to describe indications, surgical anatomy, intraoperative tips, clinical outcomes, and complications after DAA for revision THA.

Copyright © 2021 by the American Academy of Orthopaedic Surgeons.

Accuracy of Component Positioning in 1980 Total Hip Arthroplasties: A Comparative Analysis by Surgical Technique and Mode of Guidance

Benjamin G Domb, John M Redmond, Steven S Louis, Kris J Alden, Robert J Daley, Justin M LaReau, Alexandra E Petrakos, Chengcheng Gui, Carlos Suarez-Ahedo


  • American Hip Institute, Westmont, Illinois; Hinsdale Orthopaedics, Hinsdale, Illinois; Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
  • American Hip Institute, Westmont, Illinois; Mayo Clinic, Jacksonville, Florida.
  • American Hip Institute, Westmont, Illinois.
  • American Hip Institute, Westmont, Illinois; Hinsdale Orthopaedics, Hinsdale, Illinois.

PMID: 26282499 DOI: 10.1016/j.arth.2015.06.059


The purpose of this multi-surgeon study was to assess and compare the accuracy of acetabular component placement, leg length discrepancy (LLD), and global offset difference (GOD) between six different surgical techniques and modes of guidance in total hip arthroplasty (THA). A total of 1980 THAs met inclusion criteria. Robotic- and navigation-guided techniques were more consistent than other techniques in placing the acetabular cup into Lewinnek's safe zone (P<0.005 and P<0.05, respectively). Robotic-guided surgery was more consistent than other techniques in placing the acetabular component within Callanan's safe zone (P<0.005). No statistically significant differences were found between groups in the frequency of patients with excessive LLD. Clinically significant differences between groups were not found in the frequency of patients with excessive GOD. Level of Evidence: IV.

Keywords: accuracy; component placement; hip arthroplasty; multi surgeon; robotic-guided.

Copyright © 2015 Elsevier Inc. All rights reserved.

Source: pubmed