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Ruddy M, FitzPatrick DP, Stanton KT. The use of hardened bone cement as an impaction grafting extender for revision hip arthroplasty. J Mech Behav Biomed Mater 2017; 78:82-90. [PMID: 29145010 DOI: 10.1016/j.jmbbm.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
Impaction bone grafting is a method of restoring bone stock to patients who have suffered significant bone loss due to revision total hip surgery. The procedure requires morsellised cancellous bone (MCB) to be impacted into the site of bone loss in order to stabilise the prosthesis with the aim of long term resorption and reintegration of the impacted bone graft. Due to financial cost and the potential to transmit disease, the use of supplementary material, known as an extender, is frequently used to increase the graft material volume. This study investigates the use of hardened Hydroset (Stryker Corp, MA, USA), an injectable bone cement (IBC), as an extender material and compares the performance of the IBC in different weight percent inclusions to a commercially available bone graft extender (GCP, BoneSave, Stryker Corp, MA, USA). The surgical impaction procedure was standardised and samples were evaluated in terms of graft stiffness and height. It was observed that 30wt% IBC extended samples had significantly improved graft stiffness (p = 0.02) and no significant different in height (p = 0.067) over a 100% MCB control sample. Cyclic loading, representative of gait, found that the IBC subsided similarly to the commercial bone substitute in wt% above 10%. Shear testing of the impacted grafts showed no significant differences between GCP and IBC with impaction forces determining the shear parameters of impacted grafts. The effects of the impaction and cyclical loading procedures on extender particle sizes was assessed via particle size analysis. It was found that the IBC extended samples demonstrated reduced friability, evident in the better retention of particle size as a result of both impaction and gait representative loading compared to that of the GCP samples. This indicates a potential reduction in issues arising from small particle migration to joint surfaces. Scanning electron microscopy of the MCB particles with both GCP and IBC as extenders showed retention of the porous trabecular structure post-testing which is essential for revascularisation and bone growth into the graft.
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Affiliation(s)
- Mark Ruddy
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - David P FitzPatrick
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kenneth T Stanton
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland.
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52
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Synergic effect of chitosan and dicalcium phosphate on tricalcium silicate-based nanocomposite for root-end dental application. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 80:631-641. [DOI: 10.1016/j.msec.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
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53
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Shen GY, Ren H, Tang JJ, Qiu T, Zhang ZD, Zhao WH, Yu X, Huang JJ, Liang D, Yao ZS, Yang ZD, Jiang XB. Effect of osteoporosis induced by ovariectomy on vertebral bone defect/fracture in rat. Oncotarget 2017; 8:73559-73567. [PMID: 29088726 PMCID: PMC5650281 DOI: 10.18632/oncotarget.20611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022] Open
Abstract
Osteoporotic vertebral fracture (OVF) is a worldwide health concern and lacks sufficient basic studies. Suitable animal models should be the foundation for basic study and treatment of OVF. There have been few studies on the development of animal models of osteoporotic vertebral bone defects. OVF models using various animal species should be developed to evaluate the therapeutic strategy in preclinical testing. We developed an OVF model in rats. Rat osteoporosis was induced by ovariectomy (OVX), and 3 months after OVX, a 3 mm diameter hemispheric vertebral bone defect was developed in lumbar vertebra 6 (L6). Sagittal plain X-rays of the rats, their bone quantity, bone microarchitecture, and histomorphology were analyzed: 3 months after OVX, rats showed significantly lower bone quantity, relative bone volume, and total volume bone mineral density. After the vertebral bone defect had developed for 16 weeks, no significant indication of self-healing could be observed from the sagittal plain X-rays, three-dimensional images, and histomorphology. These results indicate that the rat model of osteoporotic vertebral bone defect, induced by OVX and a 3 mm diameter hemispheric vertebral bone defect, can sufficiently mimic OVF patients in clinic and provide a sound basis for subsequent studies.
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Affiliation(s)
- Geng-Yang Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Ren
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing-Jing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Qiu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Da Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Hua Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Yu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-Jing Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Dong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Bing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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54
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Aghyarian S, Bentley E, Hoang TN, Gindri IM, Kosmopoulos V, Kim HKW, C. Rodrigues D. In Vitro and In Vivo Characterization of Premixed PMMA-CaP Composite Bone Cements. ACS Biomater Sci Eng 2017; 3:2267-2277. [DOI: 10.1021/acsbiomaterials.7b00276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shant Aghyarian
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Elizabeth Bentley
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Thao N. Hoang
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Izabelle M. Gindri
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Victor Kosmopoulos
- Department
of Orthopaedic Surgery, University of North Texas Health Science Center (UNTHSC), Fort Worth, Texas 76107, United States
- Department
of Materials Science and Engineering, University of North Texas, Denton, Texas 76203, United States
| | - Harry K. W. Kim
- Center
for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, Texas 75219, United States
- Department
of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Danieli C. Rodrigues
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
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55
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Liang T, Gao CX, Yang L, Saijilafu, Yang HL, Luo ZP. Deterioration of the mechanical properties of calcium phosphate cements with Poly (γ-glutamic acid) and its strontium salt after in vitro degradation. J Mech Behav Biomed Mater 2017; 75:190-196. [PMID: 28750300 DOI: 10.1016/j.jmbbm.2017.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
The mechanical reliability of calcium phosphate cements has restricted their clinical application in load-bearing locations. Although their mechanical strength can be improved using a variety of strategies, their fatigue properties are still unclear, especially after degradation. The evolutions of uniaxial compressive properties and the fatigue behavior of calcium phosphate cements incorporating poly (γ-glutamic acid) and its strontium salt after different in vitro degradation times were investigated in the present study. Compressive strength decreased from the 61.2±5.4MPa of the original specimen, to 51.1±4.4, 42.2±3.8, 36.8±2.4 and 28.9±3.2MPa following degradation for one, two, three and four weeks, respectively. Fatigue life under same loading condition also decreased with increasing degradation time. The original specimens remained intact for one million cycles (run-out) under a maximum stress of 30MPa. After degradation for one to four weeks, the specimens were able to withstand maximum stress of 20, 15, 10 and 10MPa, respectively until run-out. Defect volume fraction within the specimens increased from 0.19±0.021% of the original specimen to 0.60±0.19%, 1.09±0.04%, 2.68±0.64% and 7.18±0.34% at degradation time of one, two, three and four weeks, respectively. Therefore, we can infer that the primary cause of the deterioration of the mechanical properties was an increasing in micro defects induced by degradation, which promoted crack initiation and propagation, accelerating the final mechanical failure of the bone cement. This study provided the data required for enhancing the mechanical reliability of the calcium phosphate cements after different degradation times, which will be significant for the modification of load-bearing biodegradable bone cements to match clinical application.
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Affiliation(s)
- Ting Liang
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Chun-Xia Gao
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Lei Yang
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Saijilafu
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Hui-Lin Yang
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Zong-Ping Luo
- Orthopaedic Institute, Department of Orthopaedics, The First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China.
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56
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MacDonald K, Price RB, Boyd D. The Feasibility and Functional Performance of Ternary Borate-Filled Hydrophilic Bone Cements: Targeting Therapeutic Release Thresholds for Strontium. J Funct Biomater 2017; 8:jfb8030028. [PMID: 28708123 PMCID: PMC5618279 DOI: 10.3390/jfb8030028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 01/25/2023] Open
Abstract
We examine the feasibility and functionality of hydrophilic modifications to a borate glass reinforced resin composite; with the objective of meeting and maintaining therapeutic thresholds for Sr release over time, as a potential method of incorporating antiosteoporotic therapy into a vertebroplasty material. Fifteen composites were formulated with the hydrophilic agent hydroxyl ethyl methacrylate (HEMA, 15, 22.5, 30, 37.5 or 45 wt% of resin phase) and filled with a borate glass (55, 60 or 65 wt% of total cement) with known Sr release characteristics. Cements were examined with respect to degree of cure, water sorption, Sr release, and biaxial flexural strength over 60 days of incubation in phosphate buffered saline. While water sorption and glass degradation increased with increasing HEMA content, Sr release peaked with the 30% HEMA compositions, scanning electron microscope (SEM) imaging confirmed the surface precipitation of a Sr phosphate compound. Biaxial flexural strengths ranged between 16 and 44 MPa, decreasing with increased HEMA content. Degree of cure increased with HEMA content (42 to 81%), while no significant effect was seen on setting times (209 to 263 s). High HEMA content may provide a method of increasing monomer conversion without effect on setting reaction, providing sustained mechanical strength over 60 days.
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Affiliation(s)
- Kathleen MacDonald
- School of Biomedical Engineering, Dalhousie University, Halifax, NS B3H 1X7, Canada.
| | - Richard B Price
- Department of Dental Clinical Sciences, Dalhousie University, Halifax, NS B3H 1X7, Canada.
- Department Applied Oral Sciences, Dalhousie University, Halifax, NS B3H 1X7, Canada.
| | - Daniel Boyd
- School of Biomedical Engineering, Dalhousie University, Halifax, NS B3H 1X7, Canada.
- Department Applied Oral Sciences, Dalhousie University, Halifax, NS B3H 1X7, Canada.
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57
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Ma B, Huan Z, Xu C, Ma N, Zhu H, Zhong J, Chang J. Preparation and in vivo evaluation of a silicate-based composite bone cement. J Biomater Appl 2017. [PMID: 28622750 DOI: 10.1177/0885328217715428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bing Ma
- Biomaterials and Tissue Engineering Research Center, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China
| | - Zhiguang Huan
- Biomaterials and Tissue Engineering Research Center, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China
| | - Chen Xu
- Biomaterials and Tissue Engineering Research Center, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China
| | - Nan Ma
- The Central Hospital of Xuhui District, Shanghai, China
| | - Haibo Zhu
- The Central Hospital of Xuhui District, Shanghai, China
| | - Jipin Zhong
- Yancheng Beiersheng Biotecnology Co. Ltd, Jiangsu, China
| | - Jiang Chang
- Biomaterials and Tissue Engineering Research Center, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China
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58
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Zhu T, Ren H, Li A, Liu B, Cui C, Dong Y, Tian Y, Qiu D. Novel bioactive glass based injectable bone cement with improved osteoinductivity and its in vivo evaluation. Sci Rep 2017; 7:3622. [PMID: 28620229 PMCID: PMC5472605 DOI: 10.1038/s41598-017-03207-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/24/2017] [Indexed: 11/09/2022] Open
Abstract
Recently, more and more attention has been paid to the development of a new generation of injectable bone cements that are bioactive, biodegradable and are able to have appropriate mechanical properties for treatment of vertebral compression fractures (VCFs). In this study, a novel PSC/CS composite cement with high content of PSC (a phytic acid-derived bioactive glass) was prepared and evaluated in both vitro and vivo. The PSC/CS cement showed excellent injectability, good resistance to disintegration, radiopacity and suitable mechanical properties. The in vitro test showed that the cement was bioactive, biocompatible and could maintain its shape sustainably, which made it possible to provide a long-term mechanical support for bone regeneration. Radiography, microcomputed tomography and histology of critical sized rabbit femoral condyle defects implanted with the cements proved the resorption and osteoinductivity of the cement. Compared with the PMMA and CSPC, there were more osteocyte and trabeculae at the Bone-Cement interface in the group PSC/CS cement. The volume of the residual bone cement suggested that PSC/CS had certain ability of degradation and the resorption rate was much lower than that of the CSPC cement. Together, the results indicated that the cement was a promising bone cement to treat the VCFs.
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Affiliation(s)
- Tengjiao Zhu
- Orthopedic Department, Peking University Third Hospital, Beijing, 100191, P.R. China
- Orthopedic Department, Peking University International Hospital, Beijing, 102206, P.R. China
| | - Huihui Ren
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P.R. China
- University of Chinese Academy of Sciences, Beijing, 100190, P.R. China
| | - Ailing Li
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P.R. China
| | - Bingchuan Liu
- Orthopedic Department, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Caiyun Cui
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, 100081, P.R. China
| | - Yanmei Dong
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, 100081, P.R. China
| | - Yun Tian
- Orthopedic Department, Peking University Third Hospital, Beijing, 100191, P.R. China.
| | - Dong Qiu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, P.R. China.
- University of Chinese Academy of Sciences, Beijing, 100190, P.R. China.
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59
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Goñi I, Rodríguez R, García-Arnáez I, Parra J, Gurruchaga M. Preparation and characterization of injectable PMMA-strontium-substituted bioactive glass bone cement composites. J Biomed Mater Res B Appl Biomater 2017; 106:1245-1257. [PMID: 28580716 DOI: 10.1002/jbm.b.33935] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022]
Abstract
In most minimally-invasive procedures used to address severe pain arising from compression fractures of the vertebral bodies, such as percutaneous vertebroplasty (PVP), a poly(methyl methacrylate) (PMMA) bone cement is used. Shortcomings of this type of cement, such as high exotherm temperature and lack of bioactivity, are well known. We prepared different formulations of a composite bone cement, whose solid constituents consisted of PMMA beads and particles of a bioactive glass (BG), where 0-20%(w/w) of the calcium component was substituted by strontium. The difference between the formulations was in the relative amounts of the solid phase constituents and in the Sr-content of BG. We determined the influence of the mixture of solid phase constituents of the cement formulation on a collection of properties, such as maximum exotherm temperature (Tmax ), setting time (tset ), and injectability (I). The selection of the PMMA beads was crucial to obtain cement composite formulations capable to be efficiently injected. Results allowed to select nine solid phase mixtures to be further tested. Then, we determined the influence of the composition of these composite bone cements on Tmax , tset , I, and cell proliferation. The results showed that the performance of various of the selected composite cements was better than that of PMMA cement reference, with lower Tmax , lower tset , and higher I. We found that incorporation of Sr-substituted BGs into these materials bestows bioactivity properties associated with the role of Sr in bone formation, leading to some composite cement formulations that may be suitable for use in PVP. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1245-1257, 2018.
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Affiliation(s)
- I Goñi
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - R Rodríguez
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - I García-Arnáez
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - J Parra
- Unidad Asociada CAA-CSIC. Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Complejo Asistencial de Ávila. Hospital Provincial., 05071, Ávila, Spain
| | - M Gurruchaga
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
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60
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Self-hardening and thermoresponsive alpha tricalcium phosphate/pluronic pastes. Acta Biomater 2017; 49:563-574. [PMID: 27872015 DOI: 10.1016/j.actbio.2016.11.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/21/2022]
Abstract
Although calcium phosphate cements (CPCs) are used for bone regeneration in a wide range of clinical applications, various physicochemical phenomena are known to hinder their potential use in minimally invasive surgery or in highly vascularized surgical sites, mainly because of their lack of injectability or their low washout resistance. The present work shows that the combination of CPCs with an inverse-thermoresponsive hydrogel is a good strategy for finely tuning the cohesive and rheological properties of CPCs to achieve clinical acceptable injectability to prevent phase separation during implantation and cohesion to avoid washout of the paste. The thermoresponsive CPC developed combines alpha-tricalcium phosphate with an aqueous solution of pluronic F127, which exhibits an inverse thermoresponsive behaviour, with a gelling transformation at around body temperature. These novel CPCs exhibited temperature-dependent properties. Addition of the polymer enhanced the injectability of the paste, even at a low liquid-to-powder ratio, and allowed the rheological properties of the cement to be tuned, with the injection force decreasing with the temperature of the paste. Moreover, the cohesion of the paste was also temperature-dependent and increased as the temperature of the host medium increased due to gelling induced in the paste. The thermoresponsive cement exhibited excellent cohesion and clinically acceptable setting times at 37°C, irrespective of the initial temperature of the paste. The addition of pluronic F127 slightly delayed the setting reaction in the early stages but did not hinder the full transformation to calcium-deficient hydroxyapatite. Moreover, the frozen storage of premixed thermoresponsive cement pastes was explored, the main physicochemical properties of the cements being maintained upon thawing, even after 18months of frozen storage. This avoids the need to mix the cement in the operating theatre and allows its use off-the-shelf. The reverse thermoresponsive cements studied herein open up new perspectives in the surgical field, where the sequential gelling/hardening of these novel cements could allow for a better and safer clinical application. STATEMENT OF SIGNIFICANCE Calcium phosphate cements are attractive bone substitutes due to their similarity to the bone mineral phase. Although they can be injectable, cohesion and stability of the paste are crucial in terms of performance and safety. A common strategy is the combination with hydrogels. However, this often results in a decrease of viscosity with increasing temperature, which can lead to extravasation and particle leakage from the bone defect. The preferred evolution would be the opposite: a low viscosity would enhance mixing and injection, and an instantaneous increase of viscosity after injection would ensure washout resistance to the blood flow. Here we develop for the first time a calcium phosphate cement exhibiting reverse thermoresponsive properties using a poloxamer featuring inverse thermal gelling.
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61
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Golubevas R, Zarkov A, Alinauskas L, Stankeviciute Z, Balciunas G, Garskaite E, Kareiva A. Fabrication and investigation of high-quality glass-ceramic (GC)–polymethyl methacrylate (PMMA) composite for regenerative medicine. RSC Adv 2017. [DOI: 10.1039/c7ra05188c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Investigations of mechanical and dissolution properties show glass ceramic–PMMA composite potential for regenerative medicine when extreme strength is not required.
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Affiliation(s)
| | - Aleksej Zarkov
- Institute of Chemistry
- Vilnius University
- Vilnius LT-03225
- Lithuania
| | | | | | - Giedrius Balciunas
- Scientific Institute of Thermal Insulation
- Vilnius Gediminas Technical University
- Lithuania
| | - Edita Garskaite
- Institute of Chemistry
- Vilnius University
- Vilnius LT-03225
- Lithuania
| | - Aivaras Kareiva
- Institute of Chemistry
- Vilnius University
- Vilnius LT-03225
- Lithuania
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62
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Dadkhah M, Pontiroli L, Fiorilli S, Manca A, Tallia F, Tcacencu I, Vitale-Brovarone C. Preparation and characterisation of an innovative injectable calcium sulphate based bone cement for vertebroplasty application. J Mater Chem B 2017; 5:102-115. [DOI: 10.1039/c6tb02139e] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Spine-Ghost: a novel injectable resorbable cement containing mesoporous bioactive glass and a radiopaque glass-ceramic phase in a calcium sulphate matrix.
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Affiliation(s)
- Mehran Dadkhah
- Department of Applied Science and Technology
- Politecnico di Torino
- 10129 Torino
- Italy
| | - Lucia Pontiroli
- Department of Applied Science and Technology
- Politecnico di Torino
- 10129 Torino
- Italy
- Oral Biology
| | - Sonia Fiorilli
- Department of Applied Science and Technology
- Politecnico di Torino
- 10129 Torino
- Italy
| | - Antonio Manca
- Radiology Unit
- Istituto di Candiolo – Fondazione del Piemonte per l'Oncologia (FPO)
- IRCCS
- Candiolo (Torino)
- Italy
| | - Francesca Tallia
- Department of Applied Science and Technology
- Politecnico di Torino
- 10129 Torino
- Italy
- Department of Materials
| | - Ion Tcacencu
- Department of Dental Medicine
- Karolinska Institutet
- Huddinge
- Sweden
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63
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Decreased extrusion of calcium phosphate cement versus high viscosity PMMA cement into spongious bone marrow-an ex vivo and in vivo study in sheep vertebrae. Spine J 2016; 16:1468-1477. [PMID: 27496285 DOI: 10.1016/j.spinee.2016.07.529] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebroplasty or kyphoplasty of osteoporotic vertebral fractures bears the risk of pulmonary cement embolism (3.5%-23%) caused by leakage of commonly applied acrylic polymethylmethacrylate (PMMA) cement to spongious bone marrow or outside of the vertebrae. Ultraviscous cement and specific augmentation systems have been developed to reduce such adverse effects. Rapidly setting, resorbable, physiological calcium phosphate cement (CPC) may also represent a suitable alternative. PURPOSE This study aimed to compare the intravertebral extrusion of CPC and PMMA cement in an ex vivo and in vivo study in sheep. STUDY DESIGN/SETTING A prospective experimental animal study was carried out. METHODS Defects (diameter 5 mm; 15 mm depth) were created by a ventrolateral percutaneous approach in lumbar vertebrae of female Merino sheep (2-4 years) either ex vivo (n=17) or in vivo (n=6), and injected with: (1) CPC (L3); (2) CPC reinforced with 10% poly(l-lactide-co-glycolide) (PLGA) fibers (L4); or (3) PMMA cement (L5; Kyphon HV-R). Controls were untouched (L1) or empty defects (L2). The effects of the cement injections were assessed in vivo by blood gas analysis and ex vivo by computed tomography (CT), micro-CT (voxel size: 67 µm), histology, and biomechanical testing. RESULTS Following ex vivo injection, micro-CT documented significantly increased extrusion of PMMA cement in comparison to CPC (+/- fibers) starting at a distance of 1 mm from the edge of the defect (confirmed by histology); this was also demonstrated by micro-CT following in vivo cement injection. In addition, blood gas analysis showed consistently significantly lower values for the fraction of oxygenized hemoglobin/total hemoglobin (FO2Hb) in the arterial blood until 25 minutes following injection of the PMMA cement (p ≤ .05 vs. CPC; 7, 15 minutes). Biomechanical testing following ex vivo injection showed significantly lower compressive strength and Young modulus than untouched controls for the empty defect (40% and 34% reduction, respectively) and all three cement-injected defects (21%-27% and 29%-32% reduction, respectively), without significant differences among the cements. CONCLUSIONS Because of comparable compressive strength, but significantly lower cement extrusion into spongious bone marrow than PMMA cement, physiological CPC (+/- PLGA fibers) may represent an attractive alternative to PMMA for vertebroplasty or kyphoplasty of osteoporotic vertebral fractures to reduce the frequency or severity of adverse effects.
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Danesi V, Tozzi G, Cristofolini L. Application of digital volume correlation to study the efficacy of prophylactic vertebral augmentation. Clin Biomech (Bristol, Avon) 2016; 39:14-24. [PMID: 27631716 DOI: 10.1016/j.clinbiomech.2016.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic augmentation is meant to reinforce the vertebral body, but in some cases it is suspected to actually weaken it. Past studies only investigated structural failure and the surface strain distribution. To elucidate the failure mechanism of the augmented vertebra, more information is needed about the internal strain distribution. This study aims to measure, for the first time, the full-field three-dimensional strain distribution inside augmented vertebrae in the elastic regime and to failure. METHODS Eight porcine vertebrae were prophylactically-augmented using two augmentation materials. They were scanned with a micro-computed tomography scanner (38.8μm voxel resolution) while undeformed, and loaded at 5%, 10%, and 15% compressions. Internal strains (axial, antero-posterior and lateral-lateral components) were computed using digital volume correlation. FINDINGS For both augmentation materials, the highest strains were measured in the regions adjacent to the injected cement mass, whereas the cement-interdigitated-bone was less strained. While this was already visible in the elastic regime (5%), it was a predictor of the localization of failure, which became visible at higher degrees of compression (10% and 15%), when failure propagated across the trabecular bone. Localization of high strains and failure was consistent between specimens, but different between the cement types. INTERPRETATION This study indicated the potential of digital volume correlation in measuring the internal strain (elastic regime) and failure in augmented vertebrae. While the cement-interdigitated region becomes stiffer (less strained), the adjacent non-augmented trabecular bone is affected by the stress concentration induced by the cement mass. This approach can help establish better criteria to improve vertebroplasty.
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Affiliation(s)
- Valentina Danesi
- Department of Industrial Engineering, Alma Mater Studiorum, Università di Bologna, Italy
| | - Gianluca Tozzi
- School of Engineering, University of Portsmouth, United Kingdom.
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum, Università di Bologna, Italy
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Dickey B, Price R, Boyd D. Exploring the unexpected influence of the Si:Ge ratio on the molecular architecture and mechanical properties of Al-free GICs. J Biomater Appl 2016; 31:730-742. [DOI: 10.1177/0885328216672947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Germanium (Ge)-based glass ionomer cements have demonstrated the ability to balance strength with extended setting times, a unique set of characteristics for aluminum-free glass ionomer cements. However, the mechanical properties of current Ge-based glass ionomer cements significantly deteriorate over time, which jeopardizes their clinical potential. This work explores the effect of incrementally decreasing the Si:Ge ratio in the glass phase of zinc-silicate glass ionomer cements to identify potential mechanisms responsible for the time-induced mechanical instability of Ge-based glass ionomer cements. The influence of Ge was evaluated on the basis of changes in mechanical properties and molecular architecture of the cements over a 180-day period. It was observed that the compressive strength and modulus of the cements were sustained when Si:Ge ratios were ≥1:1, but when Si:Ge ratios are <1:1 these properties decreased significantly over time. These mechanical changes were independent of structural changes in the glass ionomer cement matrices, as the level of metal–carboxylate crosslinks remained constant over time across the various Si:Ge ratios explored. However, it was noted the temporal decline of mechanical properties was proportional to the increased release of degradation byproducts, in particular Ge that was released from the cements in substantially greater quantities than other glass constituents. Unexpectedly, the slowest setting cement (Si:Ge 1:1) was also the strongest; behavior that is uncommon in Si-based glass ionomer cements, supports the potential of Ge-containing glass ionomer cements as injectable bone cements in applications such as percutaneous vertebroplasty.
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66
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Morphological and mechanical characterization of composite bone cement containing polymethylmethacrylate matrix functionalized with trimethoxysilyl and bioactive glass. J Mech Behav Biomed Mater 2016; 59:11-20. [DOI: 10.1016/j.jmbbm.2015.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
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Comparison of a quasi-dynamic and a static extraction method for the cytotoxic evaluation of acrylic bone cements. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 62:274-82. [DOI: 10.1016/j.msec.2016.01.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 01/05/2016] [Accepted: 01/20/2016] [Indexed: 11/20/2022]
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Chevalier Y, Santos I, Müller PE, Pietschmann MF. Bone density and anisotropy affect periprosthetic cement and bone stresses after anatomical glenoid replacement: A micro finite element analysis. J Biomech 2016; 49:1724-1733. [PMID: 27087675 DOI: 10.1016/j.jbiomech.2016.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/16/2016] [Accepted: 04/02/2016] [Indexed: 11/25/2022]
Abstract
Glenoid loosening is still a main complication for shoulder arthroplasty. We hypothesize that cement and bone stresses potentially leading to fixation failure are related not only to glenohumeral conformity, fixation design or eccentric loading, but also to bone volume fraction, cortical thickness and degree of anisotropy in the glenoid. In this study, periprosthetic bone and cement stresses were computed with micro finite element models of the replaced glenoid depicting realistic bone microstructure. These models were used to quantify potential effects of bone microstructural parameters under loading conditions simulating different levels of glenohumeral conformity and eccentric loading simulating glenohumeral instability. Results show that peak cement stresses were achieved near the cement-bone interface in all loading schemes. Higher stresses within trabecular bone tissue and cement mantle were obtained within specimens of lower bone volume fraction and in regions of low anisotropy, increasing with decreasing glenohumeral conformity and reaching their maxima below the keeled design when the load is shifted superiorly. Our analyses confirm the combined influences of eccentric load shifts with reduced bone volume fraction and anisotropy on increasing periprosthetic stresses. They finally suggest that improving fixation of glenoid replacements must reduce internal cement and bone tissue stresses, in particular in glenoids of low bone density and heterogeneity.
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Affiliation(s)
- Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.
| | - Inês Santos
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
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Smirnov VV, Antonova OS, Goldberg MA, Smirnov SV, Shvorneva LI, Egorov AA, Baikin AS, Barinov SM. Bone cements in the calcium phosphate–calcium sulfate system. DOKLADY CHEMISTRY 2016. [DOI: 10.1134/s0012500816040030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lewis G. Properties of nanofiller-loaded poly (methyl methacrylate) bone cement composites for orthopedic applications: a review. J Biomed Mater Res B Appl Biomater 2016; 105:1260-1284. [DOI: 10.1002/jbm.b.33643] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/09/2015] [Accepted: 02/12/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering; The University of Memphis; Memphis, 316 Engineering Science Building Tennessee 38152
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Mouzakis D, Zaoutsos SP, Bouropoulos N, Rokidi S, Papanicolaou G. Influence of artificially-induced porosity on the compressive strength of calcium phosphate bone cements. J Biomater Appl 2016; 31:112-20. [DOI: 10.1177/0885328216636762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The biological and mechanical nature of calcium phosphate cements (CPC's) matches well with that of bone tissues, thus they can be considered as an appropriate environment for bone repair as bone defect fillers. The current study focuses on the experimental characterization of the mechanical properties of CPCs that are favorably used in clinical applications. Aiming on evaluation of their mechanical performance, tests in compression loading were conducted in order to determine the mechanical properties of the material under study. In this context, experimental results occurring from the above mechanical tests on porous specimens that were fabricated from three different porous additives, namely albumin, gelatin and sodium alginate, are provided, while assessment of their mechanical properties in respect to the used porous media is performed. Additionally, samples reinforced with hydroxyapatite crystals were also tested in compression and the results are compared with those of the above tested porous CPCs. The knowledge obtained allows the improvement of their biomechanical properties by controlling their structure in a micro level, and finds a way to compromise between mechanical and biological response.
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Affiliation(s)
- Dionysios Mouzakis
- Department of Mechanical Engineering, Technological Educational Institute of Thessaly, Larissa, Greece
| | | | - Nikolaos Bouropoulos
- Department of Materials Science, University of Patras, Rion, Greece
- Institute of Chemical Engineering and High Temperature Chemical Processes FORTH, Patras, Greece
| | - Stamatia Rokidi
- Department of Materials Science, University of Patras, Rion, Greece
| | - George Papanicolaou
- Composite Materials Group, Department of Mechanical and Aeronautics Engineering, University of Patras, Rion, Greece
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Jacobs E, Saralidze K, Roth AK, de Jong JJ, van den Bergh JP, Lataster A, Brans BT, Knetsch ML, Djordjevic I, Willems PC, Koole LH. Synthesis and characterization of a new vertebroplasty cement based on gold-containing PMMA microspheres. Biomaterials 2016; 82:60-70. [DOI: 10.1016/j.biomaterials.2015.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/15/2015] [Accepted: 12/19/2015] [Indexed: 12/27/2022]
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73
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Zhang J, Liu W, Gauthier O, Sourice S, Pilet P, Rethore G, Khairoun K, Bouler JM, Tancret F, Weiss P. A simple and effective approach to prepare injectable macroporous calcium phosphate cement for bone repair: Syringe-foaming using a viscous hydrophilic polymeric solution. Acta Biomater 2016; 31:326-338. [PMID: 26631875 DOI: 10.1016/j.actbio.2015.11.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/28/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022]
Abstract
In this study, we propose a simple and effective strategy to prepare injectable macroporous calcium phosphate cements (CPCs) by syringe-foaming via hydrophilic viscous polymeric solution, such as using silanized-hydroxypropyl methylcellulose (Si-HPMC) as a foaming agent. The Si-HPMC foamed CPCs demonstrate excellent handling properties such as injectability and cohesion. After hardening the foamed CPCs possess hierarchical macropores and their mechanical properties (Young's modulus and compressive strength) are comparable to those of cancellous bone. Moreover, a preliminary in vivo study in the distal femoral sites of rabbits was conducted to evaluate the biofunctionality of this injectable macroporous CPC. The evidence of newly formed bone in the central zone of implantation site indicates the feasibility and effectiveness of this foaming strategy that will have to be optimized by further extensive animal experiments. STATEMENT OF SIGNIFICANCE A major challenge in the design of biomaterial-based injectable bone substitutes is the development of cohesive, macroporous and self-setting calcium phosphate cement (CPC) that enables rapid cell invasion with adequate initial mechanical properties without the use of complex processing and additives. Thus, we propose a simple and effective strategy to prepare injectable macroporous CPCs through syringe-foaming using a hydrophilic viscous polymeric solution (silanized-hydroxypropyl methylcellulose, Si-HPMC) as a foaming agent, that simultaneously meets all the aforementioned aims. Evidence from our in vivo studies shows the existence of newly formed bone within the implantation site, indicating the feasibility and effectiveness of this foaming strategy, which could be used in various CPC systems using other hydrophilic viscous polymeric solutions.
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Affiliation(s)
- Jingtao Zhang
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France; Université de Nantes, Polytech Nantes, Institut des Matériaux Jean Rouxel, CNRS UMR 6502, Rue Christian Pauc, BP 50609, 44306 Nantes Cedex 3, France
| | - Weizhen Liu
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France; Université de Nantes, Polytech Nantes, Institut des Matériaux Jean Rouxel, CNRS UMR 6502, Rue Christian Pauc, BP 50609, 44306 Nantes Cedex 3, France
| | - Olivier Gauthier
- ONIRIS - Ecole Nationale Veterinaire de Nantes, Atlanpole-La Chantrerie, BP 40706, 44307 Nantes cedex 3, France
| | - Sophie Sourice
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France
| | - Paul Pilet
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France; CHU de Nantes, Nantes University Hospital, PHU 4 OTONN, 1 Pl A. Ricordeau Nantes, France
| | - Gildas Rethore
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France; CHU de Nantes, Nantes University Hospital, PHU 4 OTONN, 1 Pl A. Ricordeau Nantes, France
| | - Khalid Khairoun
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France
| | - Jean-Michel Bouler
- Université de Nantes, CEISAM, CNRS UMR 6230, 2 rue de la Houssinière, BP 92208, 44322 Nantes Cedex 3, France
| | - Franck Tancret
- Université de Nantes, Polytech Nantes, Institut des Matériaux Jean Rouxel, CNRS UMR 6502, Rue Christian Pauc, BP 50609, 44306 Nantes Cedex 3, France
| | - Pierre Weiss
- Université de Nantes, INSERM UMRS 791, Laboratoire d'Ingénierie Ostéo-Articulaire et Dentaire, 1 place Alexis Ricordeau, BP 84215, 44042 Nantes Cedex 1, France; CHU de Nantes, Nantes University Hospital, PHU 4 OTONN, 1 Pl A. Ricordeau Nantes, France.
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Tsuru K, Maruta M, Matsuya S, Ishikawa K. Effects of the method of apatite seed crystals addition on setting reaction of α-tricalcium phosphate based apatite cement. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:244. [PMID: 26411440 DOI: 10.1007/s10856-015-5570-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
Appropriate setting time is an important parameter that determines the effectiveness of apatite cement (AC) for clinical application, given the issues of crystalline inflammatory response phenomena if AC fails to set. To this end, the present study analyzes the effects of the method of apatite seed crystals addition on the setting reaction of α-tricalcium phosphate (α-TCP) based AC. Two ACs, both consisting of α-TCP and calcium deficient hydroxyapatite (cdHAp), were analyzed in this study. In one AC, cdHAp was added externally to α-TCP and this AC was abbreviated as AC(EA). In the other AC, α-TCP was partially hydrolyzed to form cdHAp on the surface of α-TCP. This AC was referred to as AC(PH). Results indicate a decrease in the setting time of both ACs with the addition of cdHAp. Among them, for the given amount of added cdHAp, AC(PH) showed relatively shorter setting time than AC(EA). Besides, the mechanical strength of the set AC(PH) was also higher than that of set AC(EA). These properties of AC(PH) were attributed to the predominant crystal growth of cdHAp in the vicinity of the α-TCP particle surface. Accordingly, it can be concluded that the partial hydrolysis of α-TCP may be a better approach to add low crystalline cdHAp onto α-TCP based AC.
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Affiliation(s)
- Kanji Tsuru
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Michito Maruta
- Section of Bioengineering, Department of Dental Engineering, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Shigeki Matsuya
- Section of Bioengineering, Department of Dental Engineering, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Chevalier Y. Numerical Methodology to Evaluate the Effects of Bone Density and Cement Augmentation on Fixation Stiffness of Bone-Anchoring Devices. J Biomech Eng 2015; 137:2382283. [PMID: 26121601 DOI: 10.1115/1.4030943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Indexed: 01/02/2023]
Abstract
Bone quality is one of the reported factors influencing the success of bone anchors in arthroscopic repairs of torn rotator cuffs at the shoulder. This work was aimed at developing refined numerical methods to investigate how bone quality can influence the fixation stiffness of bone anchors. To do that bone biopsies were scanned at 26-μm resolution with a high-resolution microcomputer tomography (micro-CT) scanner and their images were processed for virtual implantation of a typical design of bone anchor. These were converted to microfinite element (μFE) and homogenized classical FE models, and analyses were performed to simulate pulling on the bone anchor with and without cement augmentation. Quantification of structural stiffness for each implanted specimen was then computed, as well as stress distributions within the bone structures, and related to the bone volume fraction of the specimens. Results show that the classical method is excellently correlated to structural predictions of the more refined μFE method, despite the qualitative differences in local stresses in the bone surrounding the implant. Predictions from additional loading cases suggest that structural fixation stiffness in various directions is related to apparent bone density of the surrounding bone. Augmentation of anchoring with bone cement stiffens the fixation and alters these relations. This work showed the usability of homogenized FE (hFE) in the evaluation of bone anchor fixation and will be used to develop new methodologies for virtual investigations leading to optimized repairs of rotator cuff and glenoid Bankart lesions.
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Affiliation(s)
- Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, Munich D-81377, Germany e-mail:
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Barbeck M, Hoffmann C, Sader R, Peters F, Hübner WD, Kirkpatrick CJ, Ghanaati S. Injectable Bone Substitute Based on β-TCP Combined With a Hyaluronan-Containing Hydrogel Contributes to Regeneration of a Critical Bone Size Defect Towards Restitutio ad Integrum. J ORAL IMPLANTOL 2015; 42:127-37. [PMID: 26301338 DOI: 10.1563/aaid-joi-d-14-00203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the present in vivo study, the regenerative potential of a new injectable bone substitute (IBS) composed of beta-tricalcium phosphate (β-TCP) and hyaluronan was tested in a rabbit distal femoral condyle model. To achieve this, 2 defects of 6 mm in diameter and 10 mm in length were drilled into each femur condyle in a total of 12 animals. For each animal, 1 hole was filled with the substitute material, and the other was left empty to serve as the control. After 1, 3, and 6 months, the regenerative process was analyzed by radiography as well as by histological and histomorphometrical analysis. The results revealed that bone tissue formation took place through osteoconductive processes over time, starting from the defect borders to the center. Both the β-TCP content and the hydrogel support bone tissue growth. The histomorphometrical measurements showed that the amount of bone formation in the experimental group was significantly higher compared with that found in the control group after 3 months (19.51 ± 5.08% vs. 1.96 ± 0.77%, P < .05) and 6 months (4.57 ± 1.56% vs. 0.23 ± 0.21%, P < .05). The application of the IBS gave a restitutio ad integrum result after 6 months and was associated with its nearly complete degradation, in contrast to the results found in the control group. In conclusion, the results of the present study demonstrate that the IBS contributes to sufficient bone regeneration by serving as a scaffold-like structure, combined with its degradation within 6 months.
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Affiliation(s)
- Mike Barbeck
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany.,2 REPAIR-Lab, Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Robert Sader
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Fabian Peters
- 3 Curasan AG, Frankfurt Plant, Frankfurt am Main, Germany
| | | | - Charles James Kirkpatrick
- 2 REPAIR-Lab, Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Shahram Ghanaati
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany.,2 REPAIR-Lab, Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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In Vitro and In Vivo Response to Low-Modulus PMMA-Based Bone Cement. BIOMED RESEARCH INTERNATIONAL 2015; 2015:594284. [PMID: 26366415 PMCID: PMC4558433 DOI: 10.1155/2015/594284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Abstract
The high stiffness of acrylic bone cements has been hypothesized to contribute to the increased number of fractures encountered after vertebroplasty, which has led to the development of low-modulus cements. However, there is no data available on the in vivo biocompatibility of any low-modulus cement. In this study, the in vitro cytotoxicity and in vivo biocompatibility of two types of low-modulus acrylic cements, one modified with castor oil and one with linoleic acid, were evaluated using human osteoblast-like cells and a rodent model, respectively. While the in vitro cytotoxicity appeared somewhat affected by the castor oil and linoleic acid additions, no difference could be found in the in vivo response to these cements in comparison to the base, commercially available cement, in terms of histology and flow cytometry analysis of the presence of immune cells. Furthermore, the in vivo radiopacity of the cements appeared unaltered. While these results are promising, the mechanical behavior of these cements in vivo remains to be investigated.
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Harmata AJ, Uppuganti S, Granke M, Guelcher SA, Nyman JS. Compressive fatigue and fracture toughness behavior of injectable, settable bone cements. J Mech Behav Biomed Mater 2015; 51:345-55. [PMID: 26282077 DOI: 10.1016/j.jmbbm.2015.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 01/09/2023]
Abstract
Bone grafts used to repair weight-bearing tibial plateau fractures often experience cyclic loading, and there is a need for bone graft substitutes that prevent failure of fixation and subsequent morbidity. However, the specific mechanical properties required for resorbable grafts to optimize structural compatibility with native bone have yet to be established. While quasi-static tests are utilized to assess weight-bearing ability, compressive strength alone is a poor indicator of in vivo performance. In the present study, we investigated the effects of interfacial bonding on material properties under conditions that re-capitulate the cyclic loading associated with weight-bearing fractures. Dynamic compressive fatigue properties of polyurethane (PUR) composites made with either unmodified (U-) or polycaprolactone surface-modified (PCL-) 45S5 bioactive glass (BG) particles were compared to a commercially available calcium sulfate and phosphate-based (CaS/P) bone cement at physiologically relevant stresses (5-30 MPa). Fatigue resistance of PCL-BG/polymer composite was superior to that of the U-BG/polymer composite and the CaS/P cement at higher stress levels for each of the fatigue failure criteria, related to modulus, creep, and maximum displacement, and was comparable to human trabecular bone. Steady state creep and damage accumulation occurred during the fatigue life of the PCL-BG/polymer and CaS/P cement, whereas creep of U-BG/polymer primarily occurred at a low number of loading cycles. From crack propagation testing, fracture toughness or resistance to crack growth was significantly higher for the PCL-BG composite than for the other materials. Finally, the fatigue and fracture toughness properties were intermediate between those of trabecular and cortical bone. These findings highlight the potential of PCL-BG/polyurethane composites as weight-bearing bone grafts.
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Affiliation(s)
- Andrew J Harmata
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Sasidhar Uppuganti
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Mathilde Granke
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Scott A Guelcher
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Jeffry S Nyman
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212, USA.
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79
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No YJ, Roohani-Esfahani SI, Zreiqat H. Nanomaterials: the next step in injectable bone cements. Nanomedicine (Lond) 2015; 9:1745-64. [PMID: 25321173 DOI: 10.2217/nnm.14.109] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Injectable bone cements (IBCs) are biocompatible materials that can be used as bone defect fillers in maxillofacial surgeries and in orthopedic fracture treatment in order to augment weakened bone due to osteoporosis. Current clinically available IBCs, such as polymethylmethacrylate and calcium phosphate cement, have certain advantages; however, they possess several drawbacks that prevent them from gaining universal acceptance. New gel-based injectable materials have also been developed, but these are too mechanically weak for load-bearing applications. Recent research has focused on improving various injectable materials using nanomaterials in order to render them suitable for bone tissue regeneration. This article outlines the requirements of IBCs, the advantages and limitations of currently available IBCs and the state-of-the-art developments that have demonstrated the effects of nanomaterials within injectable systems.
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Affiliation(s)
- Young Jung No
- Biomaterials & Tissue Engineering Research Unit, School of AMME, The University of Sydney, Sydney 2006, Australia
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80
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Liu H, Guan Y, Wei D, Gao C, Yang H, Yang L. Reinforcement of injectable calcium phosphate cement by gelatinized starches. J Biomed Mater Res B Appl Biomater 2015; 104:615-25. [PMID: 25953516 DOI: 10.1002/jbm.b.33434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/23/2015] [Accepted: 04/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Huiling Liu
- Department of Orthopaedics; Orthopaedic Institute, The First Affiliated Hospital, Soochow University; Suzhou Jiangsu 215006 People's Republic of China
| | - Ying Guan
- College of Chemistry, Chemical Engineering and Materials Science, Soochow University; Suzhou Jiangsu 215123 People's Republic of China
| | - Donglei Wei
- Department of Orthopaedics; Orthopaedic Institute, The First Affiliated Hospital, Soochow University; Suzhou Jiangsu 215006 People's Republic of China
| | - Chunxia Gao
- Department of Orthopaedics; Orthopaedic Institute, The First Affiliated Hospital, Soochow University; Suzhou Jiangsu 215006 People's Republic of China
| | - Huilin Yang
- Department of Orthopaedics; Orthopaedic Institute, The First Affiliated Hospital, Soochow University; Suzhou Jiangsu 215006 People's Republic of China
| | - Lei Yang
- Department of Orthopaedics; Orthopaedic Institute, The First Affiliated Hospital, Soochow University; Suzhou Jiangsu 215006 People's Republic of China
- The State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences; Beijing 100190 People's Republic of China
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81
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Zhang J, Wang L, Zhang W, Zhang M, Luo ZP. Synchronization of calcium sulphate cement degradation and new bone formation is improved by external mechanical regulation. J Orthop Res 2015; 33:685-91. [PMID: 25643826 DOI: 10.1002/jor.22839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/19/2015] [Indexed: 02/04/2023]
Abstract
A major challenge faced in the bone materials of weight-bearing without internal fixture support is the mismatch of material degradation and new bone formation, leading to weakening or even failure of the overall bony structure. This study demonstrated in the rat femur model that calcium sulphate cement degradation and new bone formation could be better synchronized by external mechanical force. An ascending force in line with calcium sulphate cement degradation could achieve bone healing in 37 days with ultimate load to failure of 87.00 ± 7.30 N, similar to that of intact femur (80.46 ± 2.79 N, p = 0.369). In contrast, the healing process under either a constant force or no force illustrated significant residual defect volumes of 1.47 ± 0.44 and 4.08 ± 0.89 mm(3) (p < 0.001), and weaker ultimate loads to failure of 69.56 ± 4.74 and 59.17 ± 7.48 N, respectively (p < 0.001). Our results suggest that the mechanical regulation approach deserves further investigation and may potentially offer a clinical strategy to improve synchronization.
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Affiliation(s)
- Jie Zhang
- The 1st Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, Suzhou, 215007, China
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82
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Persson C, Robert E, Carlsson E, Robo C, López A, Godoy-Gallardo M, Ginebra MP, Engqvist H. The effect of unsaturated fatty acid and triglyceride oil addition on the mechanical and antibacterial properties of acrylic bone cements. J Biomater Appl 2015; 30:279-89. [DOI: 10.1177/0885328215581316] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acrylic bone cements have an elastic modulus several times higher than the surrounding trabecular bone. This has been hypothesized to contribute to certain clinical complications. There are indications that the addition of specific fatty acids and triglyceride oils may reduce the elastic modulus of these types of cements. Some of these additives also appear to have inherent antibiotic properties, although this has never been evaluated in bone cements. In this study, several types of fatty acids and triglyceride oils were evaluated for use in acrylic bone cements. Their mechanical properties were evaluated under uniaxial compression testing and selected cements were then further characterized in terms of microstructure, handling and antibacterial properties using scanning electron microscopy, polymerization temperature measurements, agar diffusion tests and bactericidal activity assays of cement extracts. It was found that any of the evaluated fatty acids or triglyceride oils could be used to tailor the stiffness of acrylic bone cements, although at varying concentrations, which also depended on the type of commercial base cement used. In particular, the addition of very small amounts of linoleic acid (<2.0 wt%) resulted in Young’s moduli and compressive strengths in the range of human trabecular bone, while maintaining a similar setting time. Further, the addition of 12.6 wt% ricinoleic acid to Osteopal V cement was found to have a significant antibacterial effect, inhibiting growth of Staphylococcus aureus in an agar diffusion test as well as demonstrating 100% bactericidal activity against the same strain.
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Affiliation(s)
- Cecilia Persson
- Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Elise Robert
- Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Elin Carlsson
- Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Céline Robo
- Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Alejandro López
- Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Maria Godoy-Gallardo
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgy, Technical University of Catalonia (UPC), Barcelona, Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgy, Technical University of Catalonia (UPC), Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Håkan Engqvist
- Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
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83
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Harrison R, Criss ZK, Feller L, Modi SP, Hardy JG, Schmidt CE, Suggs LJ, Murphy MB. Mechanical properties of α-tricalcium phosphate-based bone cements incorporating regenerative biomaterials for filling bone defects exposed to low mechanical loads. J Biomed Mater Res B Appl Biomater 2015; 104:149-57. [PMID: 25677680 DOI: 10.1002/jbm.b.33362] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/30/2014] [Accepted: 12/17/2014] [Indexed: 12/25/2022]
Abstract
Calcium phosphate-based cements with enhanced regenerative potential are promising biomaterials for the healing of bone defects in procedures such as percutaneous vertebroplasty. With a view to the use of such cements for low load bearing applications such as sinus augmentation or filling extraction sites. However, the inclusion of certain species into bone cement formulations has the potential to diminish the mechanical properties of the formulations and thereby reduce their prospects for clinical translation. Consequently, we have prepared α-tricalcium phosphate (α-TCP)-based bone cements including materials that we would expect to improve their regenerative potential, and describe the mechanical properties of the resulting formulations herein. Formulations incorporated α-TCP, hydroxyapatite, biopolymer-thickened wetting agents, sutures, and platelet poor plasma. The mechanical properties of the composites were composition dependent, and optimized formulations had clinically relevant mechanical properties. Such calcium phosphate-based cements have potential as replacements for cements such as those based on polymethylmethacrylate.
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Affiliation(s)
- Reed Harrison
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712
| | - Zachary K Criss
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712
| | - Lacie Feller
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712
| | - Shan P Modi
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712
| | - John G Hardy
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, 32611-6131
| | - Christine E Schmidt
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, 32611-6131
| | - Laura J Suggs
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712
| | - Matthew B Murphy
- Department of Biomedical Engineering, The University of Texas at Austin, Texas, 78712
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84
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Valliant EM, Gagnier D, Dickey BT, Boyd D, Joseph Filiaggi M. Calcium polyphosphate as an additive to zinc-silicate glass ionomer cements. J Biomater Appl 2015; 30:61-70. [DOI: 10.1177/0885328215568985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aluminum-free glass ionomer cements (GICs) are under development for orthopedic applications, but are limited by their insufficient handling properties. Here, the addition of calcium polyphosphate (CPP) was investigated as an additive to an experimental zinc-silicate glass ionomer cement. A 50% maximum increase in working time was observed with CPP addition, though this was not clinically significant due to the short working times of the starting zinc-silicate GIC. Surprisingly, CPP also improved the mechanical properties, especially the tensile strength which increased by ∼33% after 30 days in TRIS buffer solution upon CPP addition up to 37.5 wt%. This strengthening may have been due to the formation of ionic crosslinks between the polyphosphate chains and polyacrylic acid. Thus, CPP is a potential additive to future GIC compositions as it has been shown to improve handling and mechanical properties. In addition, CPP may stimulate new bone growth and provide the ability for drug delivery, which are desirable modifications for an orthopedic cement.
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Affiliation(s)
- Esther Mae Valliant
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - David Gagnier
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Brett Thomas Dickey
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Daniel Boyd
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Mark Joseph Filiaggi
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
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85
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Ravarian R, Murphy CM, Schindeler A, Rawal A, Hook JM, Dehghani F. Bioactive poly(methyl methacrylate) for bone fixation. RSC Adv 2015. [DOI: 10.1039/c5ra08824k] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An efficient and specifically formulated superior hybrid of poly(methyl methacrylate) and bioactive glass as a bone fixation biomaterial.
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Affiliation(s)
- Roya Ravarian
- School of Chemical and Biomolecular Engineering
- University of Sydney
- Sydney
- Australia
| | - Ciara M. Murphy
- Orthopaedic Research & Biotechnology, The Children's Hospital at Westmead
- Westmead
- Australia
- Discipline of Paediatrics & Child Health
- University of Sydney
| | - Aaron Schindeler
- Orthopaedic Research & Biotechnology, The Children's Hospital at Westmead
- Westmead
- Australia
- Discipline of Paediatrics & Child Health
- University of Sydney
| | - Aditya Rawal
- NMR Facility
- Mark Wainwright Analytical Centre
- UNSW
- Sydney
- Australia
| | - James M. Hook
- NMR Facility
- Mark Wainwright Analytical Centre
- UNSW
- Sydney
- Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering
- University of Sydney
- Sydney
- Australia
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86
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Huang SC, Wu BC, Ding SJ. Stem cell differentiation-induced calcium silicate cement with bacteriostatic activity. J Mater Chem B 2015; 3:570-580. [DOI: 10.1039/c4tb01617c] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The calcium silicate cement (CSC) on osteogenic differentiation of hMSCs and bacteriostatic abilities was more effective than calcium phosphate cement (CPC).
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Affiliation(s)
- Shu-Ching Huang
- School of Dentistry
- Chung Shan Medical University
- Taichung City 402
- Taiwan
| | - Buor-Chang Wu
- School of Dentistry
- Chung Shan Medical University
- Taichung City 402
- Taiwan
| | - Shinn-Jyh Ding
- Department of Dentistry
- Chung Shan Medical University Hospital
- Taichung City 402
- Taiwan
- Institute of Oral Science
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87
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He Z, Zhai Q, Hu M, Cao C, Wang J, Yang H, Li B. Bone cements for percutaneous vertebroplasty and balloon kyphoplasty: Current status and future developments. J Orthop Translat 2015; 3:1-11. [PMID: 30035034 PMCID: PMC5982384 DOI: 10.1016/j.jot.2014.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/16/2014] [Accepted: 11/25/2014] [Indexed: 11/26/2022] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) have gradually evolved into a serious health care problem globally. In order to reduce the morbidity of OVCF patients and improve their life quality, two minimally invasive surgery procedures, vertebroplasty (VP) and balloon kyphoplasty (BKP), have been developed. Both VP and BKP require the injection of bone cement into the vertebrae of patients to stabilize fractured vertebra. As such, bone cement as the filling material plays an essential role in the effectiveness of these treatments. In this review article, we summarize the bone cements that are currently available in the market and those still under development. Two major categories of bone cements, nondegradable acrylic bone cements (ABCs) and degradable calcium phosphate cements (CPCs), are introduced in detail. We also provide our perspectives on the future development of bone cements for VP and BKP.
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Affiliation(s)
- Zhiwei He
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qingpan Zhai
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Muli Hu
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Chengbin Cao
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Jihui Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
| | - Bin Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China
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88
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Maas M, Hess U, Rezwan K. The contribution of rheology for designing hydroxyapatite biomaterials. Curr Opin Colloid Interface Sci 2014. [DOI: 10.1016/j.cocis.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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89
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Guarnieri G, Tecame M, Izzo R, Vassallo P, Sardaro A, Iasiello F, Cavaliere C, Muto M. Vertebroplasty Using Calcium Triglyceride Bone Cement (Kryptonite™) for Vertebral Compression Fractures. A Single-Centre Preliminary Study of Outcomes at One-Year Follow-up. Interv Neuroradiol 2014; 20:576-82. [PMID: 25363260 DOI: 10.15274/inr-2014-10060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/12/2014] [Indexed: 11/12/2022] Open
Abstract
This study assessed the one-year clinical and radiographic outcomes, in terms of pain-relief, vertebral re-fracture and complications, after vertebroplasty (VP) using a new osteoconductive cement (calcium triglyceride bone cement - Kryptonite™ bone cement, Doctors Research Group Inc., Southbury, CT, USA) to treat osteoporotic vertebral compression fractures. Sixteen consecutive osteoporotic patients (12 women and four men, mean age 68+/-10.5) were treated with VP using Kryptonite™ bone cement for a total of 20 vertebral fractures. All the patients complained of a pain syndrome resistant to medical therapy and all procedures were performed under fluoroscopy control with neuroleptoanalgesia using a monopedicular approach in 12 patients and bipedicular approach in four patients. All patients were studied by MR and MDCT and were evaluated with the visual analogue scale (VAS) and the Oswestry disability index (ODI) before treatment and at one and 12 months after the procedure. A successful outcome was observed in 80% of patients, with a complete resolution of pain. Differences in pre and post treatment VAS and ODI at one-year follow-up were significant (P<0.0001). We observed a disk and venous leakage in 66% of patients but only in one case did an asymptomatic pulmonary embolism occur during cement injection. Two cases of vertebral re-fractures at distant metamers were observed during follow-up. VP using Kryptonite bone cement is a helpful procedure that allows complete and long-lasting resolution of painful vertebral symptoms. The cost of the material is very high and the rate of disk and venous leakage is too high compared to standard cement.
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Affiliation(s)
| | - Mario Tecame
- Radiology Service, Seconda Università degli Studi di Napoli SUN; Naples, Italy
| | - Roberto Izzo
- Neuroradiology Service, Cardarelli Hospital; Naples, Italy
| | | | - Angela Sardaro
- Radiology Service, Seconda Università degli Studi di Napoli SUN; Naples, Italy
| | - Francesca Iasiello
- Radiology Service, Seconda Università degli Studi di Napoli SUN; Naples, Italy
| | | | - Mario Muto
- Neuroradiology Service, Cardarelli Hospital; Naples, Italy
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90
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Jun DR, Moon SK, Choi SW. Uniform polydimethylsiloxane beads coated with polydopamine and their potential biomedical applications. Colloids Surf B Biointerfaces 2014; 121:395-9. [DOI: 10.1016/j.colsurfb.2014.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
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91
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Wang CW, Chiang TY, Chang HC, Ding SJ. Physicochemical properties and osteogenic activity of radiopaque calcium silicate-gelatin cements. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:2193-2203. [PMID: 24970350 DOI: 10.1007/s10856-014-5258-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/09/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study is to evaluate the physicochemical properties and in vitro osteogenic activity of radiopaque calcium silicate-gelatin cements. The radiopacity, setting time, working time, flow, diametral tensile strength, pH value, washout resistance and morphology of the cements with gelatin (0, 5 and 10% by weight) were measured, which compared to a popular endodontic material, ProRoot white-colored mineral trioxide aggregate (WMTA). The cell morphology, cell attachment and proliferation, alkaline phosphatase and osteocalcin levels on the cements were measured by culturing the specimens with dental pulp cells. The results indicated that the presence of gelatin significantly (P < 0.05) reduced radiopacity and diametral tensile strength and prolonged setting time. Nevertheless, the 5 wt% gelatin cement had a radiopacity (5.1 mm of Al thickness) higher than ISO 6876:2001 standards (3 mm of Al thickness). The setting time (33 min), working time (9 min) and flow value (17.4 mm) of the 5 wt% gelatin cement were significantly (P < 0.05) better than those of WMTA (corresponding 165, 6 min and 14.2 mm). The fresh WMTA completely degraded after soaking in a physiological solution for 1 h, while the gelatin cements resisted washout, showing no noticeable breakdown even after 1 day of soaking. The gelatin cement enhanced the higher expression of cell attachment, proliferation and differentiation as compared to WMTA. It was concluded that the 5 wt% gelatin-calcium silicate hybrid cement appears to be promising as a radiopaque biomaterial for medical applications such as endodontics and vertebroplasty.
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Affiliation(s)
- Chien-Wen Wang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 701, Taiwan
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92
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Liu W, Zhang J, Rethore G, Khairoun K, Pilet P, Tancret F, Bouler JM, Weiss P. A novel injectable, cohesive and toughened Si-HPMC (silanized-hydroxypropyl methylcellulose) composite calcium phosphate cement for bone substitution. Acta Biomater 2014; 10:3335-45. [PMID: 24657196 DOI: 10.1016/j.actbio.2014.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/11/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
This study reports on the incorporation of the self-setting polysaccharide derivative hydrogel (silanized-hydroxypropyl methylcellulose, Si-HPMC) into the formulation of calcium phosphate cements (CPCs) to develop a novel injectable material for bone substitution. The effects of Si-HPMC on the handling properties (injectability, cohesion and setting time) and mechanical properties (Young's modulus, fracture toughness, flexural and compressive strength) of CPCs were systematically studied. It was found that Si-HPMC could endow composite CPC pastes with an appealing rheological behavior at the early stage of setting, promoting its application in open bone cavities. Moreover, Si-HPMC gave the composite CPC good injectability and cohesion, and reduced the setting time. Si-HPMC increased the porosity of CPCs after hardening, especially the macroporosity as a result of entrapped air bubbles; however, it improved, rather than compromised, the mechanical properties of composite CPCs, which demonstrates a strong toughening and strengthening effect. In view of the above, the Si-HPMC composite CPC may be particularly promising as bone substitute material for clinic application.
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93
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Choi SY, Hur W, Kim BK, Shasteen C, Kim MH, Choi LM, Lee SH, Park CG, Park M, Min HS, Kim S, Choi TH, Choy YB. Bioabsorbable bone fixation plates for X‐ray imaging diagnosis by a radiopaque layer of barium sulfate and poly(lactic‐
co
‐glycolic acid). J Biomed Mater Res B Appl Biomater 2014; 103:596-607. [DOI: 10.1002/jbm.b.33235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/23/2014] [Accepted: 06/05/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sung Yoon Choi
- Interdisciplinary Program in Bioengineering, College of EngineeringSeoul National UniversitySeoul152‐742 Republic of Korea
| | - Woojune Hur
- Biomedical Research InstituteSeoul National University HospitalSeoul110‐744 Republic of Korea
- Department of Plastic and Reconstructive SurgeryInstitute of Human‐Environment Interface Biology, College of Medicine, Seoul National UniversitySeoul110‐799 Republic of Korea
| | - Byeung Kyu Kim
- Biomedical Research InstituteSeoul National University HospitalSeoul110‐744 Republic of Korea
- Department of Plastic and Reconstructive SurgeryInstitute of Human‐Environment Interface Biology, College of Medicine, Seoul National UniversitySeoul110‐799 Republic of Korea
| | - Catherine Shasteen
- Department of Materials Science and Engineering, College of EngineeringSeoul National UniversitySeoul151‐744 Republic of Korea
| | - Myung Hun Kim
- Interdisciplinary Program in Bioengineering, College of EngineeringSeoul National UniversitySeoul152‐742 Republic of Korea
| | - La Mee Choi
- Biomedical Research InstituteSeoul National University HospitalSeoul110‐744 Republic of Korea
- Department of Plastic and Reconstructive SurgeryInstitute of Human‐Environment Interface Biology, College of Medicine, Seoul National UniversitySeoul110‐799 Republic of Korea
| | - Seung Ho Lee
- Interdisciplinary Program in Bioengineering, College of EngineeringSeoul National UniversitySeoul152‐742 Republic of Korea
| | - Chun Gwon Park
- Interdisciplinary Program in Bioengineering, College of EngineeringSeoul National UniversitySeoul152‐742 Republic of Korea
| | - Min Park
- Interdisciplinary Program in Bioengineering, College of EngineeringSeoul National UniversitySeoul152‐742 Republic of Korea
| | - Hye Sook Min
- Department of Preventive Medicine, Graduate School of Public HealthSeoul National University College of MedicineSeoul110‐799 Republic of Korea
| | - Sukwha Kim
- Department of Plastic and Reconstructive SurgeryInstitute of Human‐Environment Interface Biology, College of Medicine, Seoul National UniversitySeoul110‐799 Republic of Korea
| | - Tae Hyun Choi
- Department of Plastic and Reconstructive SurgeryInstitute of Human‐Environment Interface Biology, College of Medicine, Seoul National UniversitySeoul110‐799 Republic of Korea
| | - Young Bin Choy
- Interdisciplinary Program in Bioengineering, College of EngineeringSeoul National UniversitySeoul152‐742 Republic of Korea
- Department of Biomedical EngineeringSeoul National University College of MedicineSeoul110‐799 Republic of Korea
- Institute of Medical and Biological Engineering, Medical Research CenterSeoul National UniversitySeoul110‐799 Republic of Korea
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94
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Bou-Francis A, López A, Persson C, Hall RM, Kapur N. Assessing cement injection behaviour in cancellous bone: An in vitro study using flow models. J Biomater Appl 2014; 29:582-94. [DOI: 10.1177/0885328214537858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Understanding the cement injection behaviour during vertebroplasty and accurately predicting the cement placement within the vertebral body is extremely challenging. As there is no standardized methodology, we propose a novel method using reproducible and pathologically representative flow models to study the influence of cement properties on injection behaviour. The models, confined between an upper glass window and a lower aluminium plate, were filled with bone marrow substitute and then injected (4, 6 and 8 min after cement mixing) with commercially available bone cements (SimplexP, Opacity+, OsteopalV and Parallax) at a constant flow rate (3 mL/min). A load cell was used to measure the force applied on the syringe plunger and calculate the peak pressure. A camera was used to monitor the cement flow during injection and calculate the following parameters when the cement had reached the boundary of the models: the time to reach the boundary, the filled area and the roundness. The peak pressure was comparable to that reported during clinical vertebroplasty and showed a similar increase with injection time. The study highlighted the influence of cement formulations and model structure on the injection behaviour and showed that cements with similar composition/particle size had similar flow behaviour, while the introduction of defects reduced the time to reach the boundary, the filled area and the roundness. The proposed method provides a novel tool for quick, robust differentiation between various cement formulations through the visualization and quantitative analysis of the cement spreading at various time intervals.
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Affiliation(s)
| | - Alejandro López
- Department of Engineering Sciences, Uppsala University, Sweden
| | - Cecilia Persson
- Department of Engineering Sciences, Uppsala University, Sweden
| | - Richard M Hall
- School of Mechanical Engineering, University of Leeds, UK
| | - Nikil Kapur
- School of Mechanical Engineering, University of Leeds, UK
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95
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Doty HA, Leedy MR, Courtney HS, Haggard WO, Bumgardner JD. Composite chitosan and calcium sulfate scaffold for dual delivery of vancomycin and recombinant human bone morphogenetic protein-2. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1449-1459. [PMID: 24504748 DOI: 10.1007/s10856-014-5167-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/27/2014] [Indexed: 06/03/2023]
Abstract
A biodegradable, composite bone graft, composed of chitosan microspheres embedded in calcium sulfate, was evaluated in vitro for point-of-care loading and delivery of antibiotics and growth factors to prevent infection and stimulate healing in large bone injuries. Microspheres were loaded with rhBMP-2 or vancomycin prior to mixing into calcium sulfate loaded with vancomycin. Composites were evaluated for set time, drug release kinetics, and bacteriostatic/bactericidal activity of released vancomycin, induction of ALP expression by released rhBMP-2, and interaction of drugs on cells. Results showed the composite set in under 36 min and released vancomycin levels that were bactericidal to S. aureus (>MIC 8-16 μg/mL) for 18 days. Composites exhibited a 1 day-delayed release, followed by a continuous release of rhBMP-2 over 6 weeks; ranging from 0.06 to 1.49 ng/mL, and showed a dose dependent release based on initial loading. Released rhBMP-2 levels were, however, too low to induce detectable levels of ALP in W20-17 cells, due to the affinity of rhBMP-2 for calcium-based materials. With stimulating amounts of rhBMP-2 (>50 ng/mL), the ALP response from W-20-17 cells was inhibited when exposed to high vancomycin levels (1,800-3,600 μg/mL). This dual-delivery system is an attractive alternative to single delivery or preloaded systems for bone regeneration since it can simultaneously fight infection and deliver a potent growth factor. Additionally, this composite can accommodate a wide range of therapeutics and thus be customizable for specific patient needs, however, the potential interactive effects of multiple agents must be investigated to ensure that functional activity is not altered.
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Affiliation(s)
- Heather A Doty
- University of Memphis - University of Tennessee Joint Biomedical Engineering Program, Herff College of Engineering, 330 Engineering Technology Building, Memphis, TN, 28152, USA
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96
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Wichlas F, Trzenschik H, Tsitsilonis S, Rohlmann A, Bail HJ. Biomechanical behavior of MRI-signal-inducing bone cements after vertebroplasty in osteoporotic vertebral bodies: An experimental cadaver study. Clin Biomech (Bristol, Avon) 2014; 29:571-6. [PMID: 24703828 DOI: 10.1016/j.clinbiomech.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conventional water-free polymethylmethacrylate cements are not MRI visible due to the lack of free protons. A new MRI-visible bone cement was developed through the addition of a contrast agent and either a saline solution or a hydroxyapatite (Wichlas et al., 2010). The purposes of the study were to examine the influence of the two MRI-signal-inducing cements on the biomechanical behavior of cadaveric osteoporotic vertebral bodies after vertebroplasty and to compare the performance of the cements with conventional polymethylmethacrylate cement. METHODS Three different cements were used: standard polymethylmethacrylate cement and two modified MRI-signal-inducing cements that were mixed with either a 0.9% saline solution or a hydroxyapatite. The modulus of elasticity for the standard polymethylmethacrylate cement was 2040MPa, and the moduli for the MRI-signal-inducing cements that were mixed with a 0.9% saline solution and a hydroxyapatite were 1477 and 1225MPa, respectively. The lumbar vertebral bodies from nine osteoporotic spines (mean age=87 years, range=78-99 years) of female cadavers were examined. Three groups were formed: polymethylmethacrylate cement with saline solution (n=14), polymethylmethacrylate cement with hydroxyapatite (n=12) and polymethylmethacrylate cement (n=13). The vertebral bodies were biomechanically tested before and after vertebroplasty. Stiffness was chosen as the primary biomechanical parameter. FINDINGS The vertebral body stiffness was nearly two-fold greater after vertebroplasty, and this increase was statistically significant for every group. All the groups had similar vertebral body stiffness value before and after the vertebroplasty. The UNIANOVA test for multivariate analysis of variance showed no influence of lumbar level, injected cement volume and initial vertebral body stiffness. INTERPRETATION The elastic moduli of the cements appear to exert little influence on the biomechanical values when the cement is in the vertebral body. Based on the direct comparison with the classic polymethylmethacrylate cement, we believe that the implementation of such cements for MRI-guided vertebroplasties is feasible.
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Affiliation(s)
- Florian Wichlas
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Heidi Trzenschik
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Serafim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies/BSRT, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Antonius Rohlmann
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hermann-Josef Bail
- Clinic for Traumatology and Orthopedics, Nuremberg Hospital South, Breslauer Str. 201, 90471, Nuremberg, Germany
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97
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Arcos D, Boccaccini A, Bohner M, Díez-Pérez A, Epple M, Gómez-Barrena E, Herrera A, Planell J, Rodríguez-Mañas L, Vallet-Regí M. The relevance of biomaterials to the prevention and treatment of osteoporosis. Acta Biomater 2014; 10:1793-805. [PMID: 24418434 DOI: 10.1016/j.actbio.2014.01.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/24/2013] [Accepted: 01/03/2014] [Indexed: 02/08/2023]
Abstract
Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. In order to analyze this scenario and propose alternatives to overcome it, the Spanish and European Network of Excellence for the Prevention and Treatment of Osteoporotic Fractures, "Ageing", was created. This network integrates three communities, e.g. clinicians, materials scientists and industrial advisors, tackling the same problem from three different points of view. Keeping in mind the premise "living longer, living better", this commentary is the result of the thoughts, proposals and conclusions obtained after one year working in the framework of this network.
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98
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Lukaszczyk J, Janicki B, López A, Skołucka K, Wojdyła H, Persson C, Piaskowski S, Smiga-Matuszowicz M. Novel injectable biomaterials for bone augmentation based on isosorbide dimethacrylic monomers. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 40:76-84. [PMID: 24857468 DOI: 10.1016/j.msec.2014.03.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Drawbacks with the commonly used PMMA-based bone cements, such as an excessive elastic modulus and potentially toxic residual monomer content, motivate the development of alternative cements. In this work an attempt to prepare an injectable biomaterial based on isosorbide-alicyclic diol derived from renewable resources was presented. Two novel dimethacrylic monomers ISDGMA - 2,5-bis(2-hydroxy-3-methacryloyloxypropoxy)-1,4:3,6-dianhydro-sorbitol and ISETDMA - dimethacrylate of ethoxylated isosorbide were synthesized and used to prepare a series of low-viscosity compositions comprising bioactive nano-sized hydroxyapatite in the form of a two-paste system. Formulations exhibited a non-Newtonian shear-thinning behavior, setting times between 2.6 min and 5.3 min at 37°C and maximum curing temperatures of 65°C. Due to the hydrophilic nature of ISDGMA, cured compositions could absorb up to 13.6% water and as a result the Young's modulus decreased from 1,429 MPa down to 470 MPa. Both, poly(ISDGMA) and poly(ISETDMA) were subjected to a MTT study on mice fibroblasts (BALB/3T3) and gave relative cell viabilities above 70% of control. A selected model bone cement was additionally investigated using human osteosarcoma cells (SaOS-2) in an MTS test, which exhibited concentration-dependent cell viability. The preliminary results, presented in this work reveal the potential of two novel dimethacrylic monomers in the preparation of an injectable biomaterial for bone augmentation, which could overcome some of the drawbacks typical for conventional acrylic bone cement.
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Affiliation(s)
- Jan Lukaszczyk
- Silesian University of Technology, Faculty of Chemistry, Department of Physical Chemistry and Technology of Polymers, ul. M. Strzody 9, 44-100 Gliwice, Poland.
| | - Bartosz Janicki
- Silesian University of Technology, Faculty of Chemistry, Department of Physical Chemistry and Technology of Polymers, ul. M. Strzody 9, 44-100 Gliwice, Poland
| | - Alejandro López
- Uppsala University, Department of Engineering Sciences, Division of Applied Materials Science, The Ångström Laboratory, Lägerhyddsvägen 1, 75120 Uppsala, Sweden
| | - Karolina Skołucka
- Celther Poland Sp. z o.o., ul. Ostrzykowizna 14A, 05-170 Zakroczym, Poland
| | - Henryk Wojdyła
- PCC Rokita SA, ul. Sienkiewicza 4, 56-120 Brzeg Dolny, Poland
| | - Cecilia Persson
- Uppsala University, Department of Engineering Sciences, Division of Applied Materials Science, The Ångström Laboratory, Lägerhyddsvägen 1, 75120 Uppsala, Sweden
| | | | - Monika Smiga-Matuszowicz
- Silesian University of Technology, Faculty of Chemistry, Department of Physical Chemistry and Technology of Polymers, ul. M. Strzody 9, 44-100 Gliwice, Poland
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99
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Compressive fatigue properties of a commercially available acrylic bone cement for vertebroplasty. Biomech Model Mechanobiol 2014; 13:1199-207. [DOI: 10.1007/s10237-014-0566-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
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100
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Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures. BIOMED RESEARCH INTERNATIONAL 2014; 2014:934206. [PMID: 24724106 PMCID: PMC3960523 DOI: 10.1155/2014/934206] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/17/2014] [Indexed: 12/29/2022]
Abstract
Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.
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