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Walsh WR, Vizesi F, Michael D, Auld J, Langdown A, Oliver R, Yu Y, Irie H, Bruce W. Beta-TCP bone graft substitutes in a bilateral rabbit tibial defect model. Biomaterials 2008; 29:266-71. [PMID: 18029011 DOI: 10.1016/j.biomaterials.2007.09.035] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
Abstract
The use of artificial bone graft substitutes has increased as the surgical applications widen and the availability of allograft bone decreases. The ideal graft substitute should reabsorb with time to allow and encourage new bone formation whilst maintaining its properties as an osteoconductive scaffold until it is no longer required. A potential disadvantage of some synthetic substitutes is their long dissolution time. Beta-tricalcium phosphates (beta-TCPs) have some advantages when compared to hydroxyapatite (HA), when used as a filler, in that it is more rapidly reabsorbed. Three commercially available and clinically used beta-TCP bone graft substitutes with the same chemistry (Vitoss, Osferion, Chronos) but with varying macro and microscopic characteristics were investigated using a bilateral tibial metaphyseal defect model in New Zealand white rabbits. When placed into tibial defects all three materials performed similarly in terms of mechanical properties of the healing defects. A decrease in properties was found at 12 weeks where implant resorption was nearly achieved while remodelling of the anteromedial cortex had yet to be completed. All materials were osteoconductive and supported new bone formation while implant resorption with time differed between materials. Vitoss resorbed faster than the other materials and is likely to differences in particle geometry, pore structure and interconnectivity.
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Affiliation(s)
- William R Walsh
- Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, L1 Clinical Sciences Building, Sydney 2031, Australia.
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Tibial cyst and intra-articular granuloma formation after anterior cruciate ligament reconstruction using polylactide carbonate osteoconductive interference screws. Arthroscopy 2008; 24:238-42. [PMID: 18237712 DOI: 10.1016/j.arthro.2007.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 11/12/2007] [Accepted: 11/12/2007] [Indexed: 02/02/2023]
Abstract
We report a case of sterile tibial cyst and intra-articular granuloma formation of the knee 6 months after a double-bundle anterior cruciate ligament reconstruction with bioabsorbable polylactide carbonate osteoconductive interference screws. The patient presented with increasing pain and swelling of the knee. Surgical exploration was performed, and 2 pretibial cavities were encountered, filled with remnants of the biodegradable screws and fibrinous material. Both sites underwent curettage, and the cavities were filled with allogeneic bone grafts. Arthroscopic evaluation of the knee showed an intact anterior cruciate ligament and a large granuloma formation anterior to the intercondylar notch in conjunction with the anteromedial tibial tunnel. Arthroscopic resection of the granuloma together with synovectomy was performed. To our knowledge, this is the first case report of this complication with polylactide carbonate screws.
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Saikia KC, Bhattacharya TD, Bhuyan SK, Talukdar DJ, Saikia SP, Jitesh P. Calcium phosphate ceramics as bone graft substitutes in filling bone tumor defects. Indian J Orthop 2008; 42:169-72. [PMID: 19826522 PMCID: PMC2759621 DOI: 10.4103/0019-5413.39588] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Synthetic bio-inert materials are currently used as an alternative to autogenous bone graft. Calcium hydroxyapatite (HA) and Beta tri-calcium phosphate (beta-TCP), which belong to the calcium phosphate ceramics group, are biocompatible and osteo-conductive. The purpose of this study is to analyse the use of HA and beta-TCP in their ceramic forms as a bone graft substitute in filling bone voids after curettage of benign bone tumors. MATERIALS AND METHODS Twenty-four patients in the age range of 3.5-55 years (mean 14.3 years) having benign bone tumors with bone defects were filled with bone graft substitute following curettage. In 20 patients bone defects were filled with block/granules of HA ceramic and in four with beta-TCP. Fibular strut graft was packed with HA in four patients. The patients were followed up for an average of 18 months (range 12-36 months). RESULTS The functional status of the patients at follow-up was evaluated and compared with preoperative functional status. Early incorporation of graft substitutes became evident radiologically between 6 and 10 weeks (Stage I). Complete incorporation (Stage III) was observed in an average of nine months (6-18 months). Clinical healing was observed before radiological healing. The average time taken to return to preoperative function was 14 weeks. There was no recurrence of lesion or growth retardation. CONCLUSION Calcium hydroxyapatite and beta-TCP are excellent bone graft substitutes for autogenous bone graft in filling voids after curettage of benign bone tumors.
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Affiliation(s)
- KC Saikia
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India,Correspondence: Dr. KC Saikia, Rajgarh Link Road, Anil Nagar, Bylane-5, House No.7, Guwahati - 781 007, Assam, India. E-mail:
| | - TD Bhattacharya
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - SK Bhuyan
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - DJ Talukdar
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - SP Saikia
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - P Jitesh
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
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Dinopoulos H, Giannoudis PV. (iv) The use of bone morphogenetic proteins (BMPs) in long-bone non-unions. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cuor.2007.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Walsh WR, Cotton NJ, Stephens P, Brunelle JE, Langdown A, Auld J, Vizesi F, Bruce W. Comparison of poly-L-lactide and polylactide carbonate interference screws in an ovine anterior cruciate ligament reconstruction model. Arthroscopy 2007; 23:757-65, 765.e1-2. [PMID: 17637412 DOI: 10.1016/j.arthro.2007.01.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 01/23/2007] [Accepted: 01/30/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare polylactide carbonate (PLC) interference screws with poly-L-lactide (PLLA) screws in an ovine anterior cruciate ligament reconstruction model. METHODS A PLC screw or PLLA screw was placed in the center of a 4-strand soft-tissue autograft fixating the graft within the tibial tunnel. Assessments were made at 6 and 12 weeks for fixation strength and at time points of 6, 12, 26, and 52 weeks via computed tomography and histology. RESULTS No adverse or inflammatory reactions were noted for either material at any time point. Mechanical fixation strength increased from 6 to 12 weeks for both the PLC and PLLA screws, with no significant differences in fixation strength being found between the 2 groups. By 26 weeks, the PLC screw was partially replaced by new bone, a process that was completed by 52 weeks. The PLLA screws were intact and surrounded by a fibrous layer at 52 weeks with no obvious resorption. New bone formation within the tendon construct located in the bone tunnel proximal to the interference screw was also noted in the PLC screw group but was not observed in the PLLA group. CONCLUSIONS This study has supported the hypothesis that this bioabsorbable composite has sufficient mechanical properties and strength retention to function successfully as an interference screw but also stimulates a biologic healing response, enabling replacement by bone and tunnel healing. CLINICAL RELEVANCE This study shows both the satisfactory mechanical characteristics and osteoconductive nature of PLC used in an interference screw in an ovine anterior cruciate ligament reconstruction model.
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Affiliation(s)
- William R Walsh
- Surgical & Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Sydney, Australia.
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56
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Cheng I, Oshtory R, Wildstein MS. The Role of Osteobiologics in Spinal Deformity. Neurosurg Clin N Am 2007; 18:393-401. [DOI: 10.1016/j.nec.2007.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen B, Lin H, Wang J, Zhao Y, Wang B, Zhao W, Sun W, Dai J. Homogeneous osteogenesis and bone regeneration by demineralized bone matrix loading with collagen-targeting bone morphogenetic protein-2. Biomaterials 2007; 28:1027-35. [PMID: 17095085 DOI: 10.1016/j.biomaterials.2006.10.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 10/09/2006] [Indexed: 12/26/2022]
Abstract
Considerable research has been focused on the development of bone morphogenetic protein-2 (BMP-2) delivery system for homologous and efficient bone regeneration. The aim of the present study was to develop a collagen-based targeting bone repair system. A collagen-binding domain (CBD) was added to the N-terminal of native BMP-2 to allow it bind to collagen specifically. We showed that the collagen-binding bone morphogenetic protein-2 (named bone morphogenetic protein2-h, BMP2-h) had maintained the full biological activity as compared to rhBMP2 lacking the CBD. In vitro functional study also demonstrated that collagen matrix could maintain higher bioactivity of BMP2-h than native BMP-2. When demineralized bone matrix (DBM) impregnated with BMP2-h was implanted subcutaneously in rats, homogeneous bone formation was observed. Moreover, in a rabbit mandible defect model, surgical implantation of collagen matrix loaded with BMP2-h exhibited remarkable osteoinductive properties and excellent homogeneous bone formation. Our studies suggested that this novel collagen-based BMP-2 targeting bone repair system induced better bone formation not only in quantity but also in quality. Similar approaches may also be used for the repair of other tissue injuries.
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Affiliation(s)
- Bing Chen
- Key Laboratory of Molecular and Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 3 Nanyitiao, Zhongguancun, Beijing 100080, China
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58
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Andrade AL, Andrade SP, Domingues RZ. In vivo performance of a sol-gel glass-coated collagen. J Biomed Mater Res B Appl Biomater 2006; 79:122-8. [PMID: 16615070 DOI: 10.1002/jbm.b.30521] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Synthetic bioactive materials offer possibilities to repair large tissue defects. It is well known that bioactivity, angiogenesis, and inflammation are key events in implant incorporation. Using glass-coated and glass-free collagen as potential bone graft substitutes, we carried out in vitro bioactivity and an in vivo angiogenesis and inflammation studies. The in vitro study showed bioactivity when the glass-coated samples were left in SBF for 5 days. This was confirmed by FTIR results, which presented P--O vibration bands characteristic of hydroxyapatite close to 1060 cm(-1) and 600 cm(-1). The in vivo response was evaluated following subcutaneous implantation of the biomaterial in the mouse dorsa. Angiogenesis, as determined by hemoglobin content extracted from implants 7 and 14 days after implantation, increased progressively in both glass-coated and glass-free collagen implants. However, vascularization was higher in the glass-coated collagen implants 14 days after implantation (mug Hb per mg wet tissue 6.0 +/- 0.3) compared with the glass-free group (1.6 +/- 0.1). The inflammatory process, determined by the levels of myeloperoxidase and N-acetylglucosaminidase, was similar for both implants. This study shows that glass-coated collagen implants hold osteogenic and angiogenic potential and may be used in clinical conditions requiring improvement of these biological processes.
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Affiliation(s)
- Angela Leão Andrade
- Department of Chemistry-ICEX, Federal University of Minas Gerais, CP 702, CEP 31270-901, Belo Horizonte, MG, Brazil
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Hokugo A, Sawada Y, Sugimoto K, Fukuda A, Mushimoto K, Morita S, Tabata Y. Preparation of prefabricated vascularized bone graft with neoangiogenesis by combination of autologous tissue and biodegradable materials. Int J Oral Maxillofac Surg 2006; 35:1034-40. [PMID: 16965895 DOI: 10.1016/j.ijom.2006.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2004] [Revised: 03/10/2006] [Accepted: 06/20/2006] [Indexed: 11/29/2022]
Abstract
Prefabricated vascularized bone grafts have previously been prepared by combining an autologous vessel bundle with auto-particulate cancellous bone and marrow (PCBM) and a biodegradable membrane. Only small quantities of low-density vascularized bone tissue have been formed using this method. The authors of the present study combined beta-tricalcium phosphate (beta-TCP), a biodegradable ceramic, with a prefabricated vascularized bone graft to augment osteogenesis. A saphenous vessel bundle from a rat was wrapped in a biodegradable membrane. Then, autologous PCBM was mixed with beta-TCP granules and packed into the rolled membrane. In the control group, beta-TCP was omitted. Bone formation was histologically assessed 6 and 9 weeks after implantation. The volume of newly formed bone tissue in the rolled membrane was greater in the presence of beta-TCP granules than in the control. Microvessels had formed throughout the new bone tissue. When a prefabricated vascularized bone graft was onlay-grafted to the femur of the same rat, the prefabricated vascularized bone graft directly fused to the cortical surface of the femur, with no intervening fibrous tissue. These findings suggest that beta-TCP in combination with PCBM enhances the volume and density of bone tissue in prefabricated vascularized bone grafts.
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Affiliation(s)
- A Hokugo
- Department of Biomaterials, Field of Tissue Engineering, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
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60
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Abstract
The development of effective bone graft substitutes is one of the most important innovations in musculoskeletal surgery. Bone graft substitutes provide an osteoconductive scaffolding similar to those of autogenous bone. They eliminate donor site morbidity,decrease operative time and complexity and treatment costs, and improve patient satisfaction. Osteoinductive and osteogenic elements may be added to further stimulate and enhance healing and incorporation of the scaffolding substance into the adjacent bone. Bone graft substitutes have proven effective in the spine and larger long bones of the extremities. The continuing development of bone graft substitutes, evaluation of their efficacy relative to autogenous bone grafts and to each other, and their use in the hand and wrist are emerging fields.
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Affiliation(s)
- William B Geissler
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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61
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Eppley BL, Pietrzak WS, Blanton MW. Allograft and alloplastic bone substitutes: a review of science and technology for the craniomaxillofacial surgeon. J Craniofac Surg 2006; 16:981-9. [PMID: 16327544 DOI: 10.1097/01.scs.0000179662.38172.dd] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bone healing is a complex and multifactorial process. As such, there are numerous steps in the process to which intervention can be directed. This has given rise to many bone graft technologies that have been used to regenerate bone, creating, perhaps, a bewildering array of options. The options that surgeons have the most familiarity with are the ones that have been available the longest (i.e., autograft and allograft). Although useful for the widest spectrum of clinical applications, limitations of these grafts has prompted the development of new materials. Demineralized bone matrix formulations and synthetic ceramic materials are now being used with greater frequency. These biomaterials have demonstrated their usefulness in facial plastic and reconstructive surgery with their ability to augment and replace portions of the craniofacial skeleton. The purpose of this article is to describe and discuss the allograft and alloplastic bone grafting technologies so that the reader can consider each in the context of the others and gain a better appreciation for how each fits into the universe of existing and emerging treatments for bone regeneration.
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Affiliation(s)
- Barry L Eppley
- Division of Plastic Surgery, Indiana School of Medicine, Indianapolis, Indiana, USA.
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Bensaïd W, Oudina K, Viateau V, Potier E, Bousson V, Blanchat C, Sedel L, Guillemin G, Petite H. De novo reconstruction of functional bone by tissue engineering in the metatarsal sheep model. ACTA ACUST UNITED AC 2006; 11:814-24. [PMID: 15998221 DOI: 10.1089/ten.2005.11.814] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Large bone defects are still a challenge to orthopedic surgeons. In this study, a massive bone defect with a clinically relevant volume was efficiently reconstructed by transplanting an engineered bone in which mesenchymal stem cells (MSCs) expanded in autologous serum (AS) were combined with a porous scaffold. In the first step, we established that the way in which the MSCs are distributed over the scaffold affects the ultimate bone-forming ability of the transplant: constructs consisting of a natural coral scaffold and a pseudo-periosteal layer of MSCs surrounding the implant (coral-MSC3D) formed significantly more bone than constructs in which the MSCs were distributed throughout the implant (p = 0.01). However, bone healing occurred in only one sheep, owing to the high resorption rate of natural coral scaffold. To overcome this problem, constructs in which MSCs were combined with a porous coralline-based hydroxyapatite (CHA) scaffold having the same architecture as natural coral but a lower resorption rate were prepared. After their implantation, these constructs were found to have the same osteogenic potential as autologous bone grafts in terms of the amount of newly formed bone present at 4 months (p = 0.89) and to have been completely replaced by newly formed, structurally competent bone within 14 months. Nevertheless, although the rate of bone healing was strikingly improved when CHA-MSC3D constructs were used (five of seven animals healed) as compared with the coral-MSC3D construct (one of seven healed), it was still less satisfactory than that obtained with autografts (five of five healed).
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Affiliation(s)
- W Bensaïd
- Laboratoire de Recherches Orthopédiques, UMR-CNRS 7052, Faculté de Médecine Lariboisière Saint-Louis, Université D. Diderot, Paris, France
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63
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Gravel M, Gross T, Vago R, Tabrizian M. Responses of mesenchymal stem cell to chitosan–coralline composites microstructured using coralline as gas forming agent. Biomaterials 2006; 27:1899-906. [PMID: 16293302 DOI: 10.1016/j.biomaterials.2005.10.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Accepted: 10/31/2005] [Indexed: 11/20/2022]
Abstract
Macroporous composites made of coralline:chitosan with new microstructural features were studied for their scaffolding potential in in vitro bone regeneration. By using different ratios of natural coralline powder, as in situ gas forming agent and reinforcing phase, followed by freeze-drying, scaffolds with controlled porosity and pore structure were prepared and cultured with mesenchymal stem cells (MSCs). Their supportive activity of cellular attachment, proliferation and differentiation were assessed through cell morphology studies, DNA content, alkaline phosphatase (ALP) activity and osteocalcin (OC) release. The coralline scaffolds showed by far the highest evaluation of cell number and ALP activity over all the other chitosan-based scaffolds. They were the only material on which the OC protein was released throughout the study. When used as a component of the chitosan composite scaffolds, these coralline's favourable properties seemed to improve the overall performance of the chitosan. Distinct cell morphology and osteoblastic phenotype expression were observed depending on the coralline-to-chitosan ratios composing the scaffolds. The coralline-chitosan composite scaffolds containing high coralline ratios generally showed higher total cell number, ALP activity and OC protein expression comparing to chitosan scaffolds. The results of this study strongly suggest that coralline:chitosan composite, especially those having a high coralline content, may enhance adhesion, proliferation and osteogenic differentiation of MSCs in comparison with pure chitosan. Coralline:chitosan composites could therefore be used as attractive scaffolds for developing new strategies for in vitro tissue engineering.
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Affiliation(s)
- Mylène Gravel
- Centre for Biorecognition and Biosensors and McGill Institute for Advanced Materials, Duff Medical Science Building, 3775 University, Montreal, Canada H3A 2B4
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Hsu CJ, Chou WY, Teng HP, Chang WN, Chou YJ. Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion. J Neurosurg Spine 2005; 3:271-5. [PMID: 16266067 DOI: 10.3171/spi.2005.3.4.0271] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF). METHODS This prospective, case-control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis-induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion-extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups. CONCLUSIONS Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.
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Affiliation(s)
- Chien-Jen Hsu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
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Martina M, Subramanyam G, Weaver JC, Hutmacher DW, Morse DE, Valiyaveettil S. Developing macroporous bicontinuous materials as scaffolds for tissue engineering. Biomaterials 2005; 26:5609-16. [PMID: 15878365 DOI: 10.1016/j.biomaterials.2005.02.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 02/08/2005] [Indexed: 10/25/2022]
Abstract
Calcareous skeletal elements (ossicles) isolated from the seastar, Pisaster giganteus, were characterized and tested as potential biocompatible substrates for cellular attachment. These ossicles have a remarkably robust open-framework architecture with an interconnected network of ca. 10 microm diameter pores. Scanning electron and confocal microscopy was used to characterize the cell-substrate interaction. Cell culturing experiments revealed that the cells firmly attach to the ossicle surface, forming cell aggregates of several layers thick. The anchored cells extended to form 'bridges' between the openings in the bicontinuous framework and the degree of coverage increased as culture time progressed. Osteoblasts grown on the ossicles were found to be viable up to 32 days after initial seeding, as proven by assaying with AlamarBlue and FDA/PI staining indicating the ossicle's potential as an alternative highly effective tissue scaffold. Given the limitation in availability of this natural material, the results presented here should be seen as offering guidelines for future development of synthetic materials with physical and chemical properties strongly conducive to bone repair and restoration.
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Affiliation(s)
- Monique Martina
- Department of Chemistry, Faculty of Science, National University of Singapore, Science Drive 3, Singapore 117543, Singapore
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66
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Abstract
Future devolvement of osteobiologic materials will no doubt replace materials currently being used. As techniques to improve biointegration and manipulation of the healing environment proceed, future graft substitutes may exceed even autogenous bone in their reliability. The primary role of bone graft use in foot and ankle surgery has been to fill traumatic defects and benign tumors or to augment arthrodesis techniques. This article highlights the osteobiologics in use today, including calcium-based ceramics, hydroxyapatite, calcium phosphates and calcium composite materials, collagen composite materials, calcium sulfate, calcium cements, and allograft.
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Affiliation(s)
- Shannon M Rush
- San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, 1425 S. Main Street, Walnut Creek, CA 94596, USA.
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67
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Abstract
The modern study of the regenerative capabilities of skeletal tissues began in 1964, when Marshall Urist discovered that bone devoid of inorganic content and dried into a powder could be implanted into the muscle of a rabbit with resultant ectopic bone formation. Use of this technology is now commonplace, and a plethora of orthobiologic materials are available to the foot and ankle surgeon. The science has even become advanced to the point that custom bone replacements can be fabricated in vitro. This points toward an exciting future for the use of this technology by foot and ankle surgeons.
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Affiliation(s)
- Glenn M Weinraub
- Department of Orthopaedic Surgery, Lewis-Gale Clinic, 1802 Braeburn Drive, Salem, VA 24153, USA.
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68
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Gil-Albarova J, Salinas AJ, Bueno-Lozano AL, Román J, Aldini-Nicolo N, García-Barea A, Giavaresi G, Fini M, Giardino R, Vallet-Regí M. The in vivo behaviour of a sol–gel glass and a glass-ceramic during critical diaphyseal bone defects healing. Biomaterials 2005; 26:4374-82. [PMID: 15701366 DOI: 10.1016/j.biomaterials.2004.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 11/09/2004] [Indexed: 10/26/2022]
Abstract
The in vivo evaluation, in New Zealand rabbits, of a sol-gel glass 70% CaO-30% SiO2 (in mol%) and a glass-ceramic obtained from thermal treatment of the glass, both bioactive in Kokubo's simulated body fluid (SBF), is presented. Femoral bone diaphyseal critical defects were filled with: (i) sol-gel glass cylinders, (ii) glass-ceramic cylinders, or (iii) no material (control group). Osteosynthesis was done by means of anterior screwed plates with an associate intramedullar Kirschner wire. Each group included 10 mature rabbits, 9 months old. Follow-up was 6 months. After sacrifice, macroscopic study showed healing of bone defects, with bone coating over the cylinders, but without evidence of satisfactory repair in control group. Radiographic study showed good implant stability and periosteal growth and bone remodelling around and over the filled bone defect. The morphometric study showed minimum evidences of degradation or resorption in glass-ceramic cylinders, maintaining its original shape, but sol-gel glass cylinders showed abundant fragmentation and surface resorption. An intimate union of the new-formed bone to both materials was observed. Mechanical study showed the higher results in the glass-ceramic group, whereas sol-gel glass and control group showed no differences. The minimum degradation of glass-ceramic cylinders suggests their application in critical bone defects locations of transmission forces or load bearing. The performance of sol-gel glass cylinders suggests their usefulness in locations where a quick resorption should be preferable, considering the possibility of serving as drug or cells vehicle for both of them.
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Affiliation(s)
- Jorge Gil-Albarova
- Hospital Universitario Miguel Servet, Servicio de Cirugía Ortopédica y Traumatología, Universidad de Zaragoza, Zaragoza, Spain
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69
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Abstract
Repair of large bone defects is still a challenge for the orthopaedic, reconstructive and maxillo-facial surgeon. Availability of pluripotent stem cells from either autologous or allogenic sources and the potential of inducing the osteogenic phenotype is motivating exploration and development of custom-tailored materials known as "bioengineered bone constructs". In such cases, the clinical scenario involves either expansion of stem cells in monolayer and loading them into a porous scaffold prior to surgery or direct cell expansion within the scaffold, and implanting this novel construct back into the donor patient. In this review, we delineate, from an engineering perspective, the progress that has been made to date and the challenges remaining in successfully translating this promising (but not yet definitively established) approach from bench to the bed site.
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Affiliation(s)
- D Logeart-Avramoglou
- Laboratoire de Recherches Orthopédiques, Faculté de Médecine Lariboisière Saint-Louis, Université Denis Diderot, Paris, France
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Gil-Albarova J, Garrido-Lahiguera R, Salinas AJ, Román J, Bueno-Lozano AL, Gil-Albarova R, Vallet-Regí M. The in vivo performance of a sol-gel glass and a glass-ceramic in the treatment of limited bone defects. Biomaterials 2005; 25:4639-45. [PMID: 15120510 DOI: 10.1016/j.biomaterials.2003.12.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Accepted: 12/02/2003] [Indexed: 10/26/2022]
Abstract
The in vivo evaluation, in New Zealand rabbits, of a SiO(2)-P(2)O(5)-CaO sol-gel glass and a SiO(2)-P(2)O(5)-CaO-MgO glass-ceramic, both bioactive in Kokubo's simulated body fluid (SBF), is presented. Bone defects, performed in the lateral aspect of distal right femoral epiphysis, 5mm in diameter and 4mm in depth, were filled with (i) sol-gel glass disks, (ii) glass-ceramic disks, or (iii) no material (control group). Each group included 8 mature and 8 immature rabbits. A 4-month radiographic study showed good implant stability without axial deviation of extremities in immature animals and periosteal growth and remodelling around and over the bone defect. After sacrifice, the macroscopic study showed healing of bone defects, with bone coating over the implants. The morphometric study showed a more generous bone formation in animals receiving sol-gel glass or glass-ceramic disks than in control group. Histomorphometric study showed an intimate union of the new-formed bone to the implants. This study allows considering both materials as eligible for bone substitution or repair. Their indications could include cavities filling and the coating of implant surfaces. The minimum degradation of glass-ceramic disks suggests its application in locations of load or transmission forces. As specific indication in growth plate surgery, both materials could be used as material of interposition after bony bridges resection.
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Affiliation(s)
- Jorge Gil-Albarova
- Hospital Universitario Miguel Servet, Servicio de Cirugía Ortopédica y Traumatología, Universidad de Zaragoza, P Isabel La Católica 1-3, Zaragoza 50009, Spain
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71
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Hiu-Yan Y, Ling Q, Kwong-Man L, Ming Z, Kwok-Sui L, Chun-yiu CJ. Novel approach for quantification of porosity for biomaterial implants using microcomputed tomography (μCT). J Biomed Mater Res B Appl Biomater 2005; 75:234-42. [PMID: 16108058 DOI: 10.1002/jbm.b.30240] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Porous bioceramics have been widely investigated in orthopaedic tissue engineering. Attention has been given to manufacturing of a porous bioceramic that mimics the trabecular bone structure for proper bone regeneration. With the advance of biomedical imaging through microcomputed tomography (microCT), this study attempted to quantify the pore structure of different bioceramics. Two bioceramic blocks (BSC and ChronOS) were synthesized by two methods. The specification claimed the porosity of the bioceramic ranged from 40% to 70%. Six blocks of each bioceramic were evaluated by conventional water immersion method and microCT. The pore size and connectivity were evaluated with standardized protocols. By the water immersion method, the porosity of BSC and ChronOS was 60.4% and 74.7%, respectively. The three-dimensional results of microCT showed that BSC porosity was 26.2% and ChronOS was 60.0%. The pore connectivity was evaluated to be 2.6 for BSC and 39.7 for ChronOS. ChronOS had functional pores with 200 microm to 400 microm in diameter (87.8%+/-0.5%), which is significantly more than 52.8%+/-11.5% of pores in BSC (p<0.05). Providing information on the functional pores objectively, the microCT evaluation serves as a good standard for specification of the bioceramic-related implants.
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Affiliation(s)
- Yeung Hiu-Yan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
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72
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Walsh WR, Loefler A, Nicklin S, Arm D, Stanford RE, Yu Y, Harris R, Gillies RM. Spinal fusion using an autologous growth factor gel and a porous resorbable ceramic. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2004; 13:359-66. [PMID: 15034772 PMCID: PMC3468045 DOI: 10.1007/s00586-003-0597-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2002] [Revised: 06/28/2003] [Accepted: 07/02/2003] [Indexed: 11/27/2022]
Abstract
Augmenting healing through a single application of an exogenous growth factor or bone morphogenetic protein is not a new concept. The use of autologous growth factors through platelet isolation and concentration provides multiple endogenous growth factors to the healing site. A posterolateral fusion model in aged sheep (5- to 6-year-old ewes) was used to examine the effects of the addition of growth factors through autologous platelet isolation on the biomechanic and histologic properties of the fusion using a resorbable coral bone graft substitute. At 6 months the combination of autologous growth factors to the Pro Osteon 500R plus aspirated bone marrow resulted in the greatest bending stiffness but not ultimate load. Autologous growth factors can be isolated from platelets and concentrated to provide multiple growth factors to the fusion site to aid in spinal fusion.
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Affiliation(s)
- William R Walsh
- Orthopaedic Research Laboratories, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
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73
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Fredericks DC, Bobst JA, Petersen EB, Nepola JV, Dennis JE, Caplan AI, Burgess AV, Overby RJ, Schulz OH. Cellular interactions and bone healing responses to a novel porous tricalcium phosphate bone graft material. Orthopedics 2004; 27:s167-73. [PMID: 14763552 DOI: 10.3928/0147-7447-20040102-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of a porous tricalcium phosphate bone void filler (Cellplex TCP, Wright Medical Technology, Inc, Arlington, Tenn) as an alternative to autograft in bone grafting was studied in benchtop, in vitro cell culture, and in vivo preclinical studies. The experimental design included material property quantification, scaffold seeding with mesenchymal stem cells, and implantation in a rabbit segmental defect model. Measured material properties denoted appropriate composition, porosity, and strengths as compared to the literature. Fluid uptake studies and mesenchymal stem cell affinity revealed the scaffold's capabilities as a suitable host for osteoprogenitor cells. In a 1-cm rabbit diaphyseal segmental defect stabilized with an external fixator, tricalcium phosphate was compared to intact autograft, crushed autograft, and open defects. Torsional strengths and stiffnesses of tricalcium phosphate-treated tibia were greater than or equivalent to both intact and crushed autograft controls. Tricalcium phosphate pores exhibited complete bony infiltration histologically. Collectively, the tricalcium phosphate material properties, cell seeding capabilities, and in vivo biological responses give evidence of this implant's functionality as a potential alternative for autograft.
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Affiliation(s)
- Douglas C Fredericks
- Bone Healing Research Laboratory, University of lowa College of Medicine, Iowa City, Iowa, USA
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74
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Walsh WR, Chapman-Sheath PJ, Cain S, Debes J, Bruce WJM, Svehla MJ, Gillies RM. A resorbable porous ceramic composite bone graft substitute in a rabbit metaphyseal defect model. J Orthop Res 2003; 21:655-61. [PMID: 12798065 DOI: 10.1016/s0736-0266(03)00012-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The success of converted corals as a bone graft substitute relies on a complex sequence of events of vascular ingrowth, differentiation of osteoprogenitor cells, bone remodeling and graft resorption occurring together with host bone ingrowth into and onto the porous coralline microstructure or voids left behind during resorption. This study examined the resorption rates and bone infiltration into a family of resorbable porous ceramic placed bilaterally in critical sized defects in the tibial metaphyseal-diaphyseal of rabbits. The ceramics are made resorbable by partially converting the calcium carbonate of corals to form a hydroxyapatite (HA) layer on all surfaces. Attempts have been made to control the resorption rate of the implant by varying the HA thickness. New bone was observed at the periosteal and endosteal cortices, which flowed into the centre of the defect supporting the osteoconductive nature of partially converted corals. The combination of an HA layer and calcium carbonate core provides a composite bone graft substitute for new tissue integration. The HA-calcium carbonate composite demonstrated an initial resorption of the inner calcium carbonate phase but the overall implant resorption and bone ingrowth behaviour did not differ with HA thickness.
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Affiliation(s)
- W R Walsh
- Orthopaedic Research Laboratories, Orthopaedic Department, University of New South Wales, Prince of Wales Hospital, Sydney, Australia.
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76
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Abstract
A better understanding of the biology of fracture healing and an increasing awareness of the limitations and potential complications of autogenous bone graft harvest have combined to foster a burgeoning interest in the development of bone graft substitutes. A few of these materials have been available for more than a decade, and many more should become available in the near future. The characteristics of the ideal bone graft substitute may vary considerably depending on the intended site of application and the clinical setting in which it is used. Knowledge of the available alternatives is a necessary prerequisite to informed decision making.
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Affiliation(s)
- John A McAuliffe
- Section of Hand Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
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Bahar H, Yaffe A, Binderman I. The influence of nacre surface and its modification on bone apposition: a bone development model in rats. J Periodontol 2003; 74:366-71. [PMID: 12710757 DOI: 10.1902/jop.2003.74.3.366] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bone graft substitutes are currently used individually or in various combinations in reconstructing bone defects. Nacre, marine mineralized structure, was recently proposed as a very biocompatible and osteoinductive material for use in periodontal and implant surgery. Our aim was to investigate the interaction between natural nacre and fresh bone marrow, during bone development, in an ectopic site of DA rats. Surface modifications of nacre were tested. METHODS Demineralized bone matrix (DBM) cylinders (demineralized cortex of diaphysis) prepared from rat femurs were filled with fresh marrow, which was removed from other 2-month old DA rat femurs. Natural nacre particle or nacre which was treated with HCl, phosphate buffer saline (PBS), and Ca(OH)2 to modify its surface was placed into the DBM cylinders. The cylinders were implanted subcutaneously at the thoracic region of growing DA rats. After 4 weeks the cylinders were surgically removed, fixed in buffered formalin, and x-rayed. Scans of the microradiographs and histological evaluation of the DBM cylinders including bone developed at the interface of nacre and its surface modifications were compared to marrow controls. RESULTS The results show that natural nacre is a poor conductive biomaterial in a bone developmental environment. Nacre surface treated with Ca(OH)2 and PBS was found to be most biocompatible. In this group, new bone was apposed directly on the nacre surface and the total amount of bone was highest in comparison to other treatment groups. CONCLUSIONS This study does not support previous observations that nacre is osseoinductive. Our model system seems to be very sensitive and capable of testing interaction between surface modifications of biomaterials and fresh marrow in the process of new bone development.
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Affiliation(s)
- Hila Bahar
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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78
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Abstract
The ability to harvest iliac crest bone is a well-established skill in the surgical armamentarium of the orthopedic surgeon. As with any surgical procedure, this operation has its own set of complications. The surgeon must be aware of these potential problems in an effort to avoid them when possible. Other autologous sites for bone harvest are available to the surgeon, and s/he should be aware of these in terms of location, limitations of use, harvest technique, and potential pitfalls. The foot and ankle surgeon almost always needs less bone graft than our colleagues in spine surgery or joint revision surgery, so these other sites may be more suitable than the iliac crest for obtaining bone graft. Nonautogenous alternatives are becoming increasingly available to the orthopedist as a way to decrease morbidity and operating times. Scranton recently published an article about his success with several different bone substitute products that are used in foot and ankle reconstructive cases. As these options become more varied, it becomes more difficult to know which product to select. Understanding the biology of bone grafting with respect to osteoconduction, osteoinduction, and osteogenesis provides the surgeon with the knowledge that is needed to make an informed choice when selecting a bone grafting option. Before choosing an alternative graft material, the surgeon should also investigate how the graft material has performed in cases similar to his or her patient's needs. In the future, with continued research, the fields of tissue engineering and gene therapy will provide even better options for nonautogenous bone graft material.
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Affiliation(s)
- David W Boone
- Raleigh Orthopaedic Clinic, 3515 Glenwood Avenue, Raleigh, NC 27612, USA.
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Su GNC, Hidaka M, Kimura Y, Yamamoto G. IN SITU COLLAGEN GELATION: A NEW METHOD FOR CONSTRUCTING LARGE TISSUE IN ROTARY CULTURE VESSELS. ACTA ACUST UNITED AC 2003; 39:368-74. [PMID: 14622034 DOI: 10.1290/1543-706x(2003)039<0368:iscgan>2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In situ collagen gelation is a method that combines a static three-dimensional culture technique with rotating bioreactors. This method was designed for large dense tissue engineering ex vivo. To challenge the current limitations on size, we combined the static collagen gel embedding method with high-aspect ratio rotating bioreactors. Rat calvarial cells in gelated collagens were cultured in rotating vessels with 5 mM beta-glycerophosphate-containing medium for 1, 2, or 3 wk and then analyzed for cell morphology, cell distribution, and viability, as well as for contraction of the collagen gel. The size of collagen gels with rat calvarial cells averaged 2.8 cm in diameter x 0.25 cm in thickness at the end of 3 wk. Scanning electron microscopy and laser scanning confocal microscopy of collagen gels revealed a homogeneous distribution of living cells. Despite the barrier effects from induced calcification, in collagen gels, cell metabolic activity (alkaline phosphatase assay and 3-[4,5-dimethyl-2-thiazolyl]-2,5-diphenyl-2H-tetrazolium bromide assay) increased over the 3 wk, and cell viability (trypan blue exclusion and flow cytometry analysis) remained at about 90% at the end of 3 wk. Based on our results, we determined that in situ collagen gelation provides a feasible method for engineering large dense tissue ex vivo.
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Affiliation(s)
- George Nan-Chang Su
- Department of Oral and Maxillofacial Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
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80
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Taboas JM, Maddox RD, Krebsbach PH, Hollister SJ. Indirect solid free form fabrication of local and global porous, biomimetic and composite 3D polymer-ceramic scaffolds. Biomaterials 2003; 24:181-94. [PMID: 12417192 DOI: 10.1016/s0142-9612(02)00276-4] [Citation(s) in RCA: 545] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Precise control over scaffold material, porosity, and internal pore architecture is essential for tissue engineering. By coupling solid free form (SFF) manufacturing with conventional sponge scaffold fabrication procedures, we have developed methods for casting scaffolds that contain designed and controlled locally porous and globally porous internal architectures. These methods are compatible with numerous bioresorbable and non-resorbable polymers, ceramics, and biologic materials. Phase separation, emulsion-solvent diffusion, and porogen leaching were used to create poly(L)lactide (PLA) scaffolds containing both computationally designed global pores (500, 600, or 800 microm wide channels) and solvent fashioned local pores (50-100 microm wide voids or 5-10 microm length plates). Globally porous PLA and polyglycolide/PLA discrete composites were made using melt processing. Biphasic scaffolds with mechanically interdigitated PLA and sintered hydroxyapatite regions were fabricated with 500 and 600 microm wide global pores. PLA scaffolds with complex internal architectures that mimicked human trabecular bone were produced. Our indirect fabrication using casting in SFF molds provided enhanced control over scaffold shape, material, porosity and pore architecture, including size, geometry, orientation, branching, and interconnectivity. These scaffolds that contain concurrent local and global pores, discrete material regions, and biomimetic internal architectures may prove valuable for multi-tissue and structural tissue interface engineering.
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Affiliation(s)
- J M Taboas
- Department of Oral Medicine, Pathology and Oncology, School of Dentistry, University of Michigan, 1011 N University Ave, Room G-018, Ann Arbor 48109, MI, USA
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81
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Thalgott JS, Klezl Z, Timlin M, Giuffre JM. Anterior lumbar interbody fusion with processed sea coral (coralline hydroxyapatite) as part of a circumferential fusion. Spine (Phila Pa 1976) 2002; 27:E518-25; discussion E526-7. [PMID: 12486360 DOI: 10.1097/00007632-200212150-00011] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of 20 patients undergoing circumferential lumbar fusion with coralline hydroxyapatite blocks anteriorly and autograft with transpedicular or translaminar facet screw fixation posteriorly. OBJECTIVES To examine the efficacy of coralline hydroxyapatite as a bone graft substitute for anterior lumbar interbody fusion. SUMMARY OF BACKGROUND DATA Autograft is the gold standard for bone grafting in the anterior lumbar spine. Harvesting bone from the iliac crest leads to significant postoperative pain and morbidity. Femoral ring allograft is a widely used alternative to autograft but has some inherent problems. Coralline hydroxyapatite was shown to be 100% successful for anterior cervical fusion when combined with rigid plating. METHODS A retrospective review of 20 patients with low back pain and indicated for surgical intervention. A circumferential instrumented fusion was performed with coralline hydroxyapatite blocks anteriorly and transpedicular or translaminar facet fixation and autograft posteriorly. All patients reached a minimum 3-year clinical and radiologic follow-up. RESULTS Radiographic follow-up yielded a solid arthrodesis rate of 93.8% by level (30 of 32 disc spaces) and 90% by patient (18 of 20). Clinical follow-up generated a mean pain reduction of 61.8% with clinical success demonstrated in 80% (16 of 20) of all patients who reported good or excellent pain relief. Eight of 12 (66.7%) patients employed before surgery returned to work in some capacity. CONCLUSIONS Coralline hydroxyapatite is a practicable anterior lumbar interbody fusion alternative to autograft and allograft as part of a circumferential fusion with rigid posterior fixation. It is not recommended for stand-alone anterior lumbar interbody fusion without further study.
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Affiliation(s)
- John S Thalgott
- International Spinal Development & Research Foundation, Las Vegas, NV 89106, USA.
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Lieberman JR, Daluiski A, Einhorn TA. The role of growth factors in the repair of bone. Biology and clinical applications. J Bone Joint Surg Am 2002; 84:1032-44. [PMID: 12063342 DOI: 10.2106/00004623-200206000-00022] [Citation(s) in RCA: 719] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jay R Lieberman
- Department of Orthopaedic Surgery, University of California at Los Angeles Medical Center, 90077, USA
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Abstract
Autogenous bone grafting is the gold standard in repair of bony defects, fracture nonunion, and promoting arthrodesis. The complications related to obtaining autogenous grafts can be significant, and numerous materials are now available for augmentation or substitution. Allograft materials are highly effective for most applications; however, the surgeon needs to be acutely aware of the source of the tissue, for some tissue banks still use unacceptable processing techniques that destroy the structural and osteoinductive capacities of the graft. DBM products are unregulated and serious concerns exist as to the distribution of inactive products as commercially available to the practicing surgeon. Pressure from the orthopedic community has caused some manufacturers to test their products for activity before distribution. Calcium-based ceramic materials are effective as osteoconductive agents and work well alone as bone void fillers; however, augmentation of these implants with osteoinductive materials should be considered for use in nonunions and arthrodesis. Composite materials that incorporate osteoinductive materials in osteoconductive scaffolds are promising. New technology in isolation and creation of recombinant human bone morphogenic proteins and growth factors, and in the application of autogenous stem cells are emerging as the future of bone grafting procedures.
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Affiliation(s)
- V James Sammarco
- Center For Orthopaedic Care, 2123 Auburn Ave., Suite 235, Cincinnati, OH 45219, USA.
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Dayi E, Aslan M, Simşek G, Yilmaz AB. The effects of bone chips dehydrated with solvent on healing bone defects. J Int Med Res 2002; 30:168-73. [PMID: 12025524 DOI: 10.1177/147323000203000209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effect of bone chips dehydrated with solvent on the healing of bone defects was evaluated. Solvent-dehydrated spongiose bone chips were placed in experimentally formed cavities in the right back tibia of rabbits. After 10, 20 and 30 days, histopathological cross-sections from the bone grafts were examined microscopically for bone healing and formation of spongiose bone, cortex and bone marrow. Spongiose bone chips had a positive and accelerating influence on the healing of bone defects in the 10-day period after transplantation, but no significant differences were observed between the treated and control groups 20 and 30 days after transplantation.
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Affiliation(s)
- E Dayi
- Department of Oral and Maxillofacial Surgery, Atatürk University, Erzurum, Turkey.
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Le Huec JC, Clément D, Lesprit E, Faber J. The use of calcium phosphates, their biological properties. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2000. [DOI: 10.1007/bf01682134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Petite H, Viateau V, Bensaïd W, Meunier A, de Pollak C, Bourguignon M, Oudina K, Sedel L, Guillemin G. Tissue-engineered bone regeneration. Nat Biotechnol 2000; 18:959-63. [PMID: 10973216 DOI: 10.1038/79449] [Citation(s) in RCA: 992] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bone lesions above a critical size become scarred rather than regenerated, leading to nonunion. We have attempted to obtain a greater degree of regeneration by using a resorbable scaffold with regeneration-competent cells to recreate an embryonic environment in injured adult tissues, and thus improve clinical outcome. We have used a combination of a coral scaffold with in vitro-expanded marrow stromal cells (MSC) to increase osteogenesis more than that obtained with the scaffold alone or the scaffold plus fresh bone marrow. The efficiency of the various combinations was assessed in a large segmental defect model in sheep. The tissue-engineered artificial bone underwent morphogenesis leading to complete recorticalization and the formation of a medullary canal with mature lamellar cortical bone in the most favorable cases. Clinical union never occurred when the defects were left empty or filled with the scaffold alone. In contrast, clinical union was obtained in three out of seven operated limbs when the defects were filled with the tissue-engineered bone.
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Affiliation(s)
- H Petite
- Laboratoire de Recherches Orthopédiques, CNRS UPRES A 7052, Université D. Diderot, Faculté de Médecine, Lariboisière Saint-Louis, 10 avenue de Verdun, 75010 Paris, France.
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93
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Abstract
The fractures that occur as a result of trauma frequently require multiple stage surgical procedures to achieve adequate union. Bone grafting with autogenous cancellous or cortico cancellous bone grafts is the traditional method used to repair bone defects. Most fractures will heal using this traditional procedure, however a number of fractures, up to 10% of the cases in United States alone, will result in delayed or impaired healing. Novel approaches are currently being investigated for the augmentation and acceleration of fracture healing. Some of these approaches include the use of biodegradable matrices; cell based approaches supplemented with osteogenic factors and genetic therapy. Cell based approaches for fracture healing have roused intense interest because of the great advance in the isolation and expansion of cells from the marrow that have the ability to differentiate into various types of cells including osteoblasts. In addition, the discovery and cloning of several proteins (bone morphogenetic proteins) that have the ability to induce bone formation, have contributed to the investigation of novel approaches to augment fracture healing. Use of genetic therapy for the augmentation of fracture healing has also recently gained strong interest. The attractive feature of gene therapy is that therapeutic proteins can be delivered locally to the fracture site in relatively high concentrations and in a sustained fashion. This review discusses these novel approaches and presents an assessment of their future clinical applicability.
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Affiliation(s)
- C Niyibizi
- University of Pittsburgh School of Medicine, Musculoskeletal Research Center, Department of Orthopaedic Surgery, 200 Lothrop Street, RM C313, Pittsburgh, PA 15213, USA.
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