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Arthroscopic Technique for Bone Augmentation With Suture Button Fixation for Anterior Shoulder Instability. Arthrosc Tech 2019; 9:e97-e102. [PMID: 32021781 PMCID: PMC6993536 DOI: 10.1016/j.eats.2019.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/02/2019] [Indexed: 02/03/2023] Open
Abstract
Glenoid bone loss remains a significant risk factor for recurrent instability after shoulder dislocation. Several options exist for glenoid bone graft augmentation, including autograft and allograft options. Strengths and weaknesses exist for each. Graft fixation with screws remains a key concern for technical viability requiring a medial portal as well as the risk of graft osteolysis. Suture button suspensory fixation is a new technique recently described for arthroscopic iliac crest bone graft; however, no description exists concerning osteochondral graft fixation. We describe an arthroscopic technique for distal tibial allograft glenoid augmentation with suspensory suture button fixation. The rationale and technical aspects of this procedure are discussed.
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Regeneration of a Pediatric Alveolar Cleft Model Using Three-Dimensionally Printed Bioceramic Scaffolds and Osteogenic Agents: Comparison of Dipyridamole and rhBMP-2. Plast Reconstr Surg 2019; 144:358-370. [PMID: 31348344 DOI: 10.1097/prs.0000000000005840] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alveolar clefts are traditionally treated with secondary bone grafting, but this is associated with morbidity and graft resorption. Although recombinant human bone morphogenetic protein-2 (rhBMP-2) is under investigation for alveolar cleft repair, safety concerns remain. Dipyridamole is an adenosine receptor indirect agonist with known osteogenic potential. This study compared dipyridamole to rhBMP-2 at alveolar cleft defects delivered using bioceramic scaffolds. METHODS Skeletally immature New Zealand White rabbits underwent unilateral, 3.5 × 3.5-mm alveolar resection adjacent to the growing suture. Five served as negative controls. The remaining defects were reconstructed with three-dimensionally printed bioceramic scaffolds coated with 1000 μm of dipyridamole (n = 6), 10,000 μm of dipyridamole (n = 7), or 0.2 mg/ml of rhBMP-2 (n = 5). At 8 weeks, new bone was quantified. Nondecalcified histologic evaluation was performed, and new bone was evaluated mechanically. Statistical analysis was performed using a generalized linear mixed model and the Wilcoxon rank sum test. RESULTS Negative controls did not heal, whereas new bone formation bridged all three-dimensionally printed bioceramic treatment groups. The 1000-μm dipyridamole scaffolds regenerated 28.03 ± 7.38 percent, 10,000-μm dipyridamole scaffolds regenerated 36.18 ± 6.83 percent (1000 μm versus 10,000 μm dipyridamole; p = 0.104), and rhBMP-2-coated scaffolds regenerated 37.17 ± 16.69 percent bone (p = 0.124 versus 1000 μm dipyridamole, and p = 0.938 versus 10,000 μm dipyridamole). On histology/electron microscopy, no changes in suture biology were evident for dipyridamole, whereas rhBMP-2 demonstrated early signs of suture fusion. Healing was highly cellular and vascularized across all groups. No statistical differences in mechanical properties were observed between either dipyridamole or rhBMP-2 compared with native bone. CONCLUSION Dipyridamole generates new bone without osteolysis and early suture fusion associated with rhBMP-2 in skeletally immature bone defects.
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Stranix JT, Piper ML, Azoury SC, Kozak G, Ben-Amotz O, Wapner KL, Levin LS. Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419884269. [PMID: 35097345 PMCID: PMC8697073 DOI: 10.1177/2473011419884269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.
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Affiliation(s)
- John T. Stranix
- Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Merisa L. Piper
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Said C. Azoury
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Geoffrey Kozak
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Oded Ben-Amotz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Keith L. Wapner
- Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - L. Scott Levin
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
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Bhamb N, Kanim LEA, Drapeau S, Mohan S, Vasquez E, Shimko D, McKAY W, Bae HW. Comparative Efficacy of Commonly Available Human Bone Graft Substitutes as Tested for Posterolateral Fusion in an Athymic Rat Model. Int J Spine Surg 2019; 13:437-458. [PMID: 31745449 DOI: 10.14444/6059] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Insufficient data exist on bone graft substitute materials efficacy; two thirds lack any clinical data.1,2 This prospective animal study identified efficacy differences among commercially available materials of several classes. Methods Historically validated muscle pouch osteoinduction study (OIS) and posterolateral fusion (PLF) were performed in an athymic rat model. Grafting material products implanted were demineralized bone matrix (DBM)-based allografts (Accell EVO3, DBX Mix, DBX Strip, Grafton Crunch, Grafton Flex, Grafton Matrix, Grafton Putty, Magnifuse, and Progenix Plus), allografts (OsteoSponge, MinerOss), cellular allograft (Osteocel Plus), ceramics (Mozaik Strip), or activated ceramics (Actifuse ABX Putty, Vitoss BA). After 4 weeks, OIS specimens were evaluated ex vivo by histologic osteoinductivity. After 8 weeks, PLF ex vivo specimens were evaluated for fusion by manual palpation (FMP), radiography (FXR), and histology (FHISTO). Results OIS: No materials exhibited a rejection reaction on histology. All DBM-based materials exhibited osteoinductive potential as new bone formation at > 88% of implanted sites. One plain allograft (OsteoSponge) formed bone at 25% of sites. No bone formed for one ceramic (Mozaik Strip), three activated ceramics (Actifuse ABX Putty), or one cellular allograft, regardless of human bone marrow aspirate (hBMA) when added. PLF: Among the 10 DBMs, 6 had FMP of 100% (Accell EVO3, DBX Mix, DBX Strip, Grafton Flex, Grafton Putty, Magnifuse), 2 had FMP of 94% (Grafton Crunch, Grafton Matrix), and 2 conditions had FMP of 0% (Progenix Plus, Progenix Plus + athymic rat iliac crest bone graft [arICBG]). Ceramics (Mozaik Strip), activated ceramics (Actifuse ABX Putty, Vitoss BA), plain allograft (OsteoSponge, MinerOss (PLF study), and cellular allograft (Osteocel Plus) demonstrated 0% FMP. ArICBG demonstrated 13% FMP. Conclusions Eight DBM-based materials (Accell EVO3, DBX Mix, DBX Strip, Grafton Crunch, Grafton Flex, Grafton Matrix, Grafton Putty, Magnifuse) demonstrated excellent (> 90% FMP) efficacy in promoting fusion via bone healing. Two DBM conditions (Progenix Plus, Progenix Plus + arICBG) showed no manual palpation fusion (FMP). Systematically, over the 2 studies (OIS and PLF), cellular (Osteocel Plus), plain allografts (OsteoSponge, MinerOss; PLF study), ceramic (Mozaik Strip), and activated ceramics (Actifuse ABX Putty, Vitoss BA) demonstrated poor FMP efficacy (< 10%). Clinical Relevance When selecting DBMs, clinicians must be cognizant of variability in DBM efficacy by product and lot. While theoretically osteoinductive, cellular allograft and activated ceramics yielded poor in vivo efficacy. Whole allograft and ceramics may provide osteoconductive scaffolding for mixed-material grafting; however, surgeons should be cautious in using them alone. Direct clinical data are needed to establish efficacy for any bone graft substitute.
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Affiliation(s)
- Neil Bhamb
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Linda E A Kanim
- Translational and Clinical Research, Spine Center, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | | | - Hyun W Bae
- Cedars-Sinai Medical Center, Los Angeles, California
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Cianciosi A, Costantini M, Bergamasco S, Testa S, Fornetti E, Jaroszewicz J, Baldi J, Latini A, Choińska E, Heljak M, Zoccali C, Cannata S, Święszkowski W, Diaz Lantada A, Gargioli C, Barbetta A. Engineering Human-Scale Artificial Bone Grafts for Treating Critical-Size Bone Defects. ACS APPLIED BIO MATERIALS 2019; 2:5077-5092. [DOI: 10.1021/acsabm.9b00756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Marco Costantini
- Department of Chemistry, University of Rome “La Sapienza”, 00185 Rome, Italy
- Institute of Physical Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland
| | - Sara Bergamasco
- Department of Chemistry, University of Rome “La Sapienza”, 00185 Rome, Italy
| | - Stefano Testa
- Department of Biology, Rome University Tor Vergata, 00133 Rome, Italy
| | - Ersilia Fornetti
- Department of Biology, Rome University Tor Vergata, 00133 Rome, Italy
| | - Jakub Jaroszewicz
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 00-661 Warsaw, Poland
| | - Jacopo Baldi
- IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Alessandro Latini
- Department of Chemistry, University of Rome “La Sapienza”, 00185 Rome, Italy
| | - Emilia Choińska
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 00-661 Warsaw, Poland
| | - Marcin Heljak
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 00-661 Warsaw, Poland
| | - Carmine Zoccali
- IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Stefano Cannata
- Department of Biology, Rome University Tor Vergata, 00133 Rome, Italy
| | - Wojciech Święszkowski
- Faculty of Materials Science and Engineering, Warsaw University of Technology, 00-661 Warsaw, Poland
| | - Andrés Diaz Lantada
- Mechanical Engineering Department, Universidad Politécnica de Madrid, 28006 Madrid, Spain
| | - Cesare Gargioli
- Department of Biology, Rome University Tor Vergata, 00133 Rome, Italy
| | - Andrea Barbetta
- Department of Chemistry, University of Rome “La Sapienza”, 00185 Rome, Italy
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Tao C, Lina X, Changxuan W, Cong L, Xiaolan Y, Tao H, Hong A. Orthogonal test design for the optimization of superparamagnetic chitosan plasmid gelatin microspheres that promote vascularization of artificial bone. J Biomed Mater Res B Appl Biomater 2019; 108:1439-1449. [PMID: 31605570 PMCID: PMC7187448 DOI: 10.1002/jbm.b.34491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/06/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
Abstract
The optimal conditions for the preparation of superparamagnetic chitosan plasmid (pReceiver‐M29‐VEGF165/DH5a) gelatin microspheres (SPCPGMs) were determined. Then, the performance of the SPCPGMs during neovascularization was evaluated in vivo. The SPCPGMs were prepared through a cross‐linking curing method and then filled into the hollow scaffold of an artificial bone. Neovascularization at the bone defect position was histologically examined in samples collected 2, 4, 6, and 8 weeks after the operation. The cellular magnetofection rate of superparamagnetic chitosan nanoparticles/plasmid (pReceiver‐M29‐VEGF165/DH5a) complexes reached 1–3% under static magnetic field (SMF). Meanwhile, the optimal conditions for SPCPGM fabrication were 20% Fe3O4 (w/v), 4 mg of plasmid, 5.3 mg of glutaraldehyde, and 500 rpm of emulsification rotate speed. Under oscillating magnetic fields (OMFs), 4–6 μg of plasmids was released daily for 21 days. Under the combined application of SMF and OMF, evident neovascularization occurred at the bone defect position 6 weeks after the operation. This result is expected to provide a new type of angiogenesis strategy for the research of bone tissue engineering.
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Affiliation(s)
- Chen Tao
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R China, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy
| | - Xie Lina
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R China, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy
| | - Wang Changxuan
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R China, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy
| | - Luo Cong
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R China, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy
| | - Yang Xiaolan
- Department of Pharmacology, Chongqing Medical University, Yuzhong District, Yixueyuan Road1#, Chongqing, 400016, China
| | - Huang Tao
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R China, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy
| | - An Hong
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Youyi Road 1#, Chongqing, 400016, China
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Human Umbilical Vein Endothelial Cells (HUVECs) Co-Culture with Osteogenic Cells: From Molecular Communication to Engineering Prevascularised Bone Grafts. J Clin Med 2019; 8:jcm8101602. [PMID: 31623330 PMCID: PMC6832897 DOI: 10.3390/jcm8101602] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022] Open
Abstract
The repair of bone defects caused by trauma, infection or tumor resection is a major clinical orthopedic challenge. The application of bone grafts in orthopedic procedures is associated with a problem of inadequate vascularization in the initial phase after implantation. Meanwhile, the survival of cells within the implanted graft and its integration with the host tissue is strongly dependent on nutrient and gaseous exchange, as well as waste product removal, which are effectuated by blood microcirculation. In the bone tissue, the vasculature also delivers the calcium and phosphate indispensable for the mineralization process. The critical role of vascularization for bone healing and function, led the researchers to the idea of generating a capillary-like network within the bone graft in vitro, which could allow increasing the cell survival and graft integration with a host tissue. New strategies for engineering pre-vascularized bone grafts, that apply the co-culture of endothelial and bone-forming cells, have recently gained interest. However, engineering of metabolically active graft, containing two types of cells requires deep understanding of the underlying mechanisms of interaction between these cells. The present review focuses on the best-characterized endothelial cells-human umbilical vein endothelial cells (HUVECs)-attempting to estimate whether the co-culture approach, using these cells, could bring us closer to development and possible clinical application of prevascularized bone grafts.
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Healing of Bone Defects in Pig's Femur Using Mesenchymal Cells Originated from the Sinus Membrane with Different Scaffolds. Stem Cells Int 2019; 2019:4185942. [PMID: 31662765 PMCID: PMC6791246 DOI: 10.1155/2019/4185942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/08/2019] [Accepted: 07/14/2019] [Indexed: 12/15/2022] Open
Abstract
Objective Repairing bone defects, especially in older individuals with limited regenerative capacity, is still a big challenge. The use of biomimetic materials that can enhance the restoration of bone structure represents a promising clinical approach. In this study, we evaluated ectopic bone formation after the transplantation of human maxillary Schneiderian sinus membrane- (hMSSM-) derived cells embedded within various scaffolds in the femur of pigs. Methods The scaffolds used were collagen, gelatin, and hydroxyapatite/tricalcium phosphate (HA/βTCP) where fibrin/thrombin was used as a control. Histological analysis was performed for the new bone formation. Quantitative real-time PCR (qRT-PCR) and immunohistochemistry (IHC) were used to assess mRNA and protein levels of specific osteoblastic markers, respectively. Results Histological analysis showed that the three scaffolds we used can support new bone formation with a more pronounced effect observed in the case of the gelatin scaffold. In addition, mRNA levels of the different tested osteoblastic markers Runt-Related Transcription Factor 2 (RUNX-2), osteonectin (ON), osteocalcin (OCN), osteopontin (OPN), alkaline phosphatase (ALP), and type 1 collagen (COL1) were higher, after 2 and 4 weeks, in cell-embedded scaffolds than in control cells seeded within the fibrin/thrombin scaffold. Moreover, there was a very clear and differential expression of RUNX-2, OCN, and vimentin in osteocytes, osteoblasts, hMSSM-derived cells, and bone matrix. Interestingly, the osteogenic markers were more abundant, at both time points, in cell-embedded gelatin scaffold than in other scaffolds (collagen, HA/βTCP, fibrin/thrombin). Conclusions These results hold promise for the development of successful bone regeneration techniques using different scaffolds embedded with hMSSM-derived cells. This trial is registered with NCT02676921.
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209
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Autogenous Iliac Crest Bone Grafting for the Treatment of Fracture Nonunion Is Equally Effective in Elderly and Nonelderly Patients. J Am Acad Orthop Surg 2019; 27:696-703. [PMID: 30628999 DOI: 10.5435/jaaos-d-18-00322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Autogenous iliac crest bone graft (ICBG) is considered the benchmark graft for nonunion repair. However, ICBG harvest is invasive and may provide reduced benefit to elderly patients. The purpose of this study was to compare the clinical and functional outcomes of ICBG use in fixation of fracture nonunions between elderly and nonelderly patients. METHODS Over a 13-year period, 242 patients who underwent operative repair of a long bone fracture nonunion and received autogenous ICBG were enrolled in a prospective research registry and followed. Data collected included patient demographics, injury information, and nonunion management. All patients had a minimum of 12 months of postoperative follow-up. Patients at least 65 years of age were classified as elderly, whereas younger patients were classified as nonelderly. Functional outcomes were evaluated at routine intervals postoperatively using the short musculoskeletal function assessment (SMFA) and visual analog scale pain scores. Bony union was determined radiographically. All postoperative complications were recorded. RESULTS Of the 242 patients included, 44 were elderly and 198 were nonelderly. No differences were found between groups with respect to postoperative pain scores or SMFA scores. Furthermore, time to union, rate of union, and postoperative complication rate did not differ between groups. Multivariate linear regression demonstrated that older age was not associated with time to union, postoperative pain scores, or postoperative SMFA scores after controlling for possible confounding variables. DISCUSSION The use of ICBG in nonunion repair among elderly patients is as effective as use in younger patients with a long bone nonunion. Concerns of increased postoperative complications and decreased rate of union in elderly patients receiving ICBG for treatment of fracture nonunion should be alleviated. ICBG remains the benchmark graft for nonunion repair among all age groups.
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210
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Kanack M, Krasnoff C, Daly L, Laurence V, Jaffurs D. Trends in Alveolar Bone Grafting and the Use of Recombinant Bone Morphogenetic Protein (RhBMP) in the United States. JOURNAL OF ADVANCED ORAL RESEARCH 2019. [DOI: 10.1177/2320206819863938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To gather information about current practices and assess the opinions, preferences, and clinical knowledge of surgeons who perform alveolar bone grafts. In addition, surgical training differences in correlation to techniques and outcomes are evaluated. Methods: A survey with both multiple choice and narrative answers regarding surgeons’ practices for alveolar bone grafting was designed and sent via email to members of the American Cleft Palate/Craniofacial Association (ACPA) identified as general craniofacial or oral maxillofacial surgeons. Responses were collected via an anonymous online survey tool. Participants: Members (336) of ACPA identified as craniofacial or oral-maxillofacial surgeons were contacted, and 62 responses were recorded. Results: The majority of survey respondents were oral-maxillofacial surgeons in practice for more than 15 years. 98.4% of respondents had used iliac crest and at least one additional source for grafting, while only 52.7% had performed grafting using recombinant bone morphogenetic protein (RhBMP). 82% used cone beam CT as their evaluation of choice for graft assessment and the majority (62.9%) waited more than 8 weeks postoperatively to image. Chi-square analysis demonstrated significantly longer time in practice for practitioners without craniofacial fellowship training. Conclusions: The results of this study demonstrate that there remains significant variation in alveolar bone grafting practices among surgeons. While some consensus exists, new innovations and technologies will require continued evaluation of surgical practices and outcomes. Long-term follow-up studies are needed especially with regard to the use of RhBMP in alveolar clefts.
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Affiliation(s)
- Melissa Kanack
- Department of Plastic Surgery, University of California, Irvine, Orange, CA, USA
| | - Chloe Krasnoff
- School of Medicine, University of California, Irvine, CA, USA
| | - Lauren Daly
- Division of Plastic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Vincent Laurence
- Providence Medical Group Plastic Surgery Services, Missoula, MT, USA
| | - Daniel Jaffurs
- Department of Plastic Surgery, University of California, Irvine, Orange, CA; Chair of Plastic Surgery, Children’s Hospital of Orange County (CHOC), Orange, CA, USA
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Daniels TR, Anderson J, Swords MP, Maislin G, Donahue R, Pinsker E, Quiton JD. Recombinant Human Platelet-Derived Growth Factor BB in Combination With a Beta-Tricalcium Phosphate (rhPDGF-BB/β-TCP)-Collagen Matrix as an Alternative to Autograft. Foot Ankle Int 2019; 40:1068-1078. [PMID: 31170812 DOI: 10.1177/1071100719851468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Joint arthrodesis often employs autograft to promote union; graft harvesting can lead to perioperative morbidity. A Canadian randomized controlled trial (RCT) demonstrated that recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) combined with beta-tricalcium phosphate (β-TCP)-collagen was a safe, effective alternative to autograft. This multicenter North American RCT compared the safety and efficacy of rhPDGF-BB/β-TCP-collagen with autograft for ankle and hindfoot fusion. Subclassification using propensity scores (PS) incorporated patients from previous trials for enhanced statistical power for noninferiority testing and broader review of treatments. METHODS Patients requiring ankle or hindfoot arthrodesis and supplemental bone graft were treated with rhPDGF-BB/β-TCP-collagen (n = 69) or autograft (n = 35). Outcomes included joint fusion on computed tomography (24 weeks), clinical healing status, visual analog scale (VAS) pain, Short-Form 12 (SF-12), American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, and Foot Function Index (FFI) scores over 52 weeks. PS methodology addressed potential selection bias arising from pooling data among these patients and 2 previous RCTs with similar inclusion criteria, surgical techniques, graft harvest techniques, and outcomes. All 132 rhPDGF-BB/β-TCP-collagen-treated patients and 167 of 189 candidate autograft-treated controls were selected for comparison by an independent statistician blinded to outcomes. RESULTS In the PS subclassification, 68.1% treatment patients and 68.4% controls achieved >50% osseous bridging at fusion sites. Clinical healing status was achieved in 84.8% of treated patients and 90.7% of controls at 52 weeks. Clinical, functional, and quality of life results demonstrated noninferiority of rhPDGF-BB/β-TCP-collagen to autograft. Safety-related outcomes were equivalent. CONCLUSION PS subclassification analysis of 3 RCTs demonstrated that rhPDGF-BB/β-TCP-collagen was as effective as autograft for ankle and hindfoot fusions, with less pain and morbidity than treatment with autograft. LEVEL OF EVIDENCE Level I, prospective randomized study.
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Affiliation(s)
- Timothy R Daniels
- 1 Division of Orthopaedic Surgery, St. Michael's Hospital, and University of Toronto, Toronto, ON, Canada
| | - John Anderson
- 2 Orthopaedic Associates of Michigan, Grand Rapids, MI, USA
| | | | - Greg Maislin
- 4 Biomedical Statistical Consulting, Wynnewood, PA, USA
| | - Rafe Donahue
- 5 Wright Medical Technology, Inc, Franklin, TN, USA
| | - Ellie Pinsker
- 1 Division of Orthopaedic Surgery, St. Michael's Hospital, and University of Toronto, Toronto, ON, Canada
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Lin K, Sheikh R, Romanazzo S, Roohani I. 3D Printing of Bioceramic Scaffolds-Barriers to the Clinical Translation: From Promise to Reality, and Future Perspectives. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E2660. [PMID: 31438561 PMCID: PMC6747602 DOI: 10.3390/ma12172660] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022]
Abstract
In this review, we summarize the challenges of the three-dimensional (3D) printing of porous bioceramics and their translational hurdles to clinical applications. The state-of-the-art of the major 3D printing techniques (powder-based and slurry-based), their limitations and key processing parameters are discussed in detail. The significant roadblocks that prevent implementation of 3D printed bioceramics in tissue engineering strategies, and medical applications are outlined, and the future directions where new research may overcome the limitations are proposed. In recent years, there has been an increasing demand for a nanoscale control in 3D fabrication of bioceramic scaffolds via emerging techniques such as digital light processing, two-photon polymerization, or large area maskless photopolymerization. However, these techniques are still in a developmental stage and not capable of fabrication of large-sized bioceramic scaffolds; thus, there is a lack of sufficient data to evaluate their contribution. This review will also not cover polymer matrix composites reinforced with particulate bioceramics, hydrogels reinforced with particulate bioceramics, polymers coated with bioceramics and non-porous bioceramics.
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Affiliation(s)
- Kang Lin
- Biomaterials Design and Tissue Engineering Lab, School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Rakib Sheikh
- Biomaterials Design and Tissue Engineering Lab, School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sara Romanazzo
- Biomaterials Design and Tissue Engineering Lab, School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Iman Roohani
- Biomaterials Design and Tissue Engineering Lab, School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia.
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213
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Ross M, McKenzie J, Couzens G. The Lister's tubercle trapdoor: a minimally invasive technique for harvesting cancellous bone from the distal radius. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:179-182. [PMID: 31375998 DOI: 10.1007/s00590-019-02523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/30/2019] [Indexed: 11/29/2022]
Abstract
Bone graft harvest from the distal radius, immediately proximal to the Lister's tubercle, is a common technique in upper limb surgery. Here, we present a minimally invasive technique to harvest bone graft using a replaceable, well vascularized access trapdoor. The hinged trapdoor technique allows a small incision over Lister's tubercle and does not violate the fibro-osseous tunnel of the third compartment. Nearby structures like the superficial radial nerve, extensor carpi radialis brevis and extensor pollicis longus are safely protected throughout. Closure of the trapdoor creates a smooth surface and therefore little or no surrounding trauma.
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Affiliation(s)
- Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Level 9, 259 Wickham Tce, Brisbane, QLD, 4000, Australia. .,The Princess Alexandra Hospital, Brisbane, QLD, Australia. .,School of Medicine, The University of Queensland, St Lucia, QLD, Australia.
| | - Jamie McKenzie
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Level 9, 259 Wickham Tce, Brisbane, QLD, 4000, Australia.,The Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gregory Couzens
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Level 9, 259 Wickham Tce, Brisbane, QLD, 4000, Australia.,The Princess Alexandra Hospital, Brisbane, QLD, Australia
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214
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Raghuram A, Singh A, Chang DK, Nunez M, Reece EM. Bone Grafts, Bone Substitutes, and Orthobiologics: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:190-199. [PMID: 31384235 DOI: 10.1055/s-0039-1693020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As reconstructive needs often extend past the soft tissue alone, a plastic surgeon must also be well versed in the methods of bony reconstruction. Understanding of the basic science of fracture healing and the biochemical mechanisms of the different bone grafts, bone substitutes, and orthobiologics is essential to selecting among the many different options available to the modern plastic surgeon. This review provides a broad overview of these different options and the specific applications for plastic surgeons based on anatomic location.
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Affiliation(s)
| | - Aspinder Singh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniel K Chang
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Mervin Nunez
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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215
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Rohman E, Gronbeck K, Tompkins M, Mittelsteadt M, Kirkham JA, Arciero RA. Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site. Am J Sports Med 2019; 47:2469-2477. [PMID: 31310727 DOI: 10.1177/0363546519861965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. HYPOTHESIS The scapular spine's harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. STUDY DESIGN Descriptive laboratory study. METHODS The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. RESULTS The scapular spine has 81.5 mm of harvestable length and a "flare" located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. CONCLUSION/CLINICAL RELEVANCE The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base.
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Affiliation(s)
- Eric Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Gronbeck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopaedic Center, Bloomington, Minnesota, USA
| | - Marcus Mittelsteadt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - James A Kirkham
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert A Arciero
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
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216
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Soo SY, Satterthwaite JD, Ashley M. Initial management and long-term follow up after the rehabilitation of a patient with severe dentoalveolar trauma: A case report. Dent Traumatol 2019; 36:84-88. [PMID: 31355992 DOI: 10.1111/edt.12504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/01/2022]
Abstract
Dental trauma is common and for patients who suffer significant oral injuries, rehabilitation can be challenging to the clinical team. This case report describes the successful prosthetic replacement of multiple missing teeth lost due to severe dentoalveolar trauma, using iliac crest bone grafting, an implant-retained removable dental prosthesis and implant-supported crowns. Good functionality and aesthetic outcome were achieved.
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Affiliation(s)
- Suet Yeo Soo
- Faculty of Dentistry, The National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | | | - Martin Ashley
- School of Dentistry, The University of Manchester, Manchester, UK
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217
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Haws BE, Khechen B, Patel DV, Yoo JS, Guntin JA, Cardinal KL, Ahn J, Singh K. Impact of Iliac Crest Bone Grafting on Postoperative Outcomes and Complication Rates Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. Neurospine 2019; 16:772-779. [PMID: 31284335 PMCID: PMC6944998 DOI: 10.14245/ns.1938006.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/07/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The relationship between bone graft technique and postoperative outcomes for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has not been well-defined. This study aims to determine the effect of iliac crest bone grafting (ICBG) on patient-reported outcomes (PROs) and complication rates following MIS TLIF. METHODS Primary, single-level MIS TLIF patients were consecutively analyzed. Patients that prospectively received a percutaneous technique of ICBG were compared to patients that retrospectively received bone morphogenetic protein-2 (BMP-2). Complication rates were assessed perioperatively and up to 1 year postoperatively. Changes in Oswestry Disability Index (ODI), visual analogue scale (VAS) back, and VAS leg pain were compared. Rates of minimum clinically important difference (MCID) achievement at final follow-up for ODI, VAS back, and VAS leg scores were compared. RESULTS One hundred forty-nine patients were included: 101 in the BMP-2 cohort and 48 in the ICBG cohort. The ICBG cohort demonstrated increases in intraoperative blood loss and shorter lengths of stay. ICBG patients also experienced longer operative times, though this did not reach statistical significance. No significant differences in complication or reoperation rates were identified. The ICBG cohort demonstrated greater improvements in VAS leg pain at 6-week and 12-week follow-up. No other significant differences in PROs or MCID achievement rates were identified. CONCLUSION Patients undergoing MIS TLIF with ICBG experienced clinically insignificant increases in intraoperative blood loss and did not experience increases in postoperative pain or disability. Complication and reoperation rates were similar between groups. These results suggest that ICBG is a safe option for MIS TLIF.
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Affiliation(s)
- Brittany E Haws
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Benjamin Khechen
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Dil V Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jordan A Guntin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kaitlyn L Cardinal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Junyoung Ahn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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218
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Cross DJ, DiDomenico LA. Calcaneal Bone Graft Procedures: An Analysis of Postsurgical Complications. J Foot Ankle Surg 2019; 58:730-733. [PMID: 31053381 DOI: 10.1053/j.jfas.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this article is to examine complications in patients who underwent bone grafting from the calcaneus between December 2001 and June 2010. This retrospective, single-practice study included 247 procedures in 242 patients, including 200 (82.64%) female and 42 (17.36%) male patients, ranging in age from 13 to 89 (median 49) years. Overall, the incidence of experiencing any form of complication was 2.43% (6 of 247); these included 5 (2.02%) feet that displayed donor site sural neuritis and 1 (0.41) that displayed a painful, hypertrophic scar at the donor site. The only statistically significant risk factor associated with the development of a calcaneal donor site complication was white race (being African American was protective). These findings indicate that procurement of autogenous bone graft from the calcaneus, as described in this report, is safe and dependable with a low incidence of complications, and irritation of the sural nerve is the most common complication associated with the procedure. Further clinical and long-term follow-up studies controlling for confounding variables need to be performed to fully determine the overall safety and efficacy of this procedure.
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Affiliation(s)
| | - Lawrence A DiDomenico
- Section Chief, Department of Podiatry, Department of Surgery, St. Elizabeth Health Center, Youngstown, OH.
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219
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Biomechanical analysis of proximal tibia bone grafting and the effect of the size of osteotomy using a validated finite element model. Med Biol Eng Comput 2019; 57:1823-1832. [PMID: 31197751 DOI: 10.1007/s11517-019-01988-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Harvesting bone graft from the proximal tibia is gaining popularity, with lower complication rates and adequate quantity of cancellous bone. The amount of harvested bone is dependent on the size of the cortical window introduced via osteotomy onto the proximal tibia, and its mechanical strength after surgery could be compromised. The aim of the study was to investigate the proximal tibia's mechanical stability after bone harvesting and the effect of varying window sizes using a validated finite element model. Two cadaveric tibiae were tested with bone strains measured for different circular cortical window diameters (10-25 mm). Sixteen finite element models of the intact and harvested tibia were simulated and validated with experimental data. The experimental and predicted max/min principal bone strains were fitted into regression models and showed good correlations. It was predicted the maximum principal bone stresses were greatest and concentrated at postero-inferior and antero-superior regions of the cortical window. A stress line progressed from the edge of the window to the posterior side of the tibia, which became more prominent with the increase of size of the cortical window. It was found that large circular osteotomies for bone harvesting at the proximal tibia induced stress concentrations and stress lines which could lead to eventual failure. Graphical abstract The formation of a stress line in the harvested tibia initiated from the postero-inferior edge of the window and progressed to the medial side. The stress line became more prominent with the increase of the size of the cortical window from 10 to 25 mm in diameter.
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220
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McNeil D, Wong IH. Arthroscopic Glenoid Bone Grafting: Preserving the Subscapularis—A Reproducible Technique. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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221
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Rogowska-Tylman J, Locs J, Salma I, Woźniak B, Pilmane M, Zalite V, Wojnarowicz J, Kędzierska-Sar A, Chudoba T, Szlązak K, Chlanda A, Święszkowski W, Gedanken A, Łojkowski W. In vivo and in vitro study of a novel nanohydroxyapatite sonocoated scaffolds for enhanced bone regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:669-684. [DOI: 10.1016/j.msec.2019.01.084] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
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222
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Goz V, Buser Z, D’Oro A, Wang C, Yoon ST, Park JB, Youssef JA, Meisel HJ, Wang JC, Brodke DS. Complications and Risk Factors Using Structural Allograft Versus Synthetic Cage: Analysis 17 783 Anterior Cervical Discectomy and Fusions Using a National Registry. Global Spine J 2019; 9:388-392. [PMID: 31218196 PMCID: PMC6562209 DOI: 10.1177/2192568218797096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the rates of perioperative complications in patients undergoing anterior cervical discectomy and fusion (ACDF) with allograft versus synthetic cage. METHODS A large national administrative health care database was queried for ACDF procedures performed between 2007 and 2014 using ICD-9 (International Statistical Classification of Diseases, 9th revision) and CPT (Current Procedural Terminology) codes. Cases that utilized structural allograft and synthetic cages were identified via CPT codes. Gender, age, frequency of obesity, cigarette use, diabetes, and number of levels fused were compared between the 2 cohorts using χ2 test. Complications within 90 days were identified via ICD-9 codes and compared between the 2 cohorts. Revision rates within 2 years were noted. RESULTS A total of 10 648 ACDF cases using synthetic cages and 7135 ACDFs using structural allograft were identified. The demographics between the 2 cohorts were similar. Overall complication rate was 8.71% in the synthetic cage group compared with 7.76% in the structural allograft group (P < .01). Use of synthetic cage was associated with higher rate of respiratory complications, 0.57% compared with 0.31% in the structural allograft cohort (P = .03), while use of structural allograft was associated with a higher rate of dysphagia, 0.64% compared with 0.33% (P < .01). Revision rate at 2 years was 0.50% and 0.56% in the synthetic cage and allograft groups, respectively (P = .03). CONCLUSIONS This data suggests that synthetic cages are associated with a marginally higher overall rate of complications with similar revision rates.
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Affiliation(s)
- Vadim Goz
- Department of Orthopaedic Surgery, University of Utah, Salt Lake
City, UT, USA
| | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | - Anthony D’Oro
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Jong-Beom Park
- Uijongbu St. Mary’s Hospital, The Catholic University of Korea
School of Medicine, Uijongbu, Korea
| | - Jim A. Youssef
- Durango Orthopedic Associates, P.C./Spine Colorado, Durango, CO,
USA
| | | | | | - Darrel S. Brodke
- Department of Orthopaedic Surgery, University of Utah, Salt Lake
City, UT, USA
- Darrel S. Brodke, University of Utah, 590
Wakara Way, Salt Lake City, UT 84108, USA.
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223
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Liu K, Wang Y, Sun Y, Qi X, Tian L, Zhao Y, Xu Y, Liu X. [Masquelet technique combined with artificial dermis for the treatment of bone and soft tissue defects in rabbits]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:578-585. [PMID: 31090351 PMCID: PMC8337203 DOI: 10.7507/1002-1892.201811020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/11/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the effect of Masquelet technique combined with artificial dermis on repairing bone and soft tissue defects in rabbits, and to observe the microstructure and vascularization of induced membrane, so as to guide the clinical treatment of Gustilo-Anderson type Ⅲ open fracture with large bone defect and soft tissue defect. METHODS Eighty male rabbits, weighing 2.03-2.27 kg (mean, 2.11 kg), were selected. The bilateral thighs of 64 rabbits were randomly divided into experimental group and control group, the remaining 16 rabbits were sham operation group. Bone and soft tissue defect models of femur were made in all rabbits. In the experimental group, the first stage of Masquelet technique was used [polymethyl methacrylate bone cement was filled in bone defect area] combined with artificial dermis treatment; in the control group, the first stage of Masquelet technique was used only; in the sham operation group, the wound was sutured directly without any treatment. Four rabbits in sham operation group and 16 rabbits in the experimental group and control group were sacrificed at 2, 4, 6, and 8 weeks after operation, respectively. The induced membranes and conjunctive membranes were observed on both sides of the femur. The membrane structure was observed by HE staining, and the microvessel density (MVD) was counted by CD34 immunohistochemical staining. RESULTS Gross observation showed that the spongy layer of collagen in the artificial dermis of the experimental group disappeared completely at 4 weeks after operation, and the induced membrane structure of the experimental group and the control group was complete; the membrane structure of the control group was translucent, and the membrane structure of the experimental group was thicker, light red opaque, accompanied by small vessel proliferation. The membrane structure of the experimental group and the control group increased gradually from 6 to 8 weeks after operation. In the sham operation group, only scar tissue proliferation was observed over time. HE staining showed that a large number of muscle fibers and a small amount of collagen fibers proliferation with inflammatory cell infiltration could be seen in the experimental group and the control group at 2 weeks after operation; most of the sham operation group were muscle fibers with a small amount of interfibrous vessels. At 4 weeks after operation, collagen fibers increased and some blood vessels formed in the experimental group. The nuclei of collagen fibers in the control group were round-like, while those in the experimental group were flat-round. At 6 and 8 weeks after operation, the collagen fibers in the experimental group and the control group increased. The nuclei of the collagen fibers in the control group were still round-like. The nuclei of the collagen fibers in the experimental group were fusiformis and deeply stained compared with those in the control group. The proliferation of blood vessels was observed in both groups, and the number of proliferation vessels in the experimental group was increased compared with that in the control group. In the sham operation group, a large number of fibroblasts still appeared, but no significant proliferation of blood vessels with time was observed. CD34 immunohistochemical staining showed that MVD in each group increased gradually with the prolongation of time after operation. MVD in the sham operation group was significantly higher than that in the experimental group and the control group at 2 weeks after operation, and significantly smaller than that in the experimental group and the control group at 4, 6, and 8 weeks after operation ( P<0.05). MVD in the experimental group was significantly higher than that in the control group at 4 and 6 weeks after operation ( P<0.05), but there was no significant difference in MVD between the two groups at 2 and 8 weeks ( P>0.05). CONCLUSION Masquelet technique combined with artificial dermis in the treatment of femoral bone defect and soft tissue defect in rabbits can significantly promote the vascularization of membrane structure at 4-6 weeks after operation. The combination of these two methods has guiding significance for the treatment of Gustilo-Anderson type Ⅲ open fracture with bone and soft tissue defects.
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Affiliation(s)
- Kui Liu
- No.2 Department of Traumatic Orthopedics, the Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University (Shijiazhuang Orthopaedic Hospital), Shijiazhuang Hebei, 050000,
| | - Yueming Wang
- Rheumatology and Immunology Department of Traditional Chinese Medicine, No. 256 Hospital of Chinese PLA, Shijiazhuang Hebei, 050000, P.R.China
| | - Yichong Sun
- No.2 Department of Traumatic Orthopedics, the Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University (Shijiazhuang Orthopaedic Hospital), Shijiazhuang Hebei, 050000, P.R.China
| | - Xiaoming Qi
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050000, P.R.China
| | - Lijun Tian
- No.2 Department of Traumatic Orthopedics, the Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University (Shijiazhuang Orthopaedic Hospital), Shijiazhuang Hebei, 050000, P.R.China
| | - Yanbin Zhao
- No.2 Department of Traumatic Orthopedics, the Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University (Shijiazhuang Orthopaedic Hospital), Shijiazhuang Hebei, 050000, P.R.China
| | - Ying Xu
- No.2 Department of Traumatic Orthopedics, the Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University (Shijiazhuang Orthopaedic Hospital), Shijiazhuang Hebei, 050000, P.R.China
| | - Xing Liu
- No.2 Department of Traumatic Orthopedics, the Third Hospital of Shijiazhuang City Affiliated to Hebei Medical University (Shijiazhuang Orthopaedic Hospital), Shijiazhuang Hebei, 050000, P.R.China
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Mahajan RK, Srinivasan K, Singh M, Jain A, Kapadia T, Tambotra A. Management of Post-Traumatic Composite Bone and Soft Tissue Defect of Leg. Indian J Plast Surg 2019; 52:45-54. [PMID: 31456612 PMCID: PMC6664845 DOI: 10.1055/s-0039-1688097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Management of composite defects of leg following trauma requires a planned ortho-plastic approach right from the outset. Timely, planned intervention results in reduced amputation rates and improved limb salvage and function. Right from the time of presentation of the patient to the emergency with such injury, the process of decision making in terms of salvage or amputation, local flap cover/free flap cover, bone reconstruction first or soft tissue or both combined, come into play. Guidelines on management are unclear for such defects, a literature search yielding various methods being used by different authors. This article is a review of current literature on management of composite leg defects. A summary of the literature search in terms of various management options given by various authors including the rationale, advantages and disadvantages of each strategy has been provided in this article. The management protocol and method followed by the author in his institute for management of such composite defects have been described in detail. The article seeks to provide readers with an understanding of the management strategies so that appropriate method could be chosen to provide best result.
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Affiliation(s)
- Ravi K Mahajan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Krishnan Srinivasan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Mahipal Singh
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Adish Jain
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Taha Kapadia
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
| | - Ankush Tambotra
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital and Clinics, Amritsar, Punjab, India
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Hiratsuka T, Uezono M, Takakuda K, Kikuchi M, Oshima S, Sato T, Suzuki S, Moriyama K. Enhanced bone formation onto the bone surface using a hydroxyapatite/collagen bone-like nanocomposite. J Biomed Mater Res B Appl Biomater 2019; 108:391-398. [PMID: 31038277 DOI: 10.1002/jbm.b.34397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/24/2019] [Accepted: 04/17/2019] [Indexed: 11/06/2022]
Abstract
The process of bone formation onto the bone surface using a hydroxyapatite/collagen bone-like nanocomposite (HAp/Col) was investigated. Immersion tests were performed to evaluate the impact of pH on the degradation of the specimens in an aqueous environment. The specimens were soaked in aqueous solutions of pH 4.0, 5.0, and 7.0. Using standardized images, the top-view areas of the specimens were measured. Animal experiments were performed to investigate the bone formation process onto the bone surface. The specimens were placed under the rat calvarial periosteum, and μCT image analysis and histological observation were performed on samples harvested on postoperative Days 3, 5, and 7. In all experiments, β-tricalciumphosphate (β-TCP) was adopted as the control. HAp/Col turned to gel in acidic environments below pH 5.0. In contrast to the β-TCP, the HAp/Col specimens placed under the periosteum expanded and attained a hollow structure with a gel-filled center, accompanied by larger volume of new bone and appearance of TRAP-positive multinucleated cells on postoperative Day 5. Therefore, HAp/Col can enhance bone formation onto the bone surface via induction of TRAP-positive multinucleated cells, and may have clinical applications.
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Affiliation(s)
- Taizo Hiratsuka
- Department of Maxillofacial Orthognathics, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayoshi Uezono
- Department of Maxillofacial Orthognathics, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Takakuda
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masanori Kikuchi
- Bioceramics Group, Research Center for Functional Materials, National Institute for Materials Science, Ibaraki, Japan
| | - Sho Oshima
- Bioceramics Group, Research Center for Functional Materials, National Institute for Materials Science, Ibaraki, Japan.,Major in Industrial Science, Graduate School of Science and Engineering, Ibaraki University, Ibaraki, Japan
| | - Taira Sato
- Bioceramics Group, Research Center for Functional Materials, National Institute for Materials Science, Ibaraki, Japan.,Department of Applied Chemistry, Graduate School of Science and Technology, Meiji University, Kanagawa, Japan
| | - Shoichi Suzuki
- Department of Maxillofacial Orthognathics, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Moriyama
- Department of Maxillofacial Orthognathics, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
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226
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Wegmann K, Knowles NK, Lalone EE, Hackl M, Müller LP, King GJW, Athwal GS. The shape match of the olecranon tip for reconstruction of the coronoid process: influence of side and osteotomy angle. J Shoulder Elbow Surg 2019; 28:e117-e124. [PMID: 30713058 DOI: 10.1016/j.jse.2018.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The integrity of the coronoid process is critical to maintaining elbow stability. Unreconstructible fractures and chronic coronoid deficiency are challenging clinical problems with no clear solution. The purposes of this study were to investigate the shape match of the ipsilateral and contralateral olecranon tips as graft options and to determine the influence of the osteotomy angle on fitment. METHODS Nineteen paired cadaveric elbow joints were investigated by 3-dimensional digital analysis of computed tomography DICOM (Digital Imaging and Communications in Medicine) data. After construction of an ulnar coordinate system, the ipsilateral and contralateral olecranon tips were digitally harvested at 10°, 20°, 30°, 40°, 50°, and 60° osteotomy angles. In an overlay analysis, we compared the shape match of the ipsilateral and contralateral grafts and the different angles. RESULTS The ipsilateral grafts showed an average mismatch of 1.8 mm (standard deviation, 1.38 mm), whereas the contralateral grafts had a significantly lower (P < .001) mean mismatch of 1.3 mm (standard deviation, 0.95 mm). The 50° osteotomy plane showed the best shape match in comparison with the native coronoid-in both the ipsilateral and contralateral grafts. Evaluation of the intraclass correlation coefficient was calculated at r = 0.944, showing high repeatability of the measurements. CONCLUSIONS The contralateral olecranon tip graft showed significantly better shape matching to the native coronoid than the ipsilateral olecranon graft. Specifically, the contralateral graft more closely matched the biomechanically critical anteromedial coronoid facet. Finally, both the contralateral and ipsilateral olecranon grafts had better shape matching with the native coronoid when osteotomy was performed at higher angles, specifically 50°.
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Affiliation(s)
- Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
| | - Nikolas K Knowles
- Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Emily E Lalone
- Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - Graham J W King
- Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - George S Athwal
- Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
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227
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Yoshida Y, Matsubara H, Fang X, Hayashi K, Nomura I, Ugaji S, Hamada T, Tsuchiya H. Adipose-derived stem cell sheets accelerate bone healing in rat femoral defects. PLoS One 2019; 14:e0214488. [PMID: 30921414 PMCID: PMC6438603 DOI: 10.1371/journal.pone.0214488] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/13/2019] [Indexed: 12/15/2022] Open
Abstract
In the present study, we investigated whether both adipose-derived stem cell (ADSC) and osteogenic-induced ADSC sheets could promote bone healing in a rat distal femoral metaphysis bone defect model. A through-hole defect of 1 mm diameter was drilled into each distal femur of 12 week old rats. Forty-five rats were randomly assigned to three groups: (1) control group; (2) ADSC sheet group; or (3) osteogenic-induced ADSC sheet group. We evaluated each group by analysis of computerized tomography scans every week after the surgery, histological analysis, and DiI labeling (a method of membrane staining for post implant cell tracing). Radiological and histological evaluations showed that a part of the hole persisted in the control group at four weeks after surgery, whereas the hole was restored almost completely by new bone formation in both sheet groups. The mean value of bone density (in Houndsfield units) for the bone defect area was significantly higher in both sheet groups than that in the control group (p = 0.05) at four weeks postoperative. A large number of osteocalcin positive osteoblasts were observed at the area of bone defect, especially in the osteogenic-induced ADCS sheet group. DiI labeling in the newly formed bone showed that each sheet had differentiated into bone tissue at four weeks after surgery. The ADSC and the osteogenic-induced ADSC sheets promoted significantly quicker bone healing in the bone defect. Moreover, the osteogenic-induced ADSC sheet may be more advantageous for bone healing than the ADSC sheet because of the higher number of osteocalcin positive osteoblasts via the transplantation.
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Affiliation(s)
- Yasuhisa Yoshida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Xiang Fang
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Issei Nomura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Shuhei Ugaji
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Tomo Hamada
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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228
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Grey ZJ, Howie RN, Durham EL, Hall SR, Helke KL, Steed MB, LaRue AC, Muise-Helmericks RC, Cray JJ. Sub-clinical dose of bone morphogenetic protein-2 does not precipitate rampant, sustained inflammatory response in bone wound healing. Wound Repair Regen 2019; 27:335-344. [PMID: 30805987 DOI: 10.1111/wrr.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/04/2023]
Abstract
Large bone injuries, defects, and chronic wounds present a major problem for medicine. Several therapeutic strategies are used clinically to precipitate bone including a combination therapy delivering osteoinductive bone morphogenetic protein 2 (rhBMP-2) via an osteoconductive scaffold (absorbable collagen sponge [ACS], i.e., INFUSE). Adverse side effects reportedly associated with rhBMP2 administration include rampant inflammation and clinical failures. Although acute inflammation is necessary for proper healing in bone, inflammatory cascade dysregulation can result in sustained tissue damage and poor healing. We hypothesized that a subclinical dose of rhBMP2 modeled in the murine calvarial defect would not precipitate alterations to inflammatory markers during acute phases of bone wound healing. We utilized the 5 mm critical size calvarial defect in C57BL6 wild-type mice which were subsequently treated with ACS and a subclinical dose of rhBMP2 shown to be optimal for healing. Three and 7-day postoperative time points were used to assess the role that rhBMP-2 plays in modulating inflammation vs. ACS alone by cytokine array and histological interrogation. Data revealed that rhBMP-2 delivery resulted in substantial modulation of several markers associated with inflammation, most of which decreased to levels similar to control by the 7-day time point. Additionally, while rhBMP-2 administration increased macrophage response, this peptide had a little noticeable effect on traditional markers of macrophage polarization (M1-iNOS, M2-Arg1). These results suggest that rhBMP-2 delivered at a lower dose does not precipitate rampant inflammation. Thus, an assessment of dosing for rhBMP-2 therapies may lead to better healing outcomes and less surgical failure.
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Affiliation(s)
- Zachary J Grey
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - R Nicole Howie
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Emily L Durham
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah Rose Hall
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kristi L Helke
- Department of Comparative Medicine, Medical University of South Carolina, Division of Lab Animal Resources 30 Courtenay Drive, Charleston, South Carolina
| | - Martin B Steed
- Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Amanda C LaRue
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina.,Department of Veterans Affairs, Ralph H. Johnston Veterans Affairs Medical Center, Charleston, South Carolina
| | - Robin C Muise-Helmericks
- Department of Regenerative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - James J Cray
- Division of Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio
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Huang J, Chi H, Chi H, Qiu L, Wang Y, Qiu Z, Zhang J, Liu X, Yan J. Stromal Cell-Derived Factor 1 Promotes Cell Migration to Enhance Bone Regeneration After Hypoxic Preconditioning. Tissue Eng Part A 2019; 25:1300-1309. [PMID: 30582421 DOI: 10.1089/ten.tea.2018.0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPACT STATEMENT Current tissue engineering strategies have progressed recently from a historical approach that is based primarily on biomaterials to a cell- and tissue-based approach. Essentially all orthopedic tissue engineering strategies can be distilled to a strategy or combination of strategies that seek to increase the number or relative performance of bone-forming cells. In our study, we explored a "cell guidance" approach using a chemokine, SDF-1α, to promote cell migration to the central scaffold, to enhance bone regeneration. In our opinion, SDF-1α is a promising candidate for in situ recruitment of bone-forming cells in regenerative therapies under hypoxia precondition.
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Affiliation(s)
- Jiaqi Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Hui Chi
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Haiyang Chi
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Lirong Qiu
- Department of Operating Theatre, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Yufu Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Zhaowen Qiu
- Heilongjiang Tuomeng Technology Co. Ltd., Harbin, P.R. China
| | - Jian Zhang
- Heilongjiang Tuomeng Technology Co. Ltd., Harbin, P.R. China
| | - Xiaoqi Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Jinglong Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
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230
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Bou Assaf R, Fayyad-Kazan M, Al-Nemer F, Makki R, Fayyad-Kazan H, Badran B, Berbéri A. Evaluation of the Osteogenic Potential of Different Scaffolds Embedded with Human Stem Cells Originated from Schneiderian Membrane: An In Vitro Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2868673. [PMID: 30766881 PMCID: PMC6350594 DOI: 10.1155/2019/2868673] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 11/07/2018] [Accepted: 01/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Novel treatments for bone defects, particularly in patients with poor regenerative capacity, are based on bone tissue engineering strategies which include mesenchymal stem cells (MSCs), bioactive factors, and convenient scaffold supports. OBJECTIVE In this study, we aimed at comparing the potential for different scaffolds to induce osteogenic differentiation of human maxillary Schneiderian sinus membrane- (hMSSM-) derived cells. Methods. hMSSM-derived cells were seeded on gelatin, collagen, or Hydroxyapatite β-Tricalcium phosphate-Fibrin (Haβ-TCP-Fibrin) scaffolds. Cell viability was determined using an MTT assay. Alizarin red staining method, Alkaline phosphatase (ALP) activity assay, and quantitative real-time PCR analysis were performed to assess hMSSM-derived cells osteogenic differentiation. RESULTS Cell viability, calcium deposition, ALP activity, and osteoblastic markers transcription levels were most striking in gelatin scaffold-embedded hMSSM-derived cells. CONCLUSION Our findings suggest a promising potential for gelatin-hMSSM-derived cell construct for treating bone defects.
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Affiliation(s)
- Rita Bou Assaf
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Beirut, Lebanon
| | - Mohammad Fayyad-Kazan
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon
| | - Fatima Al-Nemer
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon
| | - Rawan Makki
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon
| | - Hussein Fayyad-Kazan
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon
| | - Bassam Badran
- Laboratory of Cancer Biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath- Beirut, Lebanon
| | - Antoine Berbéri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Lebanese University, Beirut, Lebanon
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Abstract
The current standard of care for bone reconstruction, whether secondary to injury, nonunion, cancer resection, or idiopathic bone loss, is autologous bone grafting. Alternatives to autograft and allograft bone substitutes currently being researched are synthetic and natural graft materials that are able to guide bone regeneration. One promising material currently being researched is chitosan, a highly versatile, naturally occurring polysaccharide, derived from the exoskeleton of arthropods that is comprised of glucosamine and N-acetylglucosamine. Research on chitosan as a bone scaffold has been promising. Chitosan is efficacious in bone regeneration due to its lack of immunogenicity, its biodegradability, and its physiologic features. Chitosan combined with growth factors and/or other scaffold materials has proven to be an effective alternative to autologous bone grafts. Additionally, current studies have shown that it can provide the additional benefit of a local drug delivery system. As research in the area of bone scaffolding continues to grow, further clinical research on chitosan in conjunction with growth factors, proteins, and alloplastic materials will likely be at the forefront.
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233
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Wang X, Chu W, Zhuang Y, Shi D, Tao H, Jin C, Dai K, Zhao J, Gan Y. Bone Mesenchymal Stem Cell-Enriched β-Tricalcium Phosphate Scaffold Processed by the Screen-Enrich-Combine Circulating System Promotes Regeneration of Diaphyseal Bone Non-Union. Cell Transplant 2018; 28:212-223. [PMID: 30554525 PMCID: PMC6362520 DOI: 10.1177/0963689718818096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bone non-union after fracture, considered a therapeutic challenge for orthopedics, always needs a reversion surgery, including autograft transplantation (AGT). However, adverse events related to autograft harvest cannot be ignored. Our group designed a novel system called the bone marrow stem cell Screen-Enrich-Combine Circulating System (SECCS) by seeding mesenchymal stem cells (MSCs) into β-tricalcium phosphate (β-TCP) during surgery to thereafter rapidly process bioactive bone implantation. In this retrospective case-control study, 30 non-union patients who accepted SECCS therapy and 20 non-union patients who accepted AGT were enrolled. By SECCS therapy, the MSC-enriched β-TCP particles were implanted into the non-union gap. During the enrichment procedure, a significant proportion of MSCs were screened and enriched from bone marrow into porous β-TCP particles, and the cells possessed the capacity for three-line differentiation and were CD90+/CD105+/CD34-/CD45-. Approximately 82.0±10.7% of MSCs were enriched from 60 mL bone marrow without damaging cell viability, and approximately 11,444.0±6,018 MSCs were transplanted per patient. No implant-related infections occurred in any case. After 9 months of follow-up, 27 patients (90%) in the SECCS group acquired clinical union, compared with 18 patients (90%) in the AGT group (clinical union time, P = 0.064), and postoperative radiographic union score at 9 months post-operation was similar between the two groups. In conclusion, the SECCS could concentrate a large proportion of MSCs from bone marrow to acquire enough effective cells for therapy without in vitro cell culture. Bone substitutes processed by SECCS demonstrated encouraging promotion of bone regeneration and showed a satisfactory clinical curative effect for diaphyseal bone non-union, which was non-inferior to AGT.
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Affiliation(s)
- Xin Wang
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Both these authors contributed equally to this work as co-first authors
| | - WenXiang Chu
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China.,Both these authors contributed equally to this work as co-first authors
| | - YiFu Zhuang
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - DingWei Shi
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - HaiRong Tao
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Chen Jin
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - KeRong Dai
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Jie Zhao
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - YaoKai Gan
- 1 Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shang Hai, P.R. China.,2 Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
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Chen W, Tang K, Tao X, Yuan C, Zhou B. Clavicular non-union treated with fixation using locking compression plate without bone graft. J Orthop Surg Res 2018; 13:317. [PMID: 30541584 PMCID: PMC6292160 DOI: 10.1186/s13018-018-1015-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/21/2018] [Indexed: 11/14/2022] Open
Abstract
Background The articles that have reported on the size at which a segmental defect of clavicular non-union requires bone grafting are scarce. This study evaluated the functional and radiologic results of fixation by locking compression plate (LCP) without bone graft when the defect size is less than 2 cm following bone sclerosis removal for the treatment of clavicular non-union. Methods The study included 17 patients with mid-shaft clavicular non-union. All patients underwent bone sclerosis resection and fixation using LCP without bone graft. The patients were evaluated preoperatively, and after a minimum of 24 months (mean, 44.47 months; range, 24 to 60 months) postoperatively in terms of the disabilities of the arm, shoulder and hand (DASH) score, the Constant-Murley score, and radiography. Results In this study, no patients were lost to follow-up. The mean DASH score improved from 38.76 ± 7.76 (31.00–46.52) points preoperatively to 19.88 ± 7.18 (12.70–27.06) points 2 years postoperatively (P < 0.01). The mean Constant-Murley score improved from 41.59 ± 8.81 (32.78–50.40) points preoperatively to 75.47 ± 13.50 (61.97–88.97) points 2 years postoperatively (P < 0.01). Radiographs revealed fracture union in all patients. No correlations between the defect size and the postoperative Constant-Murley score or between the defect size and the postoperative DASH score were found based on Pearson tests. No complications, particularly acromioclavicular joint complications and sternoclavicular joint complications, were observed. Conclusions In conclusion, we can suggest, from the findings of our study, that bone sclerosis resection and fixation using LCP without bone graft is effective for the treatment of clavicular non-union involving a gap of less than 2 cm and has a low rate of complications.
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Affiliation(s)
- Wan Chen
- Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Kanglai Tang
- Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
| | - Xu Tao
- Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Chengsong Yuan
- Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Binghua Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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Watanabe M, Ohyama A, Ishikawa H, Tanaka A. Three-dimensional bone formation including vascular networks derived from dental pulp stem cells in vitro. Hum Cell 2018; 32:114-124. [DOI: 10.1007/s13577-018-00228-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
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236
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Liu J, Li X, Zhang D, Jiao J, Wu L, Hao F, Qin YX. Acceleration of Bone Defect Healing and Regeneration by Low-Intensity Ultrasound Radiation Force in a Rat Tibial Model. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2646-2654. [PMID: 30286949 DOI: 10.1016/j.ultrasmedbio.2018.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/20/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
The objective was to evaluate the effect of low-intensity pulsed ultrasound (LIPUS)-induced acoustic radiation force on trabecular bone defect repair and healing in a rat tibial model. A uniform surgical defect, 3.5 mm in diameter, was generated in the proximal bilateral tibial region of rats (N = 20). LIPUS was applied to the defects in the left tibia for 20 min every day for 2 wk. Contralateral defects in the right tibia served as a control without active LIPUS treatment. The micro-computed tomography data revealed that LIPUS-treated tibia exhibited higher bone volume/total volume, connectivity density, trabecular number, and bone mineral density and significantly lower trabecular separation. Histomorphometry analysis indicated a similar trend. Mechanical testing data revealed that LIPUS treatment significantly increased bone stiffness relative to that of the control group. Short-term (2-wk) LIPUS therapy initiated trabecular bone repair and regeneration in large trabecular bone defects, whereas cortical bone remained in the initial non-mineralization stage.
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Affiliation(s)
- Jingbo Liu
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA; School of Stomatology, China Medical University, Shenyang, China
| | - Xiaofei Li
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Dongye Zhang
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Jian Jiao
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Lin Wu
- School of Stomatology, China Medical University, Shenyang, China
| | - Fengyu Hao
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA; School of Stomatology, China Medical University, Shenyang, China
| | - Yi-Xian Qin
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.
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Goto K, Naito K, Sugiyama Y, Kinoshita M, Nagura N, Kajihara H, Iwase Y, Kaneko K. Corrective Osteotomy with Autogenous Bone Graft with Callus after Malunion of Distal Radius Fracture. J Hand Surg Asian Pac Vol 2018; 23:571-576. [PMID: 30428805 DOI: 10.1142/s2424835518720323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Corrective osteotomy with callus filling at fracture site for malunion after distal radius fracture is a rare technique, but it achieved a favorable postoperative outcome. The patient, 66-year-old female, visited our hospital 4 months after distal radius fracture. Corrective osteotomy of the distal radius was planned aiming at improving the wrist joint function, and was performed using a volar locking plate, then the bone defect was filled with callus as autogenous bone grafting. At 12 months after surgery, left wrist joint pain and the range of motion have improved, and the Mayo wrist score was excellent. To our knowledge, there has been no study on the treatment of bone defects by filling with callus. Since favorable bone fusion was achieved with callus, this treatment method may overcome the disadvantages of autogenous bone graft, such as pain at the donor region.
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Affiliation(s)
- Kenji Goto
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan.,† Department of Orthopaedic Surgery, Koto Hospital, Tokyo, Japan
| | - Kiyohito Naito
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Yoichi Sugiyama
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Mayuko Kinoshita
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Nana Nagura
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
| | - Hajime Kajihara
- † Department of Orthopaedic Surgery, Koto Hospital, Tokyo, Japan
| | - Yoshiyuki Iwase
- ‡ Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kazuo Kaneko
- * Department of Orthopaedics, Juntendo University School of Medicine, Tokyo Japan
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238
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Pihlman H, Keränen P, Paakinaho K, Linden J, Hannula M, Manninen IK, Hyttinen J, Manninen M, Laitinen-Vapaavuori O. Novel osteoconductive β-tricalcium phosphate/poly(L-lactide-co-e-caprolactone) scaffold for bone regeneration: a study in a rabbit calvarial defect. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:156. [PMID: 30298429 DOI: 10.1007/s10856-018-6159-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/18/2018] [Indexed: 06/08/2023]
Abstract
The advantages of synthetic bone graft substitutes over autogenous bone grafts include abundant graft volume, lack of complications related to the graft harvesting, and shorter operation and recovery times for the patient. We studied a new synthetic supercritical CO2 -processed porous composite scaffold of β-tricalcium phosphate and poly(L-lactide-co-caprolactone) copolymer as a bone graft substitute in a rabbit calvarial defect. Bilateral 12 mm diameter critical size calvarial defects were successfully created in 18 rabbits. The right defect was filled with a scaffold moistened with bone marrow aspirate, and the other was an empty control. The material was assessed for applicability during surgery. The follow-up times were 4, 12, and 24 weeks. Radiographic and micro-CT studies and histopathological analysis were used to evaluate new bone formation, tissue ingrowth, and biocompatibility. The scaffold was easy to shape and handle during the surgery, and the bone-scaffold contact was tight when visually evaluated after the implantation. The material showed good biocompatibility and its porosity enabled rapid invasion of vasculature and full thickness mesenchymal tissue ingrowth already at four weeks. By 24 weeks, full thickness bone ingrowth within the scaffold and along the dura was generally seen. In contrast, the empty defect had only a thin layer of new bone at 24 weeks. The radiodensity of the material was similar to the density of the intact bone. In conclusion, the new porous scaffold material, composed of microgranular β-TCP bound into the polymer matrix, proved to be a promising osteoconductive bone graft substitute with excellent handling properties.
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Affiliation(s)
- Hanna Pihlman
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
| | - Pauli Keränen
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Kaarlo Paakinaho
- Faculty of Medicine and Life Sciences, Biomeditech, University of Tampere, Tampere, Finland
- Orton Orthopaedic Hospital, Helsinki, Finland
| | - Jere Linden
- Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Hannula
- Faculty of Biomedical Science and Engineering, Tampere University of Technology, Tampere, Finland
| | | | - Jari Hyttinen
- Faculty of Medicine and Life Sciences, Biomeditech, University of Tampere, Tampere, Finland
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239
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Optimizing Osteogenic Differentiation of Ovine Adipose-Derived Stem Cells by Osteogenic Induction Medium and FGFb, BMP2, or NELL1 In Vitro. Stem Cells Int 2018; 2018:9781393. [PMID: 30356449 PMCID: PMC6178511 DOI: 10.1155/2018/9781393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 01/27/2023] Open
Abstract
Although adipose-derived stromal cells (ADSCs) have been a major focus as an alternative to autologous bone graft in orthopedic surgery, bone formation potential of ADSCs is not well known and cytokines as osteogenic inducers on ADSCs are being investigated. This study aimed at isolating ADSCs from ovine adipose tissue (AT) and optimizing osteogenic differentiation of ovine ADSCs (oADSC) by culture medium and growth factors. Four AT samples were harvested from two female ovine (Texel/Gotland breed), and oADSCs were isolated and analyzed by flow cytometry for surface markers CD29, CD44, CD31, and CD45. Osteogenic differentiation was made in vitro by seeding oADSCs in osteogenic induction medium (OIM) containing fibroblast growth factor basic (FGFb), bone morphogenetic protein 2 (BMP2), or NEL-like molecule 1 (NELL1) in 4 different dosages (1, 10, 50, and 100 ng/ml, respectively). Basic medium (DMEM) was used as control. Analysis was made after 14 days by Alizarin red staining (ARS) and quantification. This study successfully harvested AT from ovine and verified isolated cells for minimal criteria for adipose stromal cells which suggests a feasible method for isolation of oADSCs. OIM showed significantly higher ARS to basic medium, and FGFb 10 ng/ml revealed significantly higher ARS to OIM alone after 14 days.
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240
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Vascularization converts the lineage fate of bone mesenchymal stem cells to endothelial cells in tissue-engineered bone grafts by modulating FGF2-RhoA/ROCK signaling. Cell Death Dis 2018; 9:959. [PMID: 30237398 PMCID: PMC6147920 DOI: 10.1038/s41419-018-0999-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 01/03/2023]
Abstract
The prevascularization of tissue-engineered bone grafts (TEBGs) has been shown to accelerate capillary vessel ingrowth in bone defect remodeling and to enhance new bone formation. However, the exact mechanisms behind this positive effect remain unknown. Here, we report that basic fibroblast growth factor (FGF2)-Ras homolog gene family member A (RhoA)/Rho-associated protein kinase (ROCK) signaling functions as a molecular switch to regulate the lineage fate of bone mesenchymal stem cells (BMSCs) and that prevascularization promotes the cell fate switch, which contributes to increased bone regeneration with the use of prevascularized TEBGs compared with control TEBGs. Prevascularized TEBGs enhanced the in vivo endothelial differentiation of BMSCs by inhibiting RhoA/ROCK signaling. In vitro data more clearly showed that BMSCs differentiated into von Willebrand factor (vWF)-positive endothelial cells, and FGF2-induced inhibition of RhoA/ROCK signaling played a key role. Our novel findings uncovered a new mechanism that stimulates the increased vascularization of engineered bone and enhanced regeneration by promoting the endothelial differentiation of BMSCs implanted in TEBGs. These results offer a new molecular target to regulate TEBG-induced bone regeneration.
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241
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Abstract
A combination of allogeneic and autologous bone transplants is frequently used for the biological reconstruction of bone defects. Autologous bone transplants can be used either in the form of structural or cancellous bone transplants. The osteogenic potential of autologous cancellous bone is well-known and is still the gold standard with respect to osteoinduction and remodelling. Structural transplants, such as fibular and tricortical iliac crest grafts can be transplanted either free, i.e. non-vascularized or vascularized with anastomosed vessels. Allogeneic bone transplants can be used in a spongiose or structural form. In revision endoprosthetics the use of allogeneic bone transplants has essentially been reduced to impaction grafting, due to the introduction of trabecular metal as a permanently stable substitute. Allogeneic transplants have been restricted due to 3D-printing and the associated individually adapted reconstruction. In individual cases combined reconstruction consisting of allograft and endoprosthesis provide the advantage of safe load transmission and permanent reconstruction by the endoprosthesis and the possibility of soft tissue insertion of the allograft.
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242
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Orth M, Altmeyer M, Scheuer C, Braun B, Holstein J, Eglin D, D'Este M, Histing T, Laschke M, Pohlemann T, Menger M. Effects of locally applied adipose tissue-derived microvascular fragments by thermoresponsive hydrogel on bone healing. Acta Biomater 2018; 77:201-211. [PMID: 30030175 DOI: 10.1016/j.actbio.2018.07.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/13/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022]
Abstract
Insufficient vascularization is a major cause for the development of non-unions. To overcome this problem, adipose tissue-derived microvascular fragments (MVF) may serve as vascularization units. However, their application into bone defects needs a carrier system. Herein, we analyzed whether this is achieved by a thermoresponsive hydrogel (TRH). MVF were isolated from CD-1 mice and cultivated after incorporation into TRH, while non-incorporated MVF served as controls. Viability of MVF was assessed immunohistochemically over a 7-day period. Moreover, osteotomies were induced in femurs of CD-1 mice. The osteotomy gaps were filled with MVF-loaded TRH (TRH + MVF), unloaded TRH (TRH) or no material (control). Bone healing was evaluated 14 and 35 days postoperatively. MVF incorporated into TRH exhibited less apoptotic cells and showed a stable vessel morphology compared to controls. Micro-computed tomography revealed a reduced bone volume in TRH + MVF femurs. Histomorphometry showed less bone and more fibrous tissue after 35 days in TRH + MVF femurs compared to controls. Accordingly, TRH + MVF femurs exhibited a lower osseous bridging score and a reduced bending stiffness. Histology and Western blot analysis revealed an increased vascularization and CD31 expression, whereas vascular endothelial growth factor (VEGF) expression was reduced in TRH + MVF femurs. Furthermore, the callus of TRH + MVF femurs showed increased receptor activator of NF-κB ligand expression and higher numbers of osteoclasts. These findings indicate that TRH is an appropriate carrier system for MVF. Application of TRH + MVF increases the vascularization of bone defects. However, this impairs bone healing, most likely due to lower VEGF expression during the early course of bone healing. STATEMENT OF SIGNIFICANCE In the present study we analyzed for the first time the in vivo performance of a thermoresponsive hydrogel (TRH) as a delivery system for bioactive microvascular fragments (MVF). We found that TRH represents an appropriate carrier for MVF as vascularization units and maintains their viability. Application of MVF-loaded TRH impaired bone formation in an established murine model of bone healing, although vascularization was improved. This unexpected outcome was most likely due to a reduced VEGF expression in the early phase bone healing.
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243
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Seo I, Oh CW, Kim JW, Park KH. Bone Transport over the Plate for the Segmental Bone Defect of Tibia. JOURNAL OF TRAUMA AND INJURY 2018. [DOI: 10.20408/jti.2018.31.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Il Seo
- Regional Trauma Center, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Chang-Wug Oh
- Regional Trauma Center, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon-Woo Kim
- Regional Trauma Center, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyeong-Hyun Park
- Regional Trauma Center, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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244
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Tu C, Xiao Y, Ma Y, Wu H, Song M. The legacy effects of electromagnetic fields on bone marrow mesenchymal stem cell self-renewal and multiple differentiation potential. Stem Cell Res Ther 2018; 9:215. [PMID: 30092831 PMCID: PMC6085613 DOI: 10.1186/s13287-018-0955-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 02/08/2023] Open
Abstract
Background The effects of electromagnetic fields (EMF) on bone nonunion have been reported for many years. Many studies and randomized controlled trials have demonstrated that EMF exhibited benefits in curing delayed union and nonunion of long bone fractures. Most of them focused on the immediate effects, while the legacy effects of EMF remain poorly investigated. Methods In this study, rat bone marrow mesenchymal stem cells (BMSCs) were treated with EMF, and after a period of time the BMSC proliferation and differentiation were detected. Additionally, BMSC sheets with or without EMF treatment were transplanted into the rat tibia fracture nonunion models. The bone formation was evaluated after 2, 4, and 6 weeks. Results Our results showed that the proliferation capacity of BMSCs was heightened after EMF pretreatment. Over a period of time of EMF pretreatment, the capacities of osteogenic and chondrogenic differentiation were enhanced, while adipogenic differentiation was weakened. BMSC sheets pretreated with EMF could better promote the healing of tibia fracture in rats, compared to BMSC sheets alone. Furthermore, significantly higher values of radiographic grading scores were observed in the EMF group. Conclusions EMF has lasting effects on the proliferation and differentiation of BMSCs, and together with cell sheet technology can provide a new method for the treatment of fracture nonunion.
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Affiliation(s)
- Chang Tu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yifan Xiao
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yongzhuang Ma
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Mingyu Song
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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245
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Bykowski MR, Sivak W, Garland C, Cladis FP, Goldstein JA, Losee JE. A Multimodal Preemptive Analgesic Protocol for Alveolar Bone Graft Surgery: Decreased Pain, Hospital Stay, and Health Care Costs. Cleft Palate Craniofac J 2018; 56:479-486. [PMID: 30071750 DOI: 10.1177/1055665618791943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate postoperative pain, hospital length of stay (LOS), and associated costs of multiple perioperative analgesic strategies following alveolar bone grafting (ABG). DESIGN Retrospective comparative cohort study. SETTING Tertiary care pediatric hospital. PATIENTS/PARTICIPANTS Iliac crest bone graft (ICBG) harvest techniques: "Open Harvest" (n = 22), "Trephine Only" (n = 14), or "Trephine + Pain Pump" (n = 25). INTERVENTION The "Open Harvest" group underwent open ICBG harvest with 3-walled osteotomies. For the other 2 treatment groups, a trephine drill was used to harvest iliac crest bone with a ropivacaine infusion pump into the hip donor site ("Trephine + Pain Pump") or without ("Trephine Only"). Patients who underwent ABG with only cadaveric allograft were analyzed as a comparison group ("No Harvest"). MAIN OUTCOMES MEASURES Outcomes were planned prior to data collection: maximum pain score, hospital LOS, and associated health care costs. RESULTS Maximum pain scores were significantly higher in the "Open Harvest" group (7.3/10) compared to "Trephine + Pain Pump" (1.8/10; P < .0001) and "No Harvest" groups (2.8/10; P < .01). Hospital LOS decreased from 2.4 days ("Open Harvest") to 0.5 days (Trephine + Pain Pump"; P < .0001). Twelve (48%) patients from "Trephine + Pain Pump" were discharged on the day of surgery. The "Trephine + Pain Pump" saved an estimated $5336 for a unilateral ABG and $7265 for a bilateral ABG compared to "Open Harvest." CONCLUSIONS The combined use of the trephine ICBG technique and ropivacaine infusion catheter effectively decreased pain, shortened hospital stay, and improved cost saving compared to patients who have undergone other methods of ICBG.
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Affiliation(s)
- Michael R Bykowski
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wesley Sivak
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catharine Garland
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Franklyn P Cladis
- 2 Department of Anesthesiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,3 Division of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph E Losee
- 1 Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,3 Division of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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246
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Prall WC, Saller MM, Scheumaier A, Tucholski T, Taha S, Böcker W, Polzer H. Proliferative and osteogenic differentiation capacity of mesenchymal stromal cells: Influence of harvesting site and donor age. Injury 2018; 49:1504-1512. [PMID: 29941285 DOI: 10.1016/j.injury.2018.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 02/02/2023]
Abstract
Human mesenchymal stromal cells (hMSCs) are the cellular source of new bone formation and an essential component of autologous bone grafts. Autologous bone graft harvesting is routinely conducted at the iliac crest, although alternative donor sites with lower complication rates are available. Thus, the aim of this study was to compare hMSCs harvested from the iliac crest and the proximal tibia regarding their proliferative and osteogenic differentiation capacity. Furthermore, we investigated the influence of donor age on these biological properties. HMSCs were isolated from iliac crest or proximal tibia bone grafts of 46 patients. Proliferative capacity was assessed by cumulative population doublings, population doubling time, colony forming units and cell proliferation assays. Osteogenic capacity was assessed by quantification of extracellular calcium deposition and marker gene expression levels. The number of hMSCs per gram harvested tissue was determined. Furthermore, the adipogenic and chondrogenic differentiation capacity were quantified using BODIPY and Safranin Orange staining, respectively. Additional analyses were carried out after grouping young (18-49 years) and aged (≥50 years) donors. HMSCs derived from the proximal tibia featured a comparable proliferative and osteogenic differentiation capacity. No significant differences were found for any analysis conducted, when compared to hMSCs obtained from the iliac crest. Furthermore, no significant differences could be revealed when comparing young and aged donors. This was equally true for hMSCs from both donor sites after comparison within the same age group. Our study demonstrates comparable biological properties of hMSCs derived from both donor sites, the iliac crest and the proximal tibia. Furthermore, aging does not alter proliferative and osteogenic differentiation capacity. Consequently, the proximal tibia should be considered more closely as an alternative donor site in patients of all age groups.
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Affiliation(s)
- Wolf Christian Prall
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany; Paracelsus Medical University (PMU) Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Maximilian Michael Saller
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - Anna Scheumaier
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - Timo Tucholski
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - Sara Taha
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - Wolfgang Böcker
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - Hans Polzer
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany.
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Abstract
Bone grafting in the upper extremity is an important consideration in patients with injuries or conditions resulting in missing bone stock. A variety of indications can necessitate bone grafting in the upper extremity, including fractures with acute bone loss, nonunions, malunions, bony lesions, and bone loss after osteomyelitis. Selecting the appropriate bone graft option for the specific consideration is important to ensure optimal patient outcomes. Considerations such as donor site morbidity and the amount and characteristics of bone graft needed all weigh in the decision making regarding which type of bone graft to use. This article reviews the options available for bone grafting in the upper extremity.
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248
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Cheng P, Li D, Gao Y, Cao T, Jiang H, Wang J, Li J, Zhang S, Song Y, Liu B, Wang C, Yang L, Pei G. Prevascularization promotes endogenous cell-mediated angiogenesis by upregulating the expression of fibrinogen and connective tissue growth factor in tissue-engineered bone grafts. Stem Cell Res Ther 2018; 9:176. [PMID: 29973254 PMCID: PMC6030739 DOI: 10.1186/s13287-018-0925-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/29/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vascularization is one of the most important processes in tissue-engineered bone graft (TEBG)-mediated regeneration of large segmental bone defects. We previously showed that prevascularization of TEBGs promoted capillary vessel formation within the defected site and accelerated new bone formation. However, the precise mechanisms and contribution of endogenous cells were not explored. METHODS We established a large defect (5 mm) model in the femur of EGFP+ transgenic rats and implanted a β-tricalcium phosphate (β-TCP) scaffold seeded with exogenous EGFP- cells; the femoral vascular bundle was inserted into the scaffold before implantation in the prevascularized TEBG group. Histopathology and scanning electron microscopy were performed and connective tissue growth factor (CTGF) and fibrin expression, exogenous cell survival, endogenous cell migration and behavior, and collagen type I and III deposition were assessed at 1 and 4 weeks post implantation. RESULTS We found that the fibrinogen content can be increased at the early stage of vascular bundle transplantation, forming a fibrin reticulate structure and tubular connections between pores of β-TCP material, which provides a support for cell attachment and migration. Meanwhile, CTGF expression is increased, and more endogenous cells can be recruited and promote collagen synthesis and angiogenesis. By 4 weeks post implantation, the tubular connections transformed into von Willebrand factor-positive capillary-like structures with deposition of type III collagen, and accelerated angiogenesis of endogenous cells. CONCLUSIONS These findings demonstrate that prevascularization promotes the recruitment of endogenous cells and collagen deposition by upregulating fibrinogen and CTGF, directly resulting in new blood vessel formation. In addition, this molecular mechanism can be used to establish fast-acting angiogenesis materials in future clinical applications.
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Affiliation(s)
- Pengzhen Cheng
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Donglin Li
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.,Hospital 463 of People's Liberation Army, Shenyang, 110042, People's Republic of China
| | - Yi Gao
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Tianqing Cao
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Huijie Jiang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Jimeng Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.,Department of Orthopedics, The 251st Hospital of PLA, Zhangjiakou, 075000, China
| | - Junqin Li
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Shuaishuai Zhang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Yue Song
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Bin Liu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Chunmei Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Liu Yang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
| | - Guoxian Pei
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
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Kushioka J, Kaito T, Makino T, Fujiwara H, Tsukazaki H, Takenaka S, Sakai Y, Yoshikawa H. Difference in the fusion rate and bone formation between artificial bone and iliac autograft inside an inter-body fusion cage - A comparison between porous hydroxyapatite/type 1 collagen composite and autologous iliac bone. J Orthop Sci 2018; 23:622-626. [PMID: 29627140 DOI: 10.1016/j.jos.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lateral inter-body fusion (LIF) using cages with a large bone grafting space can lead to a shortage of autologous grafting materials. The use of artificial bone is an option to increase the volume of grafting materials. However, the rate of bony fusion for these materials compared to that of autologous bone is unclear. METHODS The bone fusion rate for artificial bone (HAp/Col) and autologous iliac bone (IBG) graft among 23 patients who had undergone LIF (total 66 disc levels) combined with multilevel posterior corrective fusion for the treatment of adult spinal deformity was retrospectively evaluated. To allow comparison, one of the two separate bone grafting holes in each LIF cage was filled with HAp/Col and the other, with IBG. The change in Hounsfield units (HU) inside the implanted holes at 1-year post surgery (PO1Y) from baseline and immediately after surgery and bony fusion between adjacent vertebrae, defined by the extent of trabecular continuity at PO1Y, were evaluated using computed tomography. Differences between the convex and concave sides as well as effects of the side of approach were investigated. RESULTS HU values increased significantly for IBG, from 228.9 at baseline to 286.1 at PO1Y (p < 0.001), with no change for HAp/Col. The fusion rate was higher for IBG (71.2%) than for HAp/Col (19.7%; p < 0.001). A significant effect of the location of the holes on fusion rate was identified for HAp/Col but not IBG. No effects of the side of approach were identified. CONCLUSIONS A higher rate of fusion in LIF cages was obtained with IBG than with HAp/Col, with no effect of location of implantation (convex or concave) for IBG. Therefore, exclusive use of artificial bone, particularly on the convex side, should be avoided during LIF.
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Affiliation(s)
- Junichi Kushioka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takahiro Makino
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Hiroyuki Tsukazaki
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shota Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Platelet concentrate as an additive to bone allografts: a laboratory study using an uniaxial compression test. Cell Tissue Bank 2018; 19:559-567. [PMID: 29855739 PMCID: PMC6280855 DOI: 10.1007/s10561-018-9704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/25/2018] [Indexed: 11/27/2022]
Abstract
Chemical cleaning procedures of allografts are destroying viable bone cells and denaturing osteoconductive and osteoinductive proteins present in the graft. The aim of the study was to investigate the mechanical differences of chemical cleaned allografts by adding blood, clotted blood; platelet concentrate and platelet gel using a uniaxial compression test. The allografts were chemically cleaned, dried and standardized according to their grain size distribution. Uniaxial compression test was carried out for the four groups before and after compacting the allografts. No statistically significant difference was found between native allografts, allografts mixed with blood, clotted blood, platelet concentrate and platelet concentrate gel regarding their yield limit after compaction. The authors recommend to chemical clean allografts for large defects, optimize their grain size distribution and add platelet concentrate or platelet rich plasma for enhancing as well primary stability as well bone ingrowth.
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