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Cleemann R, Bechtold JE, Sorensen M, Soballe K, Baas J. Dose-Dependent Resorption of Allograft by rhBMP-2 Uncompensated by New Bone Formation-A Canine Study With Implants and Zoledronate. J Arthroplasty 2018; 33:1215-1221.e1. [PMID: 29248483 DOI: 10.1016/j.arth.2017.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Impacted bone allograft is used to restore lost bone in total joint arthroplasties. Bone morphogenetic proteins (BMPs) can induce new bone formation to improve allograft incorporation, but they simultaneously invoke a seemingly dose-dependent allograft resorption mediated by osteoclasts. Bisphosphonates effectively inhibit osteoclast activity. Predicting allograft resorption when augmented with bone morphogenetic protein 2 (BMP-2), we intended to investigate whether a balanced bone metabolism was achievable within a range of BMP-2 doses with systemic zoledronate treatment. METHODS Implants were coated with 1 of 3 BMP-2 doses (15 μg, 60 μg, and 240 μg) or left untreated. Implants were surrounded by a 2.5-mm gap filled with impacted morselized allograft. Each of the 12 dogs included received 1 of each implant (15 μg, 60 μg, 240 μg, and untreated), 2 in each proximal humerus. During the 4-week observation period, zoledronate intravenous (0.1 mg/kg) was administered to all animals 10 days after surgery as anticatabolic treatment. Implant osseointegration was evaluated by histomorphometry and mechanical push-out tests. RESULTS Untreated implants had the best mechanical fixation and superior retention of allograft as compared to any of the BMP-2 implants. Both mechanical implant fixation and retention of allograft decreased significantly with BMP-2 dose increments. Surprisingly, there was no difference among the treatment groups in the amount of new bone. CONCLUSION The use of BMP-2 to augment impaction-grafted implants cannot be recommended even when combined with systemic zoledronate.
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Affiliation(s)
- Rasmus Cleemann
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Mette Sorensen
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Kjeld Soballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Barckman J, Baas J, Sørensen M, Bechtold JE, Soballe K. Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs(). Open Orthop J 2013; 7:18-24. [PMID: 23400644 PMCID: PMC3565231 DOI: 10.2174/1874325001307010018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants. METHODS In each of twelve dogs, we implanted two unloaded cylindrical (10 mm x 6 mm) titanium implants into the distal femur. The implants were surrounded by a 2.5-mm gap into which morselized allograft bone with or without addition of fragmented autologous periosteum was impacted. After four weeks, the animals were euthanized and the implants were evaluated by histomorphometric analysis and mechanical push-out test. RESULTS Although less new bone was found on the implant surface and increased volume of fibrous tissue was present in the gap around the implant, no difference was found between treatment groups regarding the mechanical parameters. Increased new bone formation was observed in the immediate vicinity of the periosteum fragments within the bone graft. CONCLUSION The method for periosteal augmentation used in this study did not alter the mechanical fixation although osseointegration was impaired. The observed activity of new bone formation at the boundary of the periosteum fragments may indicate maintained bone stimulating properties of the transplanted cambium layer. Augmenting the bone graft by smaller fragments of periosteum, isolated cambium layer tissue or cultured periosteal cells could be studied in the future.
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Affiliation(s)
- Jeppe Barckman
- Orthopaedic Research Laboratory, Aarhus University Hospital, Denmark
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Babiker H, Ding M, Sandri M, Tampieri A, Overgaard S. The effects of bone marrow aspirate, bone graft, and collagen composites on fixation of titanium implants. J Biomed Mater Res B Appl Biomater 2012; 100:759-66. [DOI: 10.1002/jbm.b.32509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 10/13/2011] [Accepted: 10/16/2011] [Indexed: 11/09/2022]
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Baas J, Svaneby D, Jensen TB, Elmengaard B, Bechtold J, Soballe K. Coralline hydroxyapatite granules inferior to morselized allograft around uncemented porous Ti implants: unchanged fixation by addition of concentrated autologous bone marrow aspirate. J Biomed Mater Res A 2011; 99:9-15. [PMID: 21793192 DOI: 10.1002/jbm.a.33156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/18/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
Abstract
We compared early fixation of titanium implants grafted with impacted allograft bone or coralline hydroxyapatite (HA) granules (Pro Osteon 200) with and without the addition of concentrated bone marrow cells (BMC). Autologous bone marrow aspirate was centrifuged to increase the BMC concentration. Four nonloaded cylindrical, porous coated titanium implants with a circumferential gap of 2.3 mm were inserted in the proximal humeri of eight dogs. Coralline HA granules +/- BMC were impacted around the two implants on one side, and allograft +/- BMC was impacted around the contra lateral implants. Observation time was 4 weeks. The implants surrounded by allograft bone had a three-fold better fixation than the HA-grafted implants. The concentration of BMC after centrifugation was increased with a factor 2.1. The addition of BMC to either of the bone graft materials had no statistically significant effects on implant fixation. The allografted implants were well osseointegrated, whereas the HA-grafted implants were largely encapsulated in fibrous tissue. The addition of concentrated autologous BMCs to the graft material had no effect on implant fixation. The HA-grafted implants were poorly anchored compared with allografted implants, suggesting that coralline HA granules should be considered a bone graft extender rather than a bone graft substitute.
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Affiliation(s)
- Jorgen Baas
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Build. 1a, 8000 Aarhus C, Denmark.
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Osteogenic protein-1 delivered by hydroxyapatite-coated implants improves bone ingrowth in extracortical bone bridging. Clin Orthop Relat Res 2011; 469:1470-8. [PMID: 20878288 PMCID: PMC3069257 DOI: 10.1007/s11999-010-1573-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 09/01/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Extracortical bone bridging for treatment of massive bone loss can improve stability and longevity of massive endoprostheses. Osteogenic protein-1 (OP-1), when used with allograft bone, reportedly improves extracortical bone bridging and bone ingrowth. QUESTIONS/PURPOSES We asked whether OP-1 delivered by hydroxyapatite (HA) without bone grafting could improve bone ingrowth and bone formation in the context of extracortical bone bridging. METHODS We implanted unilateral segmental femoral diaphyseal replacement prostheses in 18 dogs (three groups of six dogs). The groups consisted of an HA-coated group augmented with OP-1, an HA-coated group, and a plain porous group. Bone grafting techniques were not used to augment bone formation. The implants were retrieved at 12 weeks for histologic assessment. RESULTS After removing one specimen owing to a complication, 17 femora were analyzed (six HA-coated augmented with OP-1, five HA-coated, and six plain). We observed better bone ingrowth in the HA-coated OP-1 group than in the plain porous and HA-coated groups, with no difference between the latter two groups. There also was better bone apposition and callus height in the HA-coated OP-1 group than in the plain group but no differences between the HA-coated OP-1 and HA-coated groups or between the HA-coated and plain groups. CONCLUSIONS OP-1 (2.9 mg) delivered by HA-coated segmental replacement prostheses in this canine extracortical bone bridging model revealed improved bone ingrowth over HA-coated implants without OP-1 or plain porous-coated prostheses.
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Yan MN, Dai KR, Tang TT, Zhu ZA, Lou JR. Reconstruction of peri-implant bone defects using impacted bone allograft and BMP-2 gene-modified bone marrow stromal cells. J Biomed Mater Res A 2010; 93:304-13. [PMID: 19569214 DOI: 10.1002/jbm.a.32464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Impaction bone allografting represents an attractive procedure for bone defects reconstruction in joint replacement. And it was found that bone morphogenetic protein-2(BMP-2) gene therapy can enhance bone healing. The purpose of this study was to determine if combined adenovirus mediated human BMP-2(Adv-hBMP-2) gene-modified bone marrow stromal cells(BMSCs) with allograft enhanced the defects healing and improved the strength of implant fixation in 3-mm bone defect around a titanium alloy implant. Using the impaction grafting technique, the defects were reconstructed using freeze-dried allograft, freeze-dried allografts loaded with autogenous BMSCs, or freeze-dried allografts loaded with autogenous BMSCs modified with the human bone morphogenetic protein-2 (hBMP-2) gene. At 6 and 12 weeks, the Bone-implant Contact rate and strength of the interface in the group with BMP-2 gene medication were significantly higher than those of the non-cell or cell groups. BMP-2 gene medication also showed significant effects on allograft healing and replacement compared with those of two other groups, as evidenced by increased new bone formation and reduced graft remnants. The results suggest that BMP-2 gene medication can enhance allograft healing and osseointegration of the bone-implant interface.
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Affiliation(s)
- Meng-ning Yan
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, People's Republic of China
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Yang X, Jiang B, Huang Y, Tian Y, Chen H, Chen J, Yang B. Collagen nanofilm immobilized on at surfaces by electrodeposition method. J Biomed Mater Res B Appl Biomater 2009; 90:608-13. [DOI: 10.1002/jbm.b.31323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lei P, Zhao M, Hui LF, Xi WM. Bone Morphogenetic Protein-2 and Hyaluronic Acid on Hydroxyapatite-coated Porous Titanium to Repair the Defect of Rabbit’s Distal Femu. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-3-540-92841-6_417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Baas J, Elmengaard B, Bechtold J, Chen X, Søballe K. Ceramic bone graft substitute with equine bone protein extract is comparable to allograft in terms of implant fixation: a study in dogs. Acta Orthop 2008; 79:841-50. [PMID: 19085504 DOI: 10.1080/17453670810016948] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE We studied whether osseointegration and fixation of plasma-sprayed titanium implants grafted with beta-TCP granules (Ossaplast) can be improved by adding an osteogenic signal (Colloss E). The results were compared to implants grafted with fresh frozen morselized allograft with and without the Colloss E device. METHODS 4 porous-coated Ti implants were placed in the proximal humeri in each of 10 dogs. All implants were surrounded by a 2.5-mm defect, which was grafted with: (A) beta-TCP, (B) beta-TCP+20 mg Colloss E, (C) allograft, or (D) allograft+20 mg Colloss E. The observation time was 4 weeks. RESULTS Mechanical testing showed that the beta-TCP group with Colloss E was twice as well fixed as the control group grafted with beta-TCP granules alone, and comparable to both allograft groups. We found that every control implant in the beta-TCP grafted group was covered by a dense fibrous membrane. No fibrous tissue was seen in the beta-TCP group augmented with Colloss. These implants were well osseointegrated, with new bone covering 10-25% of the implant surface. Both treated groups had increased graft resorption compared to their respective control groups. Colloss E had no effect on new bone formation or fibrous tissue reduction around the allografted implants. INTERPRETATION The Colloss E device improved early osseointegration of implants grafted with beta-TCP granules and increased their mechanical implant fixation to the level of allografted implants. The experiment indicates that ceramic bone substitutes may be a viable alternative to allograft when combined with an osteogenic signal such as Colloss E.
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Affiliation(s)
- Jorgen Baas
- Orthopedic Research Laboratory, Aarhus University Hospital, Denmark.
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Heiner AD, Callaghan JJ, Brown TD. Stability differentials for proximal vs distal fusion of total hip arthroplasty femoral impaction grafts. J Arthroplasty 2008; 23:921-6. [PMID: 18534514 PMCID: PMC2604125 DOI: 10.1016/j.arth.2007.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 08/01/2007] [Indexed: 02/01/2023] Open
Abstract
In impaction grafting for revision joint arthroplasty, the morselized cancellous bone ideally remodels into a new contiguous lattice. However, the use of biologically active factors may sometimes be indicated to enhance fusion. The purpose of this study was to determine the stability of femoral impaction-graft constructs for which either only the proximal or distal half of the morselized cancellous bone volume was modeled as fused. Fusing the proximal half of the impaction-graft volume resulted in a higher femoral stem stability than did fusing the distal half. This proximal graft fusion also resulted in a stem stability that was similar to that of fusing the entire graft. These results emphasize the importance of proximal fixation of an impaction-grafted femoral stem.
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Affiliation(s)
- Anneliese D. Heiner
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| | - John J. Callaghan
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA,Orthopaedics Department, VA Medical Center, Iowa City, IA
| | - Thomas D. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
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Stiehl JB, Ulrich SD, Seyler TM, Bonutti PM, Marker DR, Mont MA. Bone morphogenetic proteins in total hip arthroplasty, osteonecrosis and trauma surgery. Expert Rev Med Devices 2008; 5:231-8. [PMID: 18331183 DOI: 10.1586/17434440.5.2.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review provides an overview of the use of bone morphogenetic proteins to enhance bone healing and bone graft incorporation in difficult defects created from failed total hip arthroplasties, osteonecrosis of the femoral head and trauma. Multiple publications have demonstrated that bone morphogenetic proteins are osteoinductive in preclinical trials (i.e., animal models); however, there is controversy and limited understanding of the use of this technology in orthopedic surgical practice. The question remains as to whether they are useful in difficult fractures, nonunions and large defects created from failed total hip arthroplasty or femoral head osteonecrosis. There might be a small risk for infection by the process of introducing foreign materials in a clinical situation, but this has not yet been realized to date. In addition, these materials offer an advantage in large defects where there is not enough transplantable material available from the host. We believe that the use of these materials will become more widespread with newer carriers, minimally invasive applications and diminished commercial costs.
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Affiliation(s)
- James B Stiehl
- Orthopaedic Surgeon, Orthopedic Hospital of Wisconsin, 575 W River Woods Parkway, Milwaukee, WI 53212, USA.
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Peng L, Bian WG, Liang FH, Xu HZ. Implanting hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 and hyaluronic acid into distal femoral metaphysis of rabbits. Chin J Traumatol 2008; 11:179-85. [PMID: 18507950 DOI: 10.1016/s1008-1275(08)60038-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To assess the osseointegration capability of hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 (BMP-2) and hyaluronic acid to repair defects in the distal femur metaphysis in rabbits. METHODS Porous titanium implants were made by sintering titanium powder at high temperature, which were coated with hydroxyapatite by alkali and heat treatment and with BMP-2 combined with bone regeneration materials. And hyaluronic acid was further used as delivery system to prolong the effect of BMP-2. The implants were inserted into the metaphysis of the distal femur of rabbits. The animals were killed at 6, 12 and 24 weeks to accomplish histological and biomechanical analyses. RESULTS According to the result of histological analysis, the osseointegration in BMP-2 group was better than that of the HA-coated porous titanium group. In push-out test, all the samples had bigger shear stress as time passed by. There was statistical difference between the two groups in 6 and 12 weeks but not in 24 weeks. CONCLUSION Hydroxyapatite-coated porous titanium with BMP-2 and hyaluronic acid has a good effect in repairing defects of distal femur in rabbits, which is a fine biotechnology for future clinical application.
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Affiliation(s)
- Lei Peng
- Department of Orthopedic Surgery, Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical College, Wenzhou 325000, China
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Hannink G, Schreurs BW, Buma P. No positive effects of OP-1 device on the incorporation of impacted graft materials after 8 weeks: a bone chamber study in goats. Acta Orthop 2007; 78:551-8. [PMID: 17966011 DOI: 10.1080/17453670710014211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Bone morphogenetic proteins (BMPs) have the potential to improve clinical outcome after hip revision surgery by improving graft incorporation and implant fixation. However, impaction of cancellous bone grafts and TCP/HA bone substitute mixed with OP-1 device in a bone chamber in goats in a previous study led to reduced fibrous tissue ingrowth after 4 weeks. New bone formation was not promoted by OP-1. In the current study we examined whether this reduction represented a final loss of ingrowth or was just a delay, and whether the reduction can be overcome and ultimately results in a better late ingrowth. METHODS Bone chambers with impacted allografts and impacted TCP/HA granules mixed with 2 doses of OP-1 device were implanted in proximal medial goat tibias. Impacted allografts and TCP/HA not treated with OP-1 served as controls. After 8 weeks, the incorporation was evaluated using histology and histomorphometry. RESULTS Histology revealed evidence of bone graft incorporation, which proceeded in a similar way in both allografts and TCP/HA, with and without the addition of OP-1. After 8 weeks, no difference in bone ingrowth was found between the OP-1 groups and their controls. It was only in the allografts that the addition of OP-1 resulted in more fibrous tissue ingrowth. INTERPRETATION We conclude that the previously observed delay in fibrous tissue ingrowth can be only partially overcome.
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Affiliation(s)
- Gerjon Hannink
- Orthopaedic Research Lab, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Heiner AD, Callaghan JJ, Brown TD. Stability of fused versus nonfused THA femoral impaction grafts. J Orthop Res 2007; 25:351-60. [PMID: 17143908 PMCID: PMC2718431 DOI: 10.1002/jor.20316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 08/18/2006] [Indexed: 02/04/2023]
Abstract
Impaction grafting for THA involves compacting morselized cancellous bone (MCB) into a cavitary defect to build up bone stock. Ideally, the MCB subsequently remodels into a new contiguous cancellous lattice. A recent laboratory model of MCB fusion allows simulating an impaction graft construct in this ideal eventual clinical state. The purpose of the present study was to determine the relative stability of femoral impaction graft constructs in which the MCB has fused versus that for MCB in the freshly impacted nonfused condition. Cemented femoral impaction graft constructs were created in composite femurs. For fused constructs, the MCB was mixed with an amine epoxy that causes the MCB to set up into a contiguous structure biomechanically comparable to intact cancellous bone in compression. The constructs were loaded with 500,000 physiologic gait cycles. Three-dimensional motion was measured between the femur and the stem. The fused femoral impaction grafts were much more stable than the nonfused grafts at the proximal stem location, but MCB fusion had only a modest effect on distal stem stability. These results indicate that most of the opportunity to reduce femoral stem micromotion and migration lies proximal, and that steps to enhance impaction graft remodeling and fusion are most effectively focused proximally.
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Affiliation(s)
- Anneliese D Heiner
- University of Iowa, Department of Orthopaedics and Rehabilitation, Biomechanics Laboratory, 2181 Westlawn Building, Iowa City, Iowa 52242, USA.
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Ma T, Nelson ER, Mawatari T, Oh KJ, Larsen DM, Smith RL, Goodman SB. Effects of local infusion of OP-1 on particle-induced and NSAID-induced inhibition of bone ingrowth in vivo. J Biomed Mater Res A 2007; 79:740-6. [PMID: 16988970 DOI: 10.1002/jbm.a.30949] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Excessive polyethylene wear particles from joint replacements may lead to periprosthetic osteolysis and loosening. Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease fracture healing and bone ingrowth. We hypothesized that continuous local infusion of OP-1 (BMP-7) would increase local bone formation in the presence of two different adverse stimuli, polyethylene particles, and an oral NSAID. The Drug Test Chamber (DTC) was implanted in the proximal tibia of mature rabbits. The tissue growing into the chamber was exposed to OP-1 solution (110 ng/day), which was infused via an osmotic pump. Infusion of OP-1 alone for 6 weeks enhanced local bone formation in the chamber by 80% (p < 0.05) over infusion of carrier alone. In the presence of polyethylene particles, infusion of OP-1 increased local bone formation by 38% (p < 0.05) over treatment with particles and carrier. Oral administration of NSAID reduced local bone formation by 58% (p < 0.05); this suppressive effect caused by NSAIDS was completely reversed by the infusion of OP-1 (p < 0.05). These findings underline a potential role for local treatment with OP-1 to increase bone formation in the presence of potentially adverse stimuli such as polyethylene wear particles or NSAID use.
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Affiliation(s)
- T Ma
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Hannink G, Aspenberg P, Schreurs BW, Buma P. High doses of OP-1 inhibit fibrous tissue ingrowth in impaction grafting. Clin Orthop Relat Res 2006; 452:250-9. [PMID: 16906082 DOI: 10.1097/01.blo.0000229340.18974.dc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A major concern in using growth factors in impaction grafting is the potential stimulation of the osteoclastic lineage. A solution would be using an osteoconductive material resistant to resorption and providing initial stability after reconstruction. Growth factors may promote bone formation in combination with such graft materials. We determined whether OP-1 would promote the incorporation of impacted morselized allografts and tricalcium phosphate/hydroxyapatite (TCP/HA) into host bone, whether bone formation would be preceded by an initial process of accelerated resorption, and whether the response to OP-1 remodeling/incorporation would be dose-related. We performed two bone chamber studies in goats to ascertain the early effects of OP-1 dose on resorption and incorporation of impacted morselized allografts and TCP/HA. After 4 weeks, the incorporation process of impacted morselized allografts and TCP/HA was not promoted by OP-1. We observed no signs of accelerated resorption preceding bone formation. An increase in OP-1 dose resulted in an inhibition of fibrous tissue formation but OP-1 did not promote bone formation. Early failures in impaction grafting, using mixes with OP-1, might be explained by the lack of fibrous tissue ingrowth and not by increased resorption and remodeling.
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Affiliation(s)
- Gerjon Hannink
- Orthopaedic Research Lab, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Baas J, Lamberg A, Jensen TB, Elmengaard B, Søballe K. The bovine bone protein lyophilisate Colloss improves fixation of allografted implants--an experimental study in dogs. Acta Orthop 2006; 77:791-8. [PMID: 17068713 DOI: 10.1080/17453670610013015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Impacted morselized bone allograft is a well-established way of giving joint arthroplasties additional support in situations where there is insufficient bone stock. For long-term survival of the implant, early implant fixation is important. We hypothesized that Col-loss, a bone protein lyophilisate, might improve early implant fixation of allografted implants. METHOD We inserted 4 porous-coated Ti implants in the distal femurs of 16 dogs. All implants were surrounded by a 2.5-mm gap, which was impacted with morselized allograft with or without Colloss. In each dog, the implants were treated with no Collos or low-, middle- or high-dose (0, 10, 20 and 40 mg) Colloss per cm3 allograft. The observation time was 4 weeks. RESULTS Mechanical implant fixation was improved for all 3 groups with Colloss-treated implants (p < 0.05). The best anchorage was seen in the middle-dose group, where fixation was improved by 100%. We saw a dramatic reduction in fibrous tissue on the surface of the Colloss-treated implants (p < 0.001). The Colloss groups showed increased ongrowth of new bone (p < 0.01) and accelerated gap remodeling (p < 0.05). INTERPRETATION Colloss can improve early osseointegration and fixation of allografted implants.
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Affiliation(s)
- Jorgen Baas
- Orthopedic Research Laboratory, Department of Orthopedics, Aarhus University Hospital, Denmark.
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Abstract
BACKGROUND CONTEXT The rise in spinal fusion procedures has led to an increase in the available number and variety of bone graft substitutes. As our understanding of the biologic processes that influence bony fusion has improved, appreciation for the role of the carrier material involved in bone grafts has also increased. PURPOSE The abundance of products available leaves a surgeon with many choices. Knowledge of the current advances will allow for more critical review of the literature and improved decision making when choosing bone graft materials. STUDY DESIGN/SETTING Review of the English-language literature. METHODS A critical review of basic science, animal and human studies that investigate the types and role of carrier materials used in spine surgery. RESULTS The myriad of carrier material available to the spine surgeon is related to the many options in bone graft material. Allograft is an important osteoconductive agent but has its disadvantages especially in regard to disease transmission and immunogenicity. Collagen in various forms is an effective carrier for bone morphogenic protein and autogenous stem cells and can be easily combined with other bone graft materials. Synthetic options include hydroxyapatite and calcium phosphate ceramic materials with different formulations; all are osteoconductive only but can be combined with osteoinductive and/or osteogenic components. Bioabsorbable carriers are effective for use with bone morphogenic protein and can also be used in multiple forms and settings. CONCLUSIONS Many bone graft carriers exist, and multiple studies have shown their efficacy. It appears that no one carrier is ideal but each situation might influence the choice of one carrier over another.
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Affiliation(s)
- Brian Kwon
- The Boston Spine Group, New England Baptist Hospital, Department of Orthopaedic Surgery, 125 Parker Hill Ave., Boston, MA 02120, USA
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Shih HN, Shih LY, Sung TH, Chang YC. Restoration of bone defect and enhancement of bone ingrowth using partially demineralized bone matrix and marrow stromal cells. J Orthop Res 2005; 23:1293-9. [PMID: 15946821 DOI: 10.1016/j.orthres.2005.04.005.1100230609] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Revised: 03/15/2005] [Accepted: 04/07/2005] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to investigate the capability of combining marrow stromal cells (MSC) and partially demineralized bone matrix (PDBM) to fill bone defect and enhance bone ingrowth using a canine non-weight-bearing gap model. METHODS Custom-made implants with 3mm gap between the porous surface and the host bone were used. The implants were inserted into the distal femurs of 25 mongrel dogs and the gaps were randomly assigned to be filled with culture-expanded autologous MSC-loaded PDBM, autograft, fresh-frozen allograft, PDBM alone, or nothing as controls. Histomorphometry using backscattered scanning electron microscopic examination, and mechanical push-out test were performed at 6 months after surgery. RESULTS Histomorphometry showed that amounts of bone regeneration in the gap and bone ingrowth into the porous-coated surface in the MSC-loaded PDBM-treated group were comparable to those of autograft-treated group and were significantly greater than those of allograft-treated, PDBM-treated, or non-grafted groups. Mechanical test showed the same differences. CONCLUSION The results of this study showed that combining PDBM and autologous culture-expanded MSC restored bone stock and enhanced bone ingrowth into the porous-coated area in a canine non-weight-bearing gap model. This combination may provide an option for reconstructing bone defect when we perform a cementless revision arthroplasty.
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Affiliation(s)
- Hsin-Nung Shih
- Department of Orthopedic Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, No 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan 333, Taiwan.
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Aebli N, Stich H, Schawalder P, Theis JC, Krebs J. Effects of bone morphogenetic protein-2 and hyaluronic acid on the osseointegration of hydroxyapatite-coated implants: An experimental study in sheep. J Biomed Mater Res A 2005; 73:295-302. [DOI: 10.1002/jbm.a.30299] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang R, Xu D, Landeryou T, Toth C, Dimaano N, Berry J, Evans J, Hawkins M. Ectopic bone formation using osteogenic protein-1 carried by a solution precipitated hydroxyapatite. ACTA ACUST UNITED AC 2004; 71:412-8. [PMID: 15472924 DOI: 10.1002/jbm.a.30151] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Solution precipitation of calcium and phosphate is a technique to generate hydroxyapatite [Peri-Apatitetrade mark (PA), Stryker Orthopaedics, Mahwah, NJ] on metal substrate. This study was carried out to determine the capacity of PA to adsorb osteogenic protein-1 (OP-1) and the time course of release, and to determine the osteoinductive activity of OP-1. The adsorption and release studies were conducted with (125)I-labeled OP-1- and PA-coated titanium alloy disks. The results indicate that the adsorption of OP-1 on the PA-coated disks is linear with the concentration of OP-1 up to 5 mg/mL. There is an initial release of 75% to 80% of adsorbed OP-1 within the first hour, and 92% of OP-1 is released in 3 days. The osteoinductive activity of OP-1 was determined in the rat intramuscular ectopic bone formation assay. A total of 24 titanium alloy disks were evenly divided into 3 groups with different treatments for implantation, plain disks (group A), disks coated with PA (group B), and disks coated with PA plus 40 microg OP-1 (group C). Osteogenic protein-1, 40 microg in solution, was injected into the muscle pouch in animals of group D (n = 8). The rats were sacrificed 3 weeks postoperatively and the implants were retrieved. Ectopic bone formation was evaluated with radiography and histology. Results demonstrated that OP-1 induced ectopic bone in all the animals of group C and group D. The titanium alloy disks were surrounded by trabecular bone and marrow tissue. None of the animals of group A or group B showed any evidence of osteoinduction. Our findings indicate that PA can deliver OP-1 directly to titanium alloy implants and maintain the osteoinductive activity of OP-1.
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Affiliation(s)
- Renwen Zhang
- Stryker Orthopaedics, 325 Corporate Drive, Mahwah, New Jersey 07430, USA.
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Mont MA, Ragland PS, Biggins B, Friedlaender G, Patel T, Cook S, Etienne G, Shimmin A, Kildey R, Rueger DC, Einhorn TA. Use of bone morphogenetic proteins for musculoskeletal applications. An overview. J Bone Joint Surg Am 2004; 86-A Suppl 2:41-55. [PMID: 15691108 DOI: 10.2106/00004623-200412002-00008] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael A Mont
- Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, MD 21215, USA.
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Abstract
The use of graft materials to restore bone stock and promote healing and implant stabilization is a crucial part of total knee arthroplasty, especially in revision surgery. Recent research has centered on the use of osteoinductive materials to promote bone formation. Osteogenic proteins are members of a superfamily of proteins called transforming growth factor-beta that, either alone or in combination with other regulatory molecules, induce new bone formation. The cloning and genetic expression of recombinant human osteogenic proteins has led to production of quantities sufficient for their clinical use. Recombinant human osteogenic protein-1 has been combined with bone-derived Type I collagen for delivery to an implant site. Preclinical studies have shown that the osteoinductive capacity of autograft and allograft bone and bone graft substitute materials can be notably improved with the addition of osteogenic protein-1. The use of this protein consistently improved the amount and rate of new bone formation compared with graft alone, resulting in earlier graft incorporation and consolidation. In addition, because osteogenic proteins are chondrogenic, they also may have a role in the treatment of cartilage injury and degeneration. Osteogenic protein-1 has been shown to induce hyalinelike cartilage repair of full thickness osteochondral defects in animal models with no degradation of the tissue with time. Although no detailed clinical studies in knee surgery have been reported with the use of osteogenic protein-1, in anecdotal cases its use alone and with bone graft materials indicate results consistent with those obtained in preclinical studies.
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Affiliation(s)
- Stephen D Cook
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70012, USA.
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Abstract
The use of autograft and allograft material to restore bone stock and promote healing and implant stabilization is a crucial part of total hip arthroplasty, especially in the revision situation. Recent research has centered on the use of osteoinductive materials such as osteogenic proteins or bone morphogenetic proteins to promote bone formation. These proteins are members of the transforming growth factor-beta superfamily of proteins that either alone or in combination with other regulatory molecules induce new bone formation. The cloning and genetic expression of recombinant human bone proteins has led to production of quantities sufficient for their clinical development. Preclinical studies have shown that the osteoinductive capacity of autograft and allograft bone can be improved with the addition of osteogenic proteins. Although these proteins are effective alone, their use with cancellous and cortical allograft and autograft consistently improved the amount and rate of new bone formation compared with graft alone resulting in earlier graft incorporation and consolidation. When placed in defects adjacent to porous acetabular components, the use of an osteogenic protein resulted in earlier defect healing and improved component fixation by the enhancement of bone ongrowth and ingrowth. Although no detailed clinical studies have been reported to date, an anecdotal report of their use with and without bone graft indicate results consistent with those obtained in preclinical studies.
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Affiliation(s)
- Stephen D Cook
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, SL-32, New Orleans, LA 70112, USA.
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