Hydroxyapatite clay for gap filling and adequate bone ingrowth

The Otto Aufranc Award: Demineralized bone matrix around porous implants promotes rapid gap healing and bone ingrowth

BACKGROUND

Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap healing and porous implant fixation.

QUESTIONS/PURPOSES

We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous implant.

METHODS

We inserted porous titanium implants into the proximal metaphyses of canine femora and humeri, with an initial 3-mm gap between host cancellous bone and implants. We left the gaps empty (control; n = 12) or filled them with either demineralized bone matrix (n = 6) or devitalized demineralized bone matrix (negative control; n = 6) and left them in situ for 4 or 12 weeks. We quantified volume healing of the gap with new bone using three-dimensional micro-CT scanning and quantified apposition and ingrowth using backscattered scanning electron microscopy.

RESULTS

The density of bone inside gaps filled with demineralized bone matrix reached 64% and 93% of surrounding bone density by 4 and 12 weeks, respectively. Compared with empty controls and negative controls at 4 and 12 weeks, gap healing using demineralized bone matrix was two to three times greater and bone ingrowth and apposition were up to 15 times greater.

CONCLUSIONS

Demineralized bone matrix promotes rapid bone ingrowth and gap healing around porous implants.

CLINICAL RELEVANCE

Demineralized bone matrix has potential for enhancing implant fixation in revision arthroplasty.

Intraosseous delivery of paclitaxel-loaded hydroxyapatitealginate composite beads delaying paralysis caused by metastatic spine cancer in rats

Object

Bone is frequently the first site and the only site of breast cancer at recurrence. Local control is important especially for metastatic spine cancer, because epidural spinal cord compression is significantly associated with the quality of life and survival of these patients. The authors have developed a local delivery system of paclitaxel in the form of hydroxyapatite-alginate composite beads. This study was conducted to clarify the therapeutic effect in a rat model of metastatic spine cancer.

Methods

Twenty-one rats with metastatic spine cancer were divided into 3 groups: a local treatment group (6 rats), a systemic treatment group (9 rats), and a control group (6 rats). The hind-limb motor function of the animals was monitored daily by using the Basso-Beattie-Bresnahan scale. The authors monitored the disease-free time and survival times. The log-rank test was used to define statistically significant differences between the 3 groups.

Results

The animals in the control group developed hind-limb paralysis at a mean of 10.8 days and died at a mean of 16.0 days. The animals treated with 2.4 wt% of paclitaxel-loaded hydroxyapatite-alginate composite beads (the local treatment group) showed a 140–150% increase in the disease-free time and survival time compared with that of the control group. Although an ~ 30-fold higher dosage of paclitaxel was administered, the therapeutic effect was not evident in the systemic treatment group.

Conclusions

Intraosseous delivery of paclitaxel-loaded hydroxyapatite-alginate composite beads delayed paralysis caused by metastatic spine cancer in rats. The results indicate that intraosseous chemotherapy may provide an effective local treatment of metastatic spine cancer.

Eight-year results of hydroxyapatite-coated hip arthroplasty

Ninety hips in 82 patients using Omnifit hydroxyapatite (HA)-coated prosthesis were followed for at least 7 years. All stems were stable at the final follow-up. However, aseptic loosening was found in 8 cups and 6 of them were revised. Two polyethylene wear were treated with inserts exchanged. The mechanical failure rate was 11.4% and the combined failure rate was 14.3% for HA-coated cup. Four other cups with wear and osteolysis without loosening or pain and 2 cups with polyethylene wear without osteolysis were still under observation. Our findings suggest that hip arthroplasties with HA coating on the smooth surface of a titanium cup is not reliable. The mid-term result of HA-coated stem is as good as that of porous-coated stem.

Restoration of bone defect and enhancement of bone ingrowth using partially demineralized bone matrix and marrow stromal cells

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.

Hydroxyapatite cement (BoneSource) for repair of critical sized calvarian defects--an experimental study

AIM

In an experimental study the hydroxyapatite cement BoneSource was tested for the ability in relation to the defect size and for its resorption properties.

MATERIAL AND METHODS

In an animal study, BoneSource was applied to repair bicortical defects of different sizes in frontal bones of six Goettingen minipigs. The area was evaluated radiographically and histologically 12, 18 and 40 weeks postoperatively.

RESULTS

After 40 weeks approximately 90% of the hydroxyapatite cement had been resorbed and replaced with bone. After 12 weeks, approximately 30% had been degraded, and 40% after 18 weeks. In small bone defects, the mucosa of the frontal sinus lined the bone substitute (BoneSource). In the reconstruction of large areas, a membrane was used to stabilize the material. Despite this membranous support, BoneSource material prolapsed into the frontal sinus.

DISCUSSION

Hydroxyapatite cement is for the repair of bone defects. It can be moulded to shape the reconstruction. Its use is limited by the defect size and the need for a dry bed.

CONCLUSION

BoneSource is well suited to repair small defects with proven high biocompatibility. However, in large defects, the material is not sufficiently stable.

Preparation, characterization, and in vitro release of gentamicin from coralline hydroxyapatite-alginate composite microspheres

In this work, composite microspheres were prepared from bioactive ceramics such as coralline hydroxyapatite [Ca(10)(PO(4))(6)(OH)(2)] granules, a biodegradable polymer, sodium alginate, and an antibiotic, gentamicin. Previously, we have shown a gentamicin release from coralline hydroxyapatite granules-chitosan composite microspheres. In the present investigation, we attempted to prepare composite microspheres containing coralline hydroxyapatite granules and sodium alginate by the dispersion polymerization technique with gentamicin incorporated by absorption method. The crystal structure of the composite microspheres was analyzed using X-ray powder diffractometer. Fourier transform infrared spectra clearly indicated the presence of per-acid of sodium alginate, phosphate, and hydroxyl groups in the composite microspheres. Scanning electron micrographs and optical micrographs showed that the composite microspheres were spherical in shape and porous in nature. The particle size of composite microspheres was analyzed, and the average size was found to be 15 microns. The thermal behavior of composite microspheres was studied using thermogravimetric analysis and differential scanning calorimetric analysis. The cumulative in vitro release profile of gentamicin from composite microspheres showed near zero order patterns.

Standards and guidelines for biopolymers in tissue-engineered medical products: ASTM alginate and chitosan standard guides. American Society for Testing and Materials

The American Society for Testing and Materials (ASTM) is making a concerted effort to establish standards and guidelines for the entire field of tissue-engineered medical products (TEMPS). Safety, consistency, and functionality of biomaterials used as matrices, scaffolds, and immobilizing agents in TEMPS are a concern. Therefore, the ASTM has established a number of task groups to produce standards and guidelines for such biomaterials. Alginate is a naturally occurring biomaterial used for immobilizing living cells to form an artificial organ, such as encapsulated pancreatic islets. In order to aid in successful clinical applications and to help expedite regulatory approval, the alginate used must be fully documented. The ASTM alginate guide gives information on selection of testing methodologies and safety criteria. Critical parameters such as monomer content, molecular weight, and viscosity, in addition to more general parameters, such as dry matter content, heavy metal content, bioburden, and endotoxin content are described in the ASTM document. In a like manner, the characterization parameters for chitosan, a bioadhesive polycationic polysaccharide, are described in a separate guide. For chitosan, the degree of deacetylation is of critical importance. Control of protein content and, hence, potential for hypersensitivity, endotoxin content, and total bioburden are important in chitosan preparations for TEMPS. Together these two guides represent part of the effort on behalf of the ASTM and other interested parties to ensure quality and standardization in TEMPS.

Effects of neutral sodium hydrogen phosphate on setting reaction and mechanical strength of hydroxyapatite putty

The setting reaction and mechanical strength in terms of diametral tensile strength (DTS) of hydroxyapatite (HAP) putty made of tetracalcium phosphate, dicalcium phosphate anhydrous, and neutral sodium hydrogen phosphate (Na1.8H1.2PO4) solution containing 8 wt % sodium alginate were evaluated as a function of the Na1.8H1.2PO4 concentration. In one condition, HAP putty was placed in an incubator kept at 37 degrees C and 100% relative humidity. In the other condition, immediately after mixing HAP putty was immersed in serum kept at 37 degrees C. Longer setting times and lower DTS values were observed when HAP putty was immersed in serum regardless of the Na1.8H1.2PO4 concentration. The setting times of the HAP putty in both conditions became shorter with an increase in the Na1. 8H1.2PO4 concentration, reaching approximately 7-13 min when the Na1. 8H1.2PO4 concentration was 0.6 mol/L or higher. The DTS value of HAP putty was relatively constant (10 MPa) regardless of the Na1.8H1. 2PO4 concentration (0.2-1.0 mol/L) when HAP putty was kept in an incubator. In contrast, when HAP putty was immersed in serum, the DTS value was dependent on the Na1.8H1.2PO4 concentration. It increased with the Na1.8H1.2PO4 concentration and reached approximately 5 MPa when the Na1.8H1.2PO4 concentration was 0.6 mol/L, after which it showed a relatively constant DTS value. We therefore would recommend a HAP putty that uses 0.6 mol/L Na1.8H1. 2PO4 since at that concentration the putty's setting time (approximately 10 min) is proper for clinical use and it shows good DTS value (approximately 5 MPa) even when it is immersed in serum immediately after mixing.

Non-decay type fast-setting calcium phosphate cement: hydroxyapatite putty containing an increased amount of sodium alginate

A hydroxyapatite [(HAP) Ca10(PO4)6(OH)2] putty that behaves like a putty or self-curing resin was made by increasing the amount of sodium alginate in non-decay type fast-setting calcium phosphate cement (nd-FSCPC). nd-FSCPC became viscous as the sodium alginate concentration was increased. The best handling properties were obtained when nd-FSCPC contained 8% sodium alginate in its liquid phase. When a 2-kg glass plate was placed on the paste, HAP putty spread to form an area three times that of FSCPC paste. Thus, HAP putty is expected to be easier to use than FSCPC in the filling of bone defects. HAP putty did not decay; in fact, it set within approximately 20 min when immersed in distilled water immediately after mixing. The wet diametral tensile strength value of HAP putty was approximately 12 MPa after 24 h, the same as that for nd-FSCPC containing 0.5% sodium alginate in its liquid phase, or FSCPC that is free from sodium alginate. The elements constituting set HAP putty were examined using powder X-ray diffraction and found to be predominantly apatitic minerals after 24 h. Since the handling properties of a putty or self-curing resin-like cement are very useful in certain surgical procedures, HAP putty made by increasing the sodium alginate concentration in nd-FSCPC is potentially a valuable new biomaterial for use in plastic and reconstructive surgery, as well as oral and maxillofacial surgery.

In vitro properties of a chitosan-bonded self-hardening paste with hydroxyapatite granules

A new self-hardening paste was made by using a combination of chitosan, hydroxyapatite (HA) granules, ZnO, and CaO. The sol was made by dissolving 0.1 g of chitosan in a solution of 0.1 g malic acid and 2.0 mL physiological saline solution. Mixed with 0.03 g of CaO and 0.04 g of ZnO powders was 2.77 g (55 wt %) of HA granules which had a homogeneous pore distribution and a porosity of 35-48%. The size of the granules was set for 0.1-0.3 mm. Kneading and setting of the paste generated a little amount of heat (32.8 degrees C) as compared with the heat produced by polymethyl-methacrylate (PMMA) bone cement (114.5 degrees C). The pH value of chitosan-HA-hardened composite after setting was nearly equal to that of human plasma (pH 7.4), while that of PMMA bone cement maintained an acid pH of 4.7. Hydroxyapatite granules less than 0.1 mm, 0.1-0.3 mm, or 0.3-0.6 mm were set using chitosan sol. The size of the granules did not influence the compressive strength of the set chitosan-HA-hardened composite. The greatest compressive strength of chitosan-HA-hardened composite was obtained by using 55 wt % of HA granules. The strength of the chitosan-HA-hardened composite was comparable to that of the cancellous bone derived from tibial eminentia, but was considerably lower than that of the PMMA bone cement.

Hydroxyapatite-clay bone fixation for loaded implants

A clay containing hydroxyapatite (HA clay), which was made by mixing HA granules (range of sizes: 0.1-0.3 mm) and a saline solution of sodium alginate, was inserted into the medullary canal of an osteotomized rabbit's tibia with a Ti-6Al-4V titanium alloy implant. Each implant had a conical portion for bearing load. The shear strength of the bone-implant interface for the implant with HA clay was significantly greater than that for the implant without HA clay 3 months postoperatively (P < .02), while there was no significant difference between the two strengths 1 week postoperatively. Under microscopic observation, the percentage of area of newly developed bone was also significantly greater for the implant with HA clay than for the implant without HA clay 3 months postoperatively (P < .04). This study suggests that HA clay encouraged adequate bone fixation of the loaded implant in 3 months, while the clay was not effective for immediate fixation.