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Ruddy M, FitzPatrick DP, Stanton KT. Preparation of morselised bone for impaction grafting using a blender method. J Mech Behav Biomed Mater 2017; 78:91-95. [PMID: 29145011 DOI: 10.1016/j.jmbbm.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
Impaction bone grafting is a method of restoring bone stock to patients suffering significant bone loss due to revision total hip surgery. The procedure requires morselised bone (MB) to be impacted into the site of bone loss in order to stabilise the prosthesis with the aim of the long term resorption and reintegration of the impacted bone graft. Currently, the method for producing MB requires the use of expensive surgical bone mills or manually-intensive rongeurs that can produce a limited variety of particle sizes and may have a low throughput. This study examines the potential to produce suitable MB using a domestic blender. The method produces a wide range of particle sizes without the need for an adjustment of the system. It was found through packing modelling that this particle distribution resulted in reduced initial graft porosity and thus a theoretical potential to increase the graft stiffness and ability of the graft to stabilise a prosthesis in comparison to a manually prepared roughly cut morselised bone samples. Mechanical testing confirmed the increased mechanical performance of the graft through both impaction testing and subsidence testing. The blended MB was found to exhibit greater graft stiffness under the same impaction conditions. The graft was also found to have subsided less in comparison to the rough cut, less well graded MB. Scanning electron imaging also confirmed the retention of the trabecular structure necessary for revascularisation and host bone ingrowth. In conclusion, the blender method offers a rapid and cheap way of obtaining morselised bone with favourable particle size distribution, particle morphology and mechanical properties with preservation of the bone trabecular structure.
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Affiliation(s)
- Mark Ruddy
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - David P FitzPatrick
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kenneth T Stanton
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland.
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Ruddy M, FitzPatrick DP, Stanton KT. The use of hardened bone cement as an impaction grafting extender for revision hip arthroplasty. J Mech Behav Biomed Mater 2017; 78:82-90. [PMID: 29145010 DOI: 10.1016/j.jmbbm.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
Impaction bone grafting is a method of restoring bone stock to patients who have suffered significant bone loss due to revision total hip surgery. The procedure requires morsellised cancellous bone (MCB) to be impacted into the site of bone loss in order to stabilise the prosthesis with the aim of long term resorption and reintegration of the impacted bone graft. Due to financial cost and the potential to transmit disease, the use of supplementary material, known as an extender, is frequently used to increase the graft material volume. This study investigates the use of hardened Hydroset (Stryker Corp, MA, USA), an injectable bone cement (IBC), as an extender material and compares the performance of the IBC in different weight percent inclusions to a commercially available bone graft extender (GCP, BoneSave, Stryker Corp, MA, USA). The surgical impaction procedure was standardised and samples were evaluated in terms of graft stiffness and height. It was observed that 30wt% IBC extended samples had significantly improved graft stiffness (p = 0.02) and no significant different in height (p = 0.067) over a 100% MCB control sample. Cyclic loading, representative of gait, found that the IBC subsided similarly to the commercial bone substitute in wt% above 10%. Shear testing of the impacted grafts showed no significant differences between GCP and IBC with impaction forces determining the shear parameters of impacted grafts. The effects of the impaction and cyclical loading procedures on extender particle sizes was assessed via particle size analysis. It was found that the IBC extended samples demonstrated reduced friability, evident in the better retention of particle size as a result of both impaction and gait representative loading compared to that of the GCP samples. This indicates a potential reduction in issues arising from small particle migration to joint surfaces. Scanning electron microscopy of the MCB particles with both GCP and IBC as extenders showed retention of the porous trabecular structure post-testing which is essential for revascularisation and bone growth into the graft.
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Affiliation(s)
- Mark Ruddy
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - David P FitzPatrick
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kenneth T Stanton
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland.
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van Gestel NAP, Hulsen DJW, Geurts J, Hofmann S, Ito K, Arts JJ, van Rietbergen B. Composition dependent mechanical behaviour of S53P4 bioactive glass putty for bone defect grafting. J Mech Behav Biomed Mater 2017; 69:301-306. [PMID: 28131065 DOI: 10.1016/j.jmbbm.2017.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 11/24/2022]
Abstract
To improve the handling properties of S53P4 bioactive glass granules for clinical applications, bioactive glass putty formulations were developed. These formulations contain both granules and a synthetic binder to form an injectable material that is easy to shape. To explore its applicability in load-bearing bone defect grafting, the relation between the putty composition and its mechanical behaviour was assessed in this study. Five putty formulations with variations in synthetic binder and granule content were mechanically tested in confined compression. The results showed that the impaction strains significantly decreased and the residual strains significantly increased with an increasing binder content. The stiffness of all tested formulations was found to be in the same range as the reported stiffness of cancellous bone. The measured creep strains were low and no significant differences between formulations were observed. The stiffness significantly increased when the samples were subjected to a second loading stage. The residual strains calculated from this second loading stage were also significantly different from the first loading stage, showing an increasing difference with an increasing binder content. Since residual strains are detrimental for graft layer stability in load-bearing defects, putty compositions with a low binder content would be most beneficial for confined, load-bearing bone defect grafting.
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Affiliation(s)
- N A P van Gestel
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
| | - D J W Hulsen
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands; MICT Department, Jeroen Bosch Ziekenhuis, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | - J Geurts
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands
| | - S Hofmann
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Biomechanics, Swiss Federal Institute of Technology Zürich (ETHZ), Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Department of Orthopaedics, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - J J Arts
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands
| | - B van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands.
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Hulsen DJW, Geurts J, van Gestel NAP, van Rietbergen B, Arts JJ. Mechanical behaviour of Bioactive Glass granules and morselized cancellous bone allograft in load bearing defects. J Biomech 2016; 49:1121-1127. [PMID: 26972764 DOI: 10.1016/j.jbiomech.2016.02.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/21/2016] [Accepted: 02/20/2016] [Indexed: 11/17/2022]
Abstract
Bioactive Glass (BAG) granules are osteoconductive and possess unique antibacterial properties for a synthetic biomaterial. To assess the applicability of BAG granules in load-bearing defects, the aim was to compare mechanical behaviour of graft layers consisting of BAG granules and morselized cancellous bone allograft in different volume mixtures under clinically relevant conditions. The graft layers were mechanically tested, using two mechanical testing modalities with simulated physiological loading conditions: highly controllable confined compression tests (CCT) and more clinically realistic in situ compression tests (ISCT) in cadaveric porcine bone defects. Graft layer impaction strain, residual strain, aggregate modulus, and creep strain were determined in CCT. Graft layer porosity was determined using micro computed tomography. The ISCT was used to determine graft layer subsidence in bone environment. ANOVA showed significant differences (p<0.001) between different graft layer compositions. True strains absolutely decreased for increasing BAG content: impaction strain -0.92 (allograft) to -0.39 (BAG), residual strain -0.12 to -0.01, and creep strain -0.09 to 0.00 respectively. Aggregate modulus increased with increasing BAG content from 116 to 653MPa. Porosity ranged from 66% (pure allograft) to 15% (pure BAG). Subsidence was highest for allograft, and remarkably low for a 1:1 BAG-allograft volume mixture. Both BAG granules and allograft morsels as stand-alone materials exhibit suboptimal mechanical behaviour for load-bearing purpose. BAG granules are difficult to handle and less porous, whereas allograft subsides and creeps. A 1:1 volume mixture of BAG and allograft is therefore proposed as the best graft material in load-bearing defects.
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Affiliation(s)
- D J W Hulsen
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Orthopaedic Biomechanics, Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; MICT Department, Jeroen Bosch Ziekenhuis, ׳s-Hertogenbosch, The Netherlands.
| | - J Geurts
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - N A P van Gestel
- Department of Orthopaedic Biomechanics, Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - B van Rietbergen
- Department of Orthopaedic Biomechanics, Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J J Arts
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Orthopaedic Biomechanics, Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Walschot LHB, Aquarius R, Verdonschot N, Buma P, Schreurs BW. Porous titanium particles for acetabular reconstruction in total hip replacement show extensive bony armoring after 15 weeks. A loaded in vivo study in 10 goats. Acta Orthop 2014; 85:600-8. [PMID: 25238431 PMCID: PMC4259031 DOI: 10.3109/17453674.2014.960660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The bone impaction grafting technique restores bone defects in total hip replacement. Porous titanium particles (TiPs) are deformable, like bone particles, and offer better primary stability. We addressed the following questions in this animal study: are impacted TiPs osteoconductive under loaded conditions; do released micro-particles accelerate wear; and are systemic titanium blood levels elevated after implantation of TiPs? ANIMALS AND METHODS An AAOS type-III defect was created in the right acetabulum of 10 goats weighing 63 (SD 6) kg, and reconstructed with calcium phosphate-coated TiPs and a cemented polyethylene cup. A stem with a cobalt chrome head was cemented in the femur. The goats were killed after 15 weeks. Blood samples were taken pre- and postoperatively. RESULTS The TiP-graft layer measured 5.6 (SD 0.8) mm with a mean bone ingrowth distance of 2.8 (SD 0.8) mm. Cement penetrated 0.9 (0.3-1.9) mm into the TiPs. 1 reconstruction showed minimal cement penetration (0.3 mm) and failed at the cement-TiP interface. There were no signs of accelerated wear, metallic particle debris, or osteolysis. Median systemic titanium concentrations increased on a log-linear scale from 0.5 (0.3-1.1) parts per billion (ppb) to 0.9 (0.5-2.8) ppb (p=0.01). INTERPRETATION Adequate cement pressurization is advocated for impaction grafting with TiPs. After implantation, calcium phosphate-coated TiPs were osteoconductive under loaded conditions and caused an increase in systemic titanium concentrations. However, absolute levels remained low. There were no signs of accelerated wear. A clinical pilot study should be performed to prove that application in humans is safe in the long term.
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Affiliation(s)
| | - René Aquarius
- Department of Orthopaedics, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen
| | - Nico Verdonschot
- Department of Orthopaedics, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen,Laboratory of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Pieter Buma
- Department of Orthopaedics, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen
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Walschot LHB, Aquarius R, Schreurs BW, Buma P, Verdonschot N. Better primary stability with porous titanium particles than with bone particles in cemented impaction grafting: an in vitro study in synthetic acetabula. J Biomed Mater Res B Appl Biomater 2013; 101:1243-50. [PMID: 23650084 DOI: 10.1002/jbm.b.32936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 11/27/2012] [Accepted: 01/30/2013] [Indexed: 11/05/2022]
Abstract
AIMS Impaction bone grafting creates new bone stock after hip joint replacement. Utilizing a synthetic bone substitute instead of bone might increase primary stability and is not associated with graft shortage and pathogen transmission. This study compares the initial stability of a graft layer of porous titanium particles (TiP), cancellous bone particles, and a 1:2 bone-titanium mix in synthetic cemented acetabular reconstructions. Displacement was measured by radiostereometric analysis after cyclic loading (1 Hz, maximum stress 2.5 MPa). Shear stress resistance was quantified by a lever out test of the cup. Cement penetration was quantified from cross-sections. FINDINGS Titanium reconstructions showed less residual displacement (0.13 ± 0.13 mm) than pure bone particle reconstructions (0.57 ± 0.18 mm) (p < 0.01). Titanium reconstructions were also more resistant to shear stress (p < 0.001). The bone-titanium mix showed intermediate results. Cement penetrated deeper into the bone particle graft layers (4.8 ± 0.7) than into the titanium graft layers (3.8 ± 0.5 mm) (p < 0.02). CONCLUSIONS Cemented acetabular revision reconstructions with porous TiP show better initial stability despite less cement penetration than bone particle reconstructions. Realistic preclinical in vivo testing should explore the hypothesis that porous TiP offer a safe alternative to the current gold standard of bone grafts.
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Affiliation(s)
- Lucas H B Walschot
- Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Walschot LHB, Aquarius R, Schreurs BW, Verdonschot N, Buma P. Osteoconduction of impacted porous titanium particles with a calcium-phosphate coating is comparable to osteoconduction of impacted allograft bone particles: in vivo study in a nonloaded goat model. J Biomed Mater Res B Appl Biomater 2012; 100:1483-9. [PMID: 22707449 DOI: 10.1002/jbm.b.32716] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 03/12/2012] [Accepted: 03/15/2012] [Indexed: 11/11/2022]
Abstract
AIMS Impaction grafting restores bone defects in hip arthroplasty. Defects are reconstructed with bone particles (BoP) as substitute materials with adequate mechanical and biological properties are not yet available. Ceramic particles (CeP) have mechanical drawbacks as opposed to porous titanium particles (TiP). In this in vivo study, bone ingrowth and bone volume in coated and noncoated TiP were compared to porous biphasic calcium-phospate CeP and allograft BoP. Coatings consisted of silicated calcium-phosphate and carbonated apatite. Materials were implanted in goats and impacted in cylindrical defects (diameter 8 mm) in the cancellous bone of the femur. On the basis of fluorochrome labeling and histology, bone ingrowth distance was measured at 4, 8, and 12 weeks. Cross-sectional bone area was measured at 12 weeks. FINDINGS TiP created a coherent matrix of entangled particles. CeP pulverized and were noncoherent. Bone ingrowth in TiP improved significantly by the coatings to levels comparable to BoP and CeP. Cross-sectional bone area was smaller in CeP and TiP compared to BoP. CONCLUSIONS The osteoconductive properties of impacted TiP with a calcium-phosphate coating are comparable to impacted allograft bone and impacted biphasic ceramics. A more realistic loaded in vivo study should prove that coated TiP is an attractive alternative to allograft bone.
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Affiliation(s)
- Lucas H B Walschot
- Department of Orthopedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Walschot LH, Schreurs BW, Verdonschot N, Buma P. The effect of impaction and a bioceramic coating on bone ingrowth in porous titanium particles. Acta Orthop 2011; 82:372-7. [PMID: 21504310 PMCID: PMC3235319 DOI: 10.3109/17453674.2011.579515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Porous titanium (Ti) particles can be impacted like cancellous allograft bone particles, and may therefore be used as bone substitute in impaction grafting. We evaluated the effect of impaction and of a thin silicated biphasic calcium phosphate coating on osteoconduction by Ti particles. METHODS The bone conduction chamber of Aspenberg was used in goats and filled with various groups of coated or uncoated small Ti particles (diameter 1.0-1.4 mm). Impacted allograft bone particles and empty chambers were used in control groups. Fluorochromes were administered at 4, 8, and 12 weeks. Maximum bone ingrowth distance was evaluated by histomorphometric analysis. RESULTS Histology of Ti particle graft cylinders showed a dense matrix with narrow inter-particle and intra-particle pores (< 100 μm), occluding the lumen of the bone chamber. Bone ingrowth distances gradually increased with time in all groups. Maximum bone ingrowth distance was higher in originally empty chambers than those with allograft bone particles (p = 0.01) and Ti particles (p < 0.001). Maximum bone ingrowth in allograft bone particles was higher than in all Ti groups (p ≤ 0.001). Impaction reduced osteoconduction and the coating partially compensated for the negative effect of impaction, but these differences were not statistically significant. No osteolytic reactions were found. INTERPRETATION Osteoconduction in the bone conduction chamber was reduced more by the insertion of small Ti particles than by insertion of small allograft bone particles. The osteoconductive potential of porous Ti particles should be studied further with larger-sized particles, which may allow bone ingrowth after impaction through larger inter-particle pores.
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Affiliation(s)
- Lucas H Walschot
- Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen
| | - Barend W Schreurs
- Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen
| | | | - Pieter Buma
- Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen
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