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Nele W, Martina F, Stefan R, Frank L, Georg M. Impaction bone grafting for segmental acetabular defects: a biomechanical study. Arch Orthop Trauma Surg 2023; 143:1353-1359. [PMID: 34905066 PMCID: PMC9958163 DOI: 10.1007/s00402-021-04296-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Implant loosening is the most common indication for revision after total hip arthroplasty and is associated with progressive bone destruction. Contained defects can be treated with impaction bone grafting (IBG). Segmental defects are successfully restored with metal augmentation. Considering the increasing number of hip arthroplasty cases in young patients, it would appear sensible to reconstruct the bone stock for future revisions by biological bone defect reduction. The data on the treatment of segmental defects with IBG without additional stabilization are lacking. MATERIALS AND METHODS Paprosky type IIB defects were milled into 15 porcine hemipelves with segmental defect angles of 40°, 80° and 120°. Contained defects without segmental defects (Paprosky type I) and acetabula without defects served as controls. After IBG, a cemented polyethylene cup (PE) was implanted in each case. Cup migration, rotational stiffness and maximum rupture torque were determined under physiological loading conditions after 2500 cycles. RESULTS Compared with the control without defects, IBG cups showed an asymptotic migration of 0.26 mm ± 0.11 mm on average. This seating was not dependent on the size of the defect. The maximum rupture moment was also not dependent on the defect size for cups after IBG. In contrast, the torsional stiffness of cups with an 120° segmental defect angle was significantly lower than in the control group without defects. All other defects did not differ in torsional stiffness from the control without defects. CONCLUSIONS IBG did not show inferior biomechanical properties in segmental type IIB defect angles up to 80°, compared to cups without defects.
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Affiliation(s)
- Wagener Nele
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-University, Robert Koch Straße 40, 37075, Göttingen, Germany.
| | - Fritsch Martina
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
| | - Reinicke Stefan
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
| | - Layher Frank
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
| | - Matziolis Georg
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany
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Huang Y, Zhang L, Ji Y, Deng H, Long M, Ge S, Su Y, Chan SY, Loh XJ, Zhuang A, Ruan J. A non-invasive smart scaffold for bone repair and monitoring. Bioact Mater 2023; 19:499-510. [PMID: 35600976 PMCID: PMC9097555 DOI: 10.1016/j.bioactmat.2022.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022] Open
Abstract
Existing strategies for bone defect repair are difficult to monitor. Smart scaffold materials that can quantify the efficiency of new bone formation are important for bone regeneration and monitoring. Carbon nanotubes (CNT) have promising bioactivity and electrical conductivity. In this study, a noninvasive and intelligent monitoring scaffold was prepared for bone regeneration and monitoring by integrating carboxylated CNT into chemically cross-linked carboxymethyl chitosan hydrogel. CNT scaffold (0.5% w/v) demonstrated improved mechanical properties with good biocompatibility and electrochemical responsiveness. Cyclic voltammetry and electrochemical impedance spectroscopy of CNT scaffold responded sensitively to seed cell differentiation degree in both cellular and animal levels. Interestingly, the CNT scaffold could make up the easy deactivation shortfall of bone morphogenetic protein 2 by sustainably enhancing stem cell osteogenic differentiation and new bone tissue formation through CNT roles. This research provides new ideas for the development of noninvasive and electrochemically responsive bioactive scaffolds, marking an important step in the development of intelligent tissue engineering. Existing strategies for bone defect repair are difficult to monitor. In this study, a noninvasive and intelligent monitoring scaffold was prepared for bone regeneration and monitoring. This scaffold was a combination of CNT integrated into a chemically cross-linked carboxymethyl chitosan hydrogel. CNT scaffold showed improved mechanical properties with biocompatibility and electrochemical responsiveness.
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Wassif RK, Elkayal M, Shamma RN, Elkheshen SA. Recent advances in the local antibiotics delivery systems for management of osteomyelitis. Drug Deliv 2021; 28:2392-2414. [PMID: 34755579 PMCID: PMC8583938 DOI: 10.1080/10717544.2021.1998246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic osteomyelitis is a challenging disease due to its serious rates of mortality and morbidity while the currently available treatment strategies are suboptimal. In contrast to the adopted systemic treatment approaches after surgical debridement in chronic osteomyelitis, local drug delivery systems are receiving great attention in the recent decades. Local drug delivery systems using special carriers have the pros of enhancing the feasibility of penetration of antimicrobial agents to bone tissues, providing sustained release and localized concentrations of the antimicrobial agents in the infected area while avoiding the systemic side effects and toxicity. Most important, the incorporation of osteoinductive and osteoconductive materials in these systems assists bones proliferation and differentiation, hence the generation of new bone materials is enhanced. Some of these systems can also provide mechanical support for the long bones during the healing process. Most important, if the local systems are designed to be injectable to the affected site and biodegradable, they will reduce the level of invasion required for implantation and can win the patients’ compliance and reduce the healing period. They will also allow multiple injections during the course of therapy to guard against the side effect of the long-term systemic therapy. The current review presents different available approaches for delivering antimicrobial agents for the treatment of osteomyelitis focusing on the recent advances in researches for local delivery of antibiotics.HIGHLIGHTS Chronic osteomyelitis is a challenging disease due to its serious mortality and morbidity rates and limited effective treatment options. Local drug delivery systems are receiving great attention in the recent decades. Osteoinductive and osteoconductive materials in the local systems assists bones proliferation and differentiation Local systems can be designed to provide mechanical support for the long bones during the healing process. Designing the local system to be injectable to the affected site and biodegradable will reduces the level of invasion and win the patients’ compliance.
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Affiliation(s)
- Reem Khaled Wassif
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Maha Elkayal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Seham A Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Ma CC, Wang XC, Tao NP. Hydroxyapatite From the Skull of Tuna ( Thunnus obesus) Head Combined With Chitosan to Restore Locomotive Function After Spinal Cord Injury. Front Nutr 2021; 8:734498. [PMID: 34497824 PMCID: PMC8419224 DOI: 10.3389/fnut.2021.734498] [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: 07/01/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Hydroxyapatite is an important fish bone calcium in tuna head, which is widely used to repair of bone defect. Chitosan is a degradable basic polysaccharide with good biocompatibility and bone guiding, which can achieve targeted delivery to the injured spinal cord after spinal cord injury (SCI). This study aimed to evaluate the beneficial effects of chitosan combined hydroxyapatite (chitosan-hydroxyapatite) nanoparticles on SCI. The result revealed the chitosan-hydroxyapatite particles were successfully constructed and the stability of particles was maintained at low temperature. Moreover, we found chitosan-hydroxyapatite administration could improve SCI, while chitosan alone treatment resulted in no significant increase of the Basso Beattie Bresnahan (BBB) scores compared with the control group. In addition, chitosan-hydroxyapatite particles also significantly reduced the lesion cavity volume and improved the dispersed structure, indicating it could promote the recovery of tissue function of SCI rats. This study explored the effects of chitosan-hydroxyapatite nanoparticles on the location and function of spinal cord injury, provided experimental evidence for further research on its application in spinal cord repair, and helped improve the efficient use of tuna heads.
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Affiliation(s)
- Chen-Chen Ma
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Xi-Chang Wang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China.,Shanghai Engineering Research Center of Aquatic-Product Processing and Preservation, Shanghai, China
| | - Ning-Ping Tao
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China.,Shanghai Engineering Research Center of Aquatic-Product Processing and Preservation, Shanghai, China
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Fölsch C, Bok J, Krombach GA, Rickert M, Ulloa CAF, Ahmed GA, Kampschulte M, Jahnke A. Influence of antibiotic pellets on pore size and shear stress resistance of impacted native and thermodisinfected cancellous bone: An in vitro femoral impaction bone grafting model. J Orthop 2020; 22:414-421. [PMID: 33029046 DOI: 10.1016/j.jor.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022] Open
Abstract
Introduction Morphology and mechanic properties of impacted cancellous bone are affected by carrier substances which provide high local concentrations of antibiotics. Methods Bone chips were taken from the femoral head of 6-7 months old piglets. One half was thermodisinfected and the other remained native. Ten specimens each were mixed with Herafill® antibiotic pellets and a control group of each 10 specimens respectively was examined. The cancellous bone was impacted according to Exeter technique and the implants were cemented. The distribution of the particles and the pores were defined with three dimensional computertomographic scan and shear force resistance was measured until failure. Results Shear force resistance was not measured significantly less for thermodisinfected (2.7 Nm) compared with native bone (3.5 Nm) and addition of antibiotic pellets reduced shear force resistance in both groups since this was significant for the native group. The average pore volume of the native bone specimens appeared significant smaller compared to the thermodisinfected group (p = 0.011) and the pore volume showed a negative correlation with shear force resistance (p = 0.044). Pore volume around the pellets was found significantly increased and it appeared smaller for native bone. The number of pellets located next to the implant showed a negative correlation with shear force resistance (p = 0.034) and the negative correlation increased for pellets below the tip of the shaft model (p = 0.024). Conclusion Adding antibiotic pellets to native and thermodisinfected impacted cancellous bone increased pore volume since the area around the pellets showed increased porosity which correlated with reduced shear force resistance. Computertomographic three dimensional measurement of porosity might predict shear force resistance of impacted cancellous bone and improve impaction of bone grafting intraoperatively.
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Affiliation(s)
- C Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - J Bok
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - C A Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - G A Ahmed
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - M Kampschulte
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - A Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
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Fölsch C, Dharma J, Fonseca Ulloa CA, Lips KS, Rickert M, Pruss A, Jahnke A. Influence of thermodisinfection on microstructure of human femoral heads: duration of heat exposition and compressive strength. Cell Tissue Bank 2020; 21:457-468. [PMID: 32314113 PMCID: PMC7452940 DOI: 10.1007/s10561-020-09832-5] [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: 01/13/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
Abstract
Allogeneic bone derived from living donors being necessary to match demand for bone transplantation and thermodisinfection of femoral heads is an established sterilization method. During the thermodisinfection the peripheral bone is exposed to maximum 86 °C for 94 min providing 82.5 °C within the center of the femoral head for at least 15 min. This study examined the compression force of the central and representative peripheral regions of native and thermodisinfected human femoral heads to observe wether different duration and intensity of heat exposure might alter mechanic behaviour. Slices from the equatorial region of human femoral heads were taken from each 14 native and thermodisinfected human femoral heads. The central area revealed a significantly higher compression force for native (p ≤ 0.001) and for thermodisinfected bone (p = 0.002 and p = 0.005) compared with peripheral regions since no relevant differences were found between the peripheral and intermediate areas themselves. A small reduction of compression force for thermodisinfected bone was shown since this did not appear significant due to the small number of specimens. The heat exposure did not alter the pre-existing anatomical changes of the microarchitecture of the native femoral heads from the center towards the peripheral regions. The heterogeneity of microstructure of the femoral head might be of interest concerning clinical applications of bone grafts since the difference between native and thermodisinfected bone appears moderate as shown previously. The different quantity of heat exposure did not reveal any significant influence on compression force which might enable thermodisinfection of preformed bone pieces for surgical indications.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Julian Dharma
- Labarotory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| | - Carlos Alfonso Fonseca Ulloa
- Labarotory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| | - Katrin Susanne Lips
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University, Aulweg 128, 35392, Giessen, Germany
| | - Markus Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Giessen, Germany
| | - Axel Pruss
- University Tissue Bank, Institute of Transfusion Medicine, Charité University Medical School, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander Jahnke
- Labarotory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
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