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Krishnan L, Chakrabarty P, Govarthanan K, Rao S, Santra TS. Bioglass and nano bioglass: A next-generation biomaterial for therapeutic and regenerative medicine applications. Int J Biol Macromol 2024; 277:133073. [PMID: 38880457 DOI: 10.1016/j.ijbiomac.2024.133073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/20/2024] [Accepted: 06/08/2024] [Indexed: 06/18/2024]
Abstract
Biomaterials are an indispensable component in tissue engineering that primarily functions to resemble the extracellular matrix of any tissue targeted for regeneration. In the last five decades, bioglass has been extensively used in the field of therapeutic and tissue engineering. The doping of metal components into bioglass and the synthesizing of nano bioglass particles have found remarkable implications, both in vivo and in vitro. These include various medical and biological applications such as rejuvenating tissues, facilitating regeneration, and delivering biomolecules into cells and therapy, etc. Therefore, the current review discusses the various techniques used in synthesizing bioglass particles, trends of various ion-doped nano bioglass, and their applications in therapy as well as in regenerative medicine, specifically in the fields of dentistry, cardiovascular, skin, nervous, and respiratory systems. Apart from these, this review also emphasizes the bioglass combined with diverse natural polymers (like collagen, chitosan, etc.) and their applications. Furthermore, we discuss the effectiveness of bioglass properties such as antibacterial effects, biomolecular delivery systems, tissue compatibility, and regenerative material. Finally, the prospects and limitations are elaborated.
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Affiliation(s)
- Lakshmi Krishnan
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, India
| | - Pulasta Chakrabarty
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, India
| | - Kavitha Govarthanan
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, India
| | - Suresh Rao
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, India
| | - Tuhin Subhra Santra
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, India.
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Fred EJ, Minardi S, Goodwin AM, Nandurkar TS, Plantz MA, Lyons JG, Paul JT, Foley JP, Wintring AJ, Furman AA, Jeong S, Yun C, Stock SR, Hsu WK, Hsu EL. A Mechanistic and Preclinical Assessment of BioRestore Bioactive Glass as a Synthetic Bone Graft Extender and Substitute for Osteoinduction and Spine Fusion. Clin Spine Surg 2024; 37:315-321. [PMID: 38531819 DOI: 10.1097/bsd.0000000000001597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/29/2023] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Preclinical animal study. OBJECTIVE Evaluate the osteoinductivity and bone regenerative capacity of BioRestore bioactive glass. SUMMARY OF BACKGROUND DATA BioRestore is a Food and Drug Administration (FDA)-approved bone void filler that has not yet been evaluated as a bone graft extender or substitute for spine fusion. METHODS In vitro and in vivo methods were used to compare BioRestore with other biomaterials for the capacity to promote osteodifferentiation and spinal fusion. The materials evaluated (1) absorbable collagen sponge (ACS), (2) allograft, (3) BioRestore, (4) Human Demineralized Bone Matrix (DBM), and (5) MasterGraft. For in vitro studies, rat bone marrow-derived stem cells (BMSC) were cultured on the materials in either standard or osteogenic media (SM, OM), followed by quantification of osteogenic marker genes ( Runx2, Osx, Alpl, Bglap, Spp1 ) and alkaline phosphatase (ALP) activity. Sixty female Fischer rats underwent L4-5 posterolateral fusion (PLF) with placement of 1 of 5 implants: (1) ICBG from syngeneic rats; (2) ICBG+BioRestore; (3) BioRestore alone; (4) ICBG+Allograft; or (5) ICBG+MasterGraft. Spines were harvested 8 weeks postoperatively and evaluated for bone formation and fusion via radiography, blinded manual palpation, microCT, and histology. RESULTS After culture for 1 week, BioRestore promoted similar expression levels of Runx2 and Osx to cells grown on DBM. At the 2-week timepoint, the relative ALP activity for BioRestore-OM was significantly higher ( P <0.001) than that of ACS-OM and DBM-OM ( P <0.01) and statistically equivalent to cells grown on allograft-OM. In vivo, radiographic and microCT evaluation showed some degree of bridging bone formation in all groups tested, with the exception of BioRestore alone, which did not produce successful fusions. CONCLUSIONS This study demonstrates the capacity of BioRestore to promote osteoinductivity in vitro. In vivo, BioRestore performed similarly to commercially available bone graft extender materials but was incapable of producing fusion as a bone graft substitute. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Elianna J Fred
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Silvia Minardi
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Alyssa M Goodwin
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Tejas S Nandurkar
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Mark A Plantz
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Joseph G Lyons
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Jonathan T Paul
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - James P Foley
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Allison J Wintring
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Andrew A Furman
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Soyeon Jeong
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Chawon Yun
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Stuart R Stock
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Cell and Developmental Biology, Northwestern University, Chicago, IL
| | - Wellington K Hsu
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Erin L Hsu
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
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Chen H, Lin YM, Bupphathong S, Lim J, Huang JE, Huang W, Hsieh TAS, Lin CH. Synthesis of Silanized Bioactive Glass/Gelatin Methacrylate (GelMA/Si-BG) composite hydrogel for Bone Tissue Engineering Application. J Mech Behav Biomed Mater 2023; 147:106159. [PMID: 37797555 DOI: 10.1016/j.jmbbm.2023.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Abstract
Bioactive glass (BG) has been widely employed in the field of bone tissue engineering owing to its osteoconductive properties. These properties increase the stiffness and bioactivity of polymeric hydrogels, making them ideal for the repair, replacement, and regeneration of damaged bones. In this study, we investigated the effects of incorporating silanized 45S5 bioactive glass (Si-BG) into gelatin methacrylate (GelMA) hydrogel (GelMA/Si-BG) for potential bone tissue engineering. Our findings revealed that crosslinking GelMA with Si-BG had a striking increase in bioactivity with and without osteogenic induction of human mesenchymal stem cells (hMSCs) when compared to GelMA/BG hydrogels. Meanwhile, both GelMA/Si-BG and GelMA/BG hydrogels were able to maintain the cell viability of hMSC for up to 14 days. Additionally, GelMA/Si-BG hydrogels were shown to have a significantly higher compressive modulus than GelMA/BG hydrogels. This study has demonstrated the introduction of silanized 45S5 BG into GelMA hydrogel bioactivity and mechanical properties of GelMA hydrogels, exemplifying the potential application of silanization of BG in bone tissue engineering.
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Affiliation(s)
- Hsuan Chen
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
| | - Yuan-Min Lin
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Department of Stomatology, Taipei Veterans Hospital, Taipei, 11221, Taiwan; Institute of Oral Tissue Engineering and Biomaterials, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
| | - Sasinan Bupphathong
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan; High-value Biomaterials Research and Commercialization Center, National Taipei University of Technology, Taipei, 10608, Taiwan
| | - Joshua Lim
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Jing-En Huang
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
| | - Wei Huang
- Department of Orthodontics, Rutgers School of Dental Medicine, Newark, NJ, 07103, USA
| | - Tiffany Angela S Hsieh
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Chih-Hsin Lin
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan.
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Shearer A, Montazerian M, Sly JJ, Hill RG, Mauro JC. Trends and perspectives on the commercialization of bioactive glasses. Acta Biomater 2023; 160:14-31. [PMID: 36804821 DOI: 10.1016/j.actbio.2023.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
At least 25 bioactive glass (BG) medical devices have been approved for clinical use by global regulatory agencies. Diverse applications include monolithic implants, bone void fillers, dentin hypersensitivity agents, wound dressing, and cancer therapeutics. The morphology and delivery systems of bioactive glasses have evolved dramatically since the first devices based on 45S5 Bioglass®. The particle size of these devices has generally decreased with the evolution of bioactive glass technology but primarily lies in the micron size range. Morphologies have progressed from glass monoliths to granules, putties, and cements, allowing medical professionals greater flexibility and control. Compositions of these commercial materials have primarily relied on silicate-based systems with varying concentrations of sodium, calcium, and phosphorus. Furthermore, therapeutic ions have been investigated and show promise for greater control of biological stimulation of genetic processes and increased bioactivity. Some commercial products have exploited the borate and phosphate-based compositions for soft tissue repair/regeneration. Mesoporous BGs also promise anticancer therapies due to their ability to deliver drugs in combination with radiotherapy, photothermal therapy, and magnetic hyperthermia. The objective of this article is to critically discuss all clinically approved bioactive glass products. Understanding essential regulatory standards and rules for production is presented through a review of the commercialization process. The future of bioactive glasses, their promising applications, and the challenges are outlined. STATEMENT OF SIGNIFICANCE: Bioactive glasses have evolved into a wide range of products used to treat various medical conditions. They are non-equilibrium, non-crystalline materials that have been designed to induce specific biological activity. They can bond to bone and soft tissues and contribute to their regeneration. They are promising in combating pathogens and malignancies by delivering drugs, inorganic therapeutic ions, and heat for magnetic-induced hyperthermia or laser-induced phototherapy. This review addresses each bioactive glass product approved by regulatory agencies for clinical use. A review of the commercialization process is also provided with insight into critical regulatory standards and guidelines for manufacturing. Finally, a critical evaluation of the future of bioactive glass development, applications, and challenges are discussed.
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Affiliation(s)
- Adam Shearer
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Maziar Montazerian
- Northeastern Laboratory for Evaluation and Development of Biomaterials, Department of Materials Engineering, Federal University of Campina Grande, PB, Brazil
| | - Jessica J Sly
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Robert G Hill
- Institute of Dentistry, Dental Physical Sciences Unit, Queen Mary University of London, London, United Kingdom
| | - John C Mauro
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA.
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Szadkowski M, Bahroun S, Aleksic I, Vande Kerckhove M, Ramos-Pascual S, Saffarini M, Fière V, d'Astorg H. Bioactive glass grants equivalent fusion compared to autologous iliac crest bone for ALIF: a within-patient comparative study. J Exp Orthop 2022; 9:56. [PMID: 35713816 PMCID: PMC9206065 DOI: 10.1186/s40634-022-00496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To determine within-patient fusion rates of chambers filled with bioactive glass versus autologous iliac crest bone on computed tomography (CT) following anterior lumbar interbody fusion (ALIF). Methods A consecutive series of 40 patients (58 levels) that underwent single-level (L5-S1 only) or two-level (L5-S1 and L4-L5) ALIF were assessed. Indications for fusion were one or more of the following: degenerative disc disease with or without Modic changes, spondylolisthesis, and stenosis. Each intervertebral cage had a middle beam delimiting two chambers, one of which was filled with bioactive glass and the other with autologous iliac crest bone. CT scans were graded using the Bridwell classification (grade I, best; grade IV, worst). Patients were evaluated using the Oswestry Disability Index (ODI), and by rating pain in the lower back and legs on a Visual Analog Scale (pVAS); complications and reoperations were noted. Results At 15 ± 5 months follow-up, there were no significant differences in fusion across chambers filled with bioactive glass versus chambers filled with autologous bone (p = 0.416). Two patients with Bridwell grade III at both chambers of the L4-L5 cages required reoperation using posterior instrumentation. Clinical assessment of the 38 remaining patients (54 levels) at 25 ± 2 months, revealed ODI of 15 ± 12, lower back pVAS of 1.4 ± 1.5 and legs pVAS of 1.9 ± 1.6. Conclusions For ALIF at L5-S1 or L4-L5, within-patient fusion rates were equivalent for bioactive glass compared to autologous iliac crest bone; thus, bioactive glass can substitute autologous bone, avoiding increased operative time and blood loss, as well as donor site morbidity.
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Affiliation(s)
| | - Sami Bahroun
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Ivan Aleksic
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | | | | | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
| | - Vincent Fière
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Veizi E, Alkan H, Çay N, Şahin A, Çepni Ş, Tecimel O, Fırat A. Clinical and radiological comparison of bioactive glass and poly-L-lactic acid/hydroxyapatite bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2022; 108:103247. [PMID: 35167963 DOI: 10.1016/j.otsr.2022.103247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ligament reconstruction is still the main treatment modality for patients with a complete ligament rupture. The semitendinosus tendon, alone quadrupled or double folded and combined with the gracilis tendon, is still the most frequently used autologous graft for a reconstructive procedure. Absorbable interference screw usage has gained popularity in the past decade because they create less artifacts during MR imaging and tend to osteointegrate over the years, arguably leading to a more anatomic fixation. The purpose of this study was to compare the 5-year radiological and clinical results of two different tibial graft fixation screws. HYPOTHESIS We hypothesized that bioabsorbable interference screws made of bioactive glass would lead to higher rates of osteointegration, better overall clinical results, less foreign body reaction rates and less tibial tunnel widening when compared to the poly-L-lactic acid/hydroxyapatite (PLLA-HA) screws. PATIENTS AND METHODS Fifty-one patients treated with an anatomic single bundle ACL reconstruction between June 2015 and July 2016 at our institution were included in the study. The tibial graft was fixed with a bioactive glass screw in 24, and with a PLLA-HA in 27 patients. Tibial tunnel widening, foreign body reaction, osteointegration and resorption rates were evaluated and compared on a magnetic resonance scan at a minimum of 5 year postoperatively. Overall clinical results and side-to-side difference on KT-1000 were also analyzed in-between groups. RESULTS Tibial tunnel widening was similar for both groups. Foreign body reaction, while not statistically significant, was less aggressive when bioactive glass screws were used. Osteointegration and resorption rates of the bioactive glass screws were significantly higher than the PLLA-HA group (p=0.000). While all patients showed an overall improvement on postoperative scores (p=0.000), patients with a bioactive glass interference screw had statistically higher translational stability with KT-1000, compared to the poly-L-lactic acid/hydroxyapatite group (p=0.001). DISCUSSION At a minimum of 5 years, compared to conventional PLLA-HA interference screws, 45S5 bioactive glass screw provide higher resorption rates, are more highly biodegradable and provide overall good clinical results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Enejd Veizi
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
| | - Hilmi Alkan
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Nurdan Çay
- Department of Radiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Şahin Çepni
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Fırat
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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Fiani B, Jarrah R, Shields J, Sekhon M. Enhanced biomaterials: systematic review of alternatives to supplement spine fusion including silicon nitride, bioactive glass, amino peptide bone graft, and tantalum. Neurosurg Focus 2021; 50:E10. [PMID: 34062502 DOI: 10.3171/2021.3.focus201044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal fusions are among the most common and effective spinal surgical practices; however, the current model presents some cost and safety concerns within the patient population. Therefore, enhanced biomaterials have been presented to be an innovative yet underutilized tool to supplement the success of spinal fusion surgery. Herein, the authors discuss these biomaterials, their compositions, clinical outcomes, and cost analysis through a systematic review of the literature to date. METHODS This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and guidelines. Article selection was performed using the PubMed electronic bibliographic databases. The search yielded 1168 articles that were assessed and filtered for relevance by the four authors. Following the screening of titles and abstracts, 62 articles were deemed significant enough for final selection. RESULTS To date, silicon nitride, bioactive glass, amino peptide bone grafts, and tantalum are all biomaterials that could have significant roles in supporting spinal fusion. Their unique compositions allow them to be biocompatible in the spine, and their mechanisms of action stimulate osteoblast formation and support fusion success. Moreover, these biomaterials also present positive clinical and cost outcomes that support their application in spinal procedures. However, further studies with longer follow-ups are necessary to fully understand these biomaterials prior to their incorporation in mainstream spinal practice. CONCLUSIONS The combination of their positive clinical outcomes, biocompatibility, and cost-effectiveness makes these biomaterials valuable, innovative, and effective treatment modalities that could revolutionize the current model of spinal fusion.
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Affiliation(s)
- Brian Fiani
- 1Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Ryan Jarrah
- 2College of Arts and Sciences, University of Michigan-Flint
| | - Jennifer Shields
- 3College of Human Medicine, Michigan State University, East Lansing; and
| | - Manraj Sekhon
- 4William Beaumont School of Medicine, Oakland University, Rochester, Michigan
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Romano AM, Ascione T, Casillo P, Nastrucci G, Susanna M, Di Giunta A, Ascione F. An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment. J Clin Med 2020; 9:E3683. [PMID: 33207849 PMCID: PMC7696467 DOI: 10.3390/jcm9113683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
Periprosthetic joint infections of the shoulder (PJIS) are the major cause for revision within the first two post-operative years, and are challenging both to diagnose and treat. Success depends on early identification of microorganisms, appropriate surgical procedures and efficient antibiotic administration. The peculiar microbiology of the shoulder may render the criteria for hip/knee PJI management inappropriate. In addition, later cases with clinically subtle signs often present diagnostic challenges. In recent years, specific issues of PJIS have been managed through the use of new instruments, such as MicroDTTect in pathogen detection and Bioactive Glass and tantalum cones in humeral bone loss. In the literature to date, no reports have been found that discuss the application in shoulder revisions and infections. The early identification of the microorganisms that cause infection may help improve both treatment strategies and the efficacy of therapy. MicroDTTect proved to be more efficient than swab collection for bacterial identification in orthopedic surgery, thus reducing analysis costs. The increasing number of shoulder arthroplasties is associated with an increase in the number of revisions. In cases of massive metaphyseal humeral bone loss, several techniques have been described; no reports have been reported regarding tantalum in humeral bone loss management. In some cases the tantalum cones required adaptation for femoral diaphysis in the augmentation of the humerus metaphysis and bone loss management improvement. Obtaining stable osseointegration of prosthetic implants is one of the greatest issues in orthopedic surgery, and even more crucial in revisions. Bioactive glasses demonstrated good regenerative and osseointegration properties, and an excellent candidate as a bone graft, scaffold and antibiotics deliverer. The Bioactive glasses were used to increase prosthesis-bone interface stability and fill bone defects in PJIS revision surgeries, contributing to the prevention of re-infection. Longer-term follow-up will be necessary to determine if construction durability is improved in the long term.
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Affiliation(s)
- Alfonso Maria Romano
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
- Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Napoli, Italy
| | - Tiziana Ascione
- Department of Infectious Diseases, A. Cardarelli Hospital, 80131 Napoli, Italy;
| | - Pasquale Casillo
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
| | - Guglielmo Nastrucci
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
| | - Massimiliano Susanna
- Orthopedic and Traumatology Unit, San Donà di Piave Hospital, 30027 Venezia, Italy;
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico “G.B. Morgagni”, 95125 Catania, Italy;
| | - Francesco Ascione
- Department of Shoulder Surgery, Campolongo Hospital, 84127 Salerno, Italy; (A.M.R.); (P.C.); (G.N.)
- Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Napoli, Italy
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Abstract
PURPOSE OF REVIEW To provide information on characteristics and use of various ceramics in spine fusion and future directions. RECENT FINDINGS In most recent years, focus has been shifted to the use of ceramics in minimally invasive surgeries or implementation of nanostructured surface modification features to promote osteoinductive properties. In addition, effort has been placed on the development of bioactive synthetics. Core characteristic of bioactive synthetics is that they undergo change to simulate a beneficial response within the bone. This change is based on chemical reaction and various chemical elements present in the bioactive ceramics. Recently, a synthetic 15-amino acid polypeptide bound to an anorganic bone material which mimics the cell-binding domain of type-I collagen opened a possibility for osteogenic and osteoinductive roles of this hybrid graft material. Ceramics have been present in the spine fusion arena for several decades; however, their use has been limited. The major obstacle in published literature is small sample size resulting in low evidence and a potential for bias. In addition, different physical and chemical properties of various ceramics further contribute to the limited evidence. Although ceramics have several disadvantages, they still hold a great promise as a value-based graft material with being easily available, relatively inexpensive, and non-immunogenic.
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Cottrill E, Pennington Z, Lankipalle N, Ehresman J, Valencia C, Schilling A, Feghali J, Perdomo-Pantoja A, Theodore N, Sciubba DM, Witham T. The effect of bioactive glasses on spinal fusion: A cross-disciplinary systematic review and meta-analysis of the preclinical and clinical data. J Clin Neurosci 2020; 78:34-46. [PMID: 32331941 DOI: 10.1016/j.jocn.2020.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/05/2020] [Indexed: 01/23/2023]
Abstract
Pseudarthrosis following spinal fusion is correlated with poorer patient outcomes and consequently is an area of continued interest within spinal research. Recently, bioactive glasses have been proposed as a means of augmenting fusion rates. Here, we present the first systematic review and meta-analysis of the existing preclinical and clinical literature on the effect of bioactive glasses on spinal fusion. Using the MEDLINE, Embase, and Web of Science databases, we queried all publications in the English-language literature examining the effect of bioactive glasses on spinal fusion. The primary endpoint was fusion rate at last follow-up and the secondary endpoint for clinical studies was the rate of deep wound infection. Random-effects meta-analyses were performed independently for the preclinical and clinical data. Twelve preclinical studies (267 animals) and 12 clinical studies (396 patients) evaluating a total of twelve unique bioactive glass formulations were included. Across clinical studies, fusion was seen in 84% treated with bioactive glass. On sub-analysis, fusion rates were similar for standalone autograft (91.6%) and bioactive glass-local autograft mixtures (89.6%). Standalone bioactive glass substrates produced inferior fusion rates relative to autograft alone (33.6% vs. 98.8%; OR 0.01, p < 0.02). Rates of deep wound infection did not differ between the bioactive glass and autograft groups (3.1%). The preclinical data similarly showed comparable rates of fusion between autograft and bioactive glass-treated animals. The available data suggest that bioactive glass-autograft mixtures confer similar rates of spinal fusion relative to standalone autograft without altering the risk of deep wound infection.
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Affiliation(s)
- Ethan Cottrill
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zach Pennington
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nithin Lankipalle
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Ehresman
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cara Valencia
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Schilling
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Feghali
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Nicholas Theodore
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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