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Norbertczak HT, Ingham E, Fermor HL, Wilcox RK. Decellularized Intervertebral Discs: A Potential Replacement for Degenerate Human Discs. Tissue Eng Part C Methods 2020; 26:565-576. [PMID: 33050844 PMCID: PMC7698987 DOI: 10.1089/ten.tec.2020.0104] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a major cause of back pain. Current surgical interventions have limitations. An alternative approach is to replace degenerated IVDs with a natural biological scaffold. The removal of cellular components from human IVDs should render them nonimmunogenic upon implantation. The aim of this initial proof of technical feasibility study was to develop a decellularization protocol on bovine IVDs with endplates (EPs) and assess protocol performance before application of the protocol to human IVDs with attached EP and vertebral bone (VB). A decellularization protocol based on hypotonic low concentration sodium dodecyl sulfate (0.1% w/v) with proteinase inhibitors, freeze/thaw cycles, and nuclease and sonication treatments was applied to IVDs. Histological, biochemical, and biomechanical comparisons were made between cellular and decellularized tissue. Cell removal from bovine IVDs was demonstrated and total DNA levels of the decellularized inner annulus fibrosus (iAF), outer annulus fibrosus (oAF), and EP were 40.7 (±11.4), 25.9 (±3.8), and 29.3 (±3.1) ng.mg−1 dry tissue weight, respectively (n = 6, ±95% confidence level [CL]). These values were significantly lower than in cellular tissue. No significant difference in DNA levels between bovine cellular and decellularized nucleus pulposus (NP) was found. Glycosaminoglycans (GAGs) were largely retained in the NP, iAF, and oAF. Cyclic compression testing showed sufficient sensitivity to detect an increase in stiffness of bovine IVD postdecellularization (2957.2 ± 340.8 N.mm−1) (predecellularization: 2685.4 ± 263.1 N.mm−1; n = 5, 95% CL), but the difference was within natural tissue variation. Total DNA levels for all decellularized tissue regions of human IVDs (NP, iAF, oAF, EP, and VB) were below 50 ng.mg−1 dry tissue weight (range: 2 ng.mg−1, iAF to 29 ng.mg−1, VB) and the tissue retained high levels of GAGs. Further studies to assess the biocompatibility and regenerative potential of decellularized human IVDs in vitro and in vivo are now required; however, proof of technical feasibility has been demonstrated and the retention of bone in the IVD samples would allow incorporation of the tissue into the recipient spine.
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Affiliation(s)
- Halina T Norbertczak
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, The University of Leeds, Leeds, United Kingdom
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, The University of Leeds, Leeds, United Kingdom
| | - Hazel L Fermor
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, The University of Leeds, Leeds, United Kingdom
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering and Physical Sciences, The University of Leeds, Leeds, United Kingdom
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2
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Raghuram A, Singh A, Chang DK, Nunez M, Reece EM. Bone Grafts, Bone Substitutes, and Orthobiologics: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:190-199. [PMID: 31384235 DOI: 10.1055/s-0039-1693020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As reconstructive needs often extend past the soft tissue alone, a plastic surgeon must also be well versed in the methods of bony reconstruction. Understanding of the basic science of fracture healing and the biochemical mechanisms of the different bone grafts, bone substitutes, and orthobiologics is essential to selecting among the many different options available to the modern plastic surgeon. This review provides a broad overview of these different options and the specific applications for plastic surgeons based on anatomic location.
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Affiliation(s)
| | - Aspinder Singh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Daniel K Chang
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Mervin Nunez
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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3
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Dankl L, Mayr A, Kaufmann G, Thaler M, Nogler M, Putzer D. Measuring bone defects for acetabular revision surgery for choosing an appropriate reconstruction strategy: A concept study on plastic models. Comput Biol Med 2019; 111:103336. [PMID: 31276945 DOI: 10.1016/j.compbiomed.2019.103336] [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: 03/19/2019] [Revised: 05/20/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone defects can be filled with autografts, allografts and artificial bone-materials. The aim of this study was to evaluate whether the digitization of known defect models with a navigation system is a reliable measurement method for estimating the size of a bone defect. METHODS Six preformed, cylindrical and cone-shaped defects on an artificial hip-bone were digitalized by six different observers. Reference volumes were gathered by measuring the depth of the defects, using an alginate impression material to fill out the defects and calculating the volumes from a CT scan. RESULTS One out of the six preformed defects showed a statistically significant difference between the digitalization and the calculation, four showed a significant difference between the digitalization and the mould as well as between the digitalization and the CT calculation. CONCLUSIONS This technique offers satisfactory results and consistent reproducibility when digitalizing big defects with relatively simple shape. Decreasing size and increasing complexity of the defects leads to more imprecise measurements.
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Affiliation(s)
- Lukas Dankl
- Medical University of Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Medical University of Innsbruck, Department of Radiology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gerhard Kaufmann
- Orthopaedic and Foot Center, Innsbruck, Innrain 2, 6020, Innsbruck, Austria
| | - Martin Thaler
- Medical University of Innsbruck, Department of Orthopaedic Surgery, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michael Nogler
- Medical University of Innsbruck, Department of Orthopaedics - Experimental Orthopaedics, Innrain 36, 6020, Innsbruck, Austria
| | - David Putzer
- Medical University of Innsbruck, Department of Orthopaedics - Experimental Orthopaedics, Innrain 36, 6020, Innsbruck, Austria.
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4
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Putzer D, Scholl F, Dankl L, Dammerer D, Thaler M, Nogler M. Intraoperative bone defect measurement in the acetabulum using a navigation system: The influence of bone porosity on the digitalization process. Med Eng Phys 2018; 59:75-80. [PMID: 30001979 DOI: 10.1016/j.medengphy.2018.06.005] [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: 12/20/2017] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate how bone porosity affects intraoperative volume measurement of the acetabulum in a plastic bone model study and to validate the measurement method on cadaveric acetabula. Point cloud collection was performed using a navigation system and compared to CT measurements as well as theoretical calculations on sawbones with different porosities and validated on cadaveric specimens. The grade of porosity had a significant influence on the volume measurement. In high porous materials volume calculation (61.5 cm²) was overestimated when using a digitalizer, while in materials with low porosity the volume was underestimated (57.0 cm²) in comparison to the known size of the defect (59.4 cm²). Digitalization time of the acetabulum was between 1 and 4 min. Validating the measurement on cadaveric bones no statistical significant difference could be found between digitalized volumes and theoretically calculated volumes. As digitalization of the acetabulum can be carried out in a reasonable time it could be used as a measurement tool to estimate the amount of allografts needed for filling bone defects.
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Affiliation(s)
- David Putzer
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria.
| | - Florian Scholl
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria
| | - Lukas Dankl
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Medical University of Innsbruck, Department of Orthopaedics, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Thaler
- Medical University of Innsbruck, Department of Orthopaedics, Anichstraße 35, 6020 Innsbruck, Austria
| | - Michael Nogler
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria
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5
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Platelet concentrate as an additive to bone allografts: a laboratory study using an uniaxial compression test. Cell Tissue Bank 2018; 19:559-567. [PMID: 29855739 PMCID: PMC6280855 DOI: 10.1007/s10561-018-9704-3] [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: 11/30/2017] [Accepted: 05/25/2018] [Indexed: 11/27/2022]
Abstract
Chemical cleaning procedures of allografts are destroying viable bone cells and denaturing osteoconductive and osteoinductive proteins present in the graft. The aim of the study was to investigate the mechanical differences of chemical cleaned allografts by adding blood, clotted blood; platelet concentrate and platelet gel using a uniaxial compression test. The allografts were chemically cleaned, dried and standardized according to their grain size distribution. Uniaxial compression test was carried out for the four groups before and after compacting the allografts. No statistically significant difference was found between native allografts, allografts mixed with blood, clotted blood, platelet concentrate and platelet concentrate gel regarding their yield limit after compaction. The authors recommend to chemical clean allografts for large defects, optimize their grain size distribution and add platelet concentrate or platelet rich plasma for enhancing as well primary stability as well bone ingrowth.
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Cleemann R, Bechtold JE, Sorensen M, Soballe K, Baas J. Dose-Dependent Resorption of Allograft by rhBMP-2 Uncompensated by New Bone Formation-A Canine Study With Implants and Zoledronate. J Arthroplasty 2018; 33:1215-1221.e1. [PMID: 29248483 DOI: 10.1016/j.arth.2017.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Impacted bone allograft is used to restore lost bone in total joint arthroplasties. Bone morphogenetic proteins (BMPs) can induce new bone formation to improve allograft incorporation, but they simultaneously invoke a seemingly dose-dependent allograft resorption mediated by osteoclasts. Bisphosphonates effectively inhibit osteoclast activity. Predicting allograft resorption when augmented with bone morphogenetic protein 2 (BMP-2), we intended to investigate whether a balanced bone metabolism was achievable within a range of BMP-2 doses with systemic zoledronate treatment. METHODS Implants were coated with 1 of 3 BMP-2 doses (15 μg, 60 μg, and 240 μg) or left untreated. Implants were surrounded by a 2.5-mm gap filled with impacted morselized allograft. Each of the 12 dogs included received 1 of each implant (15 μg, 60 μg, 240 μg, and untreated), 2 in each proximal humerus. During the 4-week observation period, zoledronate intravenous (0.1 mg/kg) was administered to all animals 10 days after surgery as anticatabolic treatment. Implant osseointegration was evaluated by histomorphometry and mechanical push-out tests. RESULTS Untreated implants had the best mechanical fixation and superior retention of allograft as compared to any of the BMP-2 implants. Both mechanical implant fixation and retention of allograft decreased significantly with BMP-2 dose increments. Surprisingly, there was no difference among the treatment groups in the amount of new bone. CONCLUSION The use of BMP-2 to augment impaction-grafted implants cannot be recommended even when combined with systemic zoledronate.
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Affiliation(s)
- Rasmus Cleemann
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Mette Sorensen
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Kjeld Soballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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7
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Fernandez de Grado G, Keller L, Idoux-Gillet Y, Wagner Q, Musset AM, Benkirane-Jessel N, Bornert F, Offner D. Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management. J Tissue Eng 2018; 9:2041731418776819. [PMID: 29899969 PMCID: PMC5990883 DOI: 10.1177/2041731418776819] [Citation(s) in RCA: 371] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
Abstract
Bone replacement might have been practiced for centuries with various materials of natural origin, but had rarely met success until the late 19th century. Nowadays, many different bone substitutes can be used. They can be either derived from biological products such as demineralized bone matrix, platelet-rich plasma, hydroxyapatite, adjunction of growth factors (like bone morphogenetic protein) or synthetic such as calcium sulfate, tri-calcium phosphate ceramics, bioactive glasses, or polymer-based substitutes. All these substitutes are not suitable for every clinical use, and they have to be chosen selectively depending on their purpose. Thus, this review aims to highlight the principal characteristics of the most commonly used bone substitutes and to give some directions concerning their clinical use, as spine fusion, open-wedge tibial osteotomy, long bone fracture, oral and maxillofacial surgery, or periodontal treatments. However, the main limitations to bone substitutes use remain the management of large defects and the lack of vascularization in their central part, which is likely to appear following their utilization. In the field of bone tissue engineering, developing porous synthetic substitutes able to support a faster and a wider vascularization within their structure seems to be a promising way of research.
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Affiliation(s)
- Gabriel Fernandez de Grado
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
- Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, F-67000 Strasbourg
| | - Laetitia Keller
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
| | - Ysia Idoux-Gillet
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
| | - Quentin Wagner
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
| | - Anne-Marie Musset
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
- Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, F-67000 Strasbourg
| | - Nadia Benkirane-Jessel
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
| | - Fabien Bornert
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
- Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, F-67000 Strasbourg
| | - Damien Offner
- INSERM (French National Institute of Health and Medical Research), “Regenerative Nanomedicine” laboratory, http://www.regmed.fr, UMR 1260, Faculté de Médecine, FMTS, F-67085 Strasbourg Cedex
- Université de Strasbourg, Faculté de Chirurgie Dentaire, 8 rue Ste Elisabeth, F-67000 Strasbourg
- Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, F-67000 Strasbourg
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8
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Putzer D, Ammann CG, Coraça-Huber D, Lechner R, Schmölz W, Nogler M. The Influence of Liquids on the Mechanical Properties of Allografts in Bone Impaction Grafting. Biopreserv Biobank 2017; 15:410-416. [PMID: 28686464 DOI: 10.1089/bio.2017.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Allografts are used to compensate for bone defects resulting from revision surgery, tumor surgery, and reconstructive bone surgery. Although it is well known that the reduction of fat content of allografts increases mechanical properties, the content of liquids with a known grain size distribution has not been assessed so far. The aim of the study was to compare the mechanical properties of dried allografts (DA) with allografts mixed with a saline solution (ASS) and with allografts mixed with blood (AB) having a similar grain size distribution. Fresh-frozen morselized bone chips were cleaned chemically, sieved, and reassembled in specific portions with a known grain size distribution. A uniaxial compression was used to assess the yield limit, initial density, density at yield limit, and flowability of the three groups before and after compaction with a fall hammer apparatus. No statistically significant difference could be found for the yield limit between DA and ASS (p = 0.339) and between ASS and AB (p = 0.554). DA showed a statistically significant higher yield limit than AB (p = 0.022). Excluding the effect of the grain size distribution on the mechanical properties, it was shown that allografts have a lower yield limit when lipids are present. The liquid content of allografts seems to play an inferior role as no statistically significant difference could be found between DA and ASS. It is suggested, in accordance with other studies, to chemically clean allografts before implantation to reduce the contamination risk and the fat content.
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Affiliation(s)
- David Putzer
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Christoph Gert Ammann
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Débora Coraça-Huber
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Ricarda Lechner
- 2 Department of Orthopedic Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Werner Schmölz
- 3 Department of Trauma Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Michael Nogler
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
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9
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Pierannunzii L, Zagra L. Bone grafts, bone graft extenders, substitutes and enhancers for acetabular reconstruction in revision total hip arthroplasty. EFORT Open Rev 2017; 1:431-439. [PMID: 28461922 PMCID: PMC5367522 DOI: 10.1302/2058-5241.160025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acetabular bone loss is a relevant concern for surgeons dealing with a failed total hip arthroplasty. Since the femoral head is no longer available, allografts represent the first choice for most reconstructive solutions, either as a structural buttress or impacted bone chips. Even though fresh-frozen bone is firmly recommended for structural grafts, freeze-dried and/or irradiated bone may be used alternatively for impaction grafting. Indeed, there are some papers on freeze-dried or irradiated bone impaction grafting, but their number is limited, as is the number of cases. Xenografts do not represent a viable option based on the poor available evidence but bioactive bioceramics such as hydroxyapatite and biphasic calcium phosphates are suitable bone graft extenders or even substitutes for acetabular impaction grafting. Bone-marrow-derived mesenchymal stem cells and demineralised bone matrix seem to act as reliable bone graft enhancers, i.e. adjuvant therapies able to improve the biological performance of standard bone grafts or substitutes. Among these therapies, platelet-rich plasma and bone morphogenetic proteins need to be investigated further before any recommendations can be made.
Cite this article: EFORT Open Rev 2016;1:431-439. DOI:10.1302/2058-5241.160025
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Affiliation(s)
| | - Luigi Zagra
- IRCCS Galeazzi Orthopedic Institute, Milan, Italy
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10
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Fölsch C, Kellotat A, Rickert M, Ishaque B, Ahmed G, Pruss A, Jahnke A. Effect of thermodisinfection on mechanic parameters of cancellous bone. Cell Tissue Bank 2016; 17:427-37. [PMID: 27344440 DOI: 10.1007/s10561-016-9567-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
Revision surgery of joint replacements is increasing and raises the demand for allograft bone since restoration of bone stock is crucial for longevity of implants. Proceedings of bone grafts influence the biological and mechanic properties differently. This study examines the effect of thermodisinfection on mechanic properties of cancellous bone. Bone cylinders from both femoral heads with length 45 mm were taken from twenty-three 6-8 months-old piglets, thermodisinfected at 82.5 °C according to bone bank guidelines and control remained native. The specimens were stored at -20 °C immediately and were put into 21 °C Ringer's solution for 3 h before testing. Shear and pressure modulus were tested since three point bending force was examined until destruction. Statistical analysis was done with non-parametric Wilcoxon, t test and SPSS since p < 0.05 was significant. Shear modulus was significantly reduced by thermodisinfection to 1.02 ± 0.31 GPa from 1.28 ± 0.68 GPa for unprocessed cancellous bone (p = 0.029) since thermodisinfection reduced pressure modulus not significantly from 6.30 ± 4.72 GPa for native specimens to 4.97 ± 2.23 GPa and maximum bending force was 270.03 ± 116.68 N for native and 228.80 ± 70.49 N for thermodisinfected cancellous bone. Shear and pressure modulus were reduced by thermodisinfection around 20 % and maximum bending force was impaired by about 15 % compared with native cancellous bone since only the reduction of shear modulus reached significance. The results suggest that thermodisinfection similarly affects different mechanic properties of cancellous bone and the reduction of mechanic properties should not relevantly impair clinical use of thermodisinfected cancellous bone.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Andreas Kellotat
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
| | - Markus Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Bernd Ishaque
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Gafar Ahmed
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, 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
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
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11
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Wurm A, Steiger R, Ammann CG, Putzer D, Liebensteiner MC, Nogler M, Coraça-Huber DC. Changes in the Chemical Quality of Bone Grafts During Clinical Preparation Detected by Raman Spectroscopy. Biopreserv Biobank 2016; 14:319-23. [PMID: 27028037 DOI: 10.1089/bio.2015.0097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
METHODOLOGY We determined the content of amide I, amide III, PO4, CO3, and CH2 in samples of fresh bone, bone frozen at -80°C thawed once, bone after two freeze-thaw cycles, and chemically cleaned bone chips. A total of 750 Raman spectra were collected per sample group and the derived quantitative values compared statistically by one-way ANOVA. RESULTS We found statistically significant differences between the investigated sample groups differing in their treatment already after one freeze-thaw cycle and as well after multiple freeze-thaw cycles, and/or chemical cleaning. Chemical cleaning decreased the content of all measured components compared to the fresh sample as detected by Raman spectroscopy. We further used the derived data to calculate the mineral to matrix ratios for each sample group. DISCUSSION Our data indicate that significant changes of the chemical quality and mineral to matrix ratio occur during freeze-thawing and chemical cleaning. At the same time, this study highlights the importance of sampling and testing at multiple locations for reliable predictions of the chemical composition. We think that it is very desirable to test the quality of bone graft material before transfer to a recipient; this might ultimately help define parameters to choose the best graft for the patient. It is also important to highlight that this is a preliminary study, which shows the importance of detecting changes in the chemical quality of bone grafts before transfer to the patient.
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Affiliation(s)
- Alexander Wurm
- 1 Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria .,2 University Hospital for Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Ruth Steiger
- 3 Department of Neuroradiology, Medical University of Innsbruck , Innsbruck, Austria
| | - Christoph G Ammann
- 1 Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - David Putzer
- 1 Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | | | - Michael Nogler
- 1 Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria .,2 University Hospital for Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
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Clinical–radiological evaluation of the impaction allografting and cemented stem technique in revision knee surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Mateo-Negreira J, López-Cuello P, Pipa-Muñiz I, Rodríguez García N, Murcia-Mazón A, Suárez-Suárez MA. [Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 60:141-7. [PMID: 26655209 DOI: 10.1016/j.recot.2015.09.001] [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: 03/04/2013] [Revised: 07/01/2013] [Accepted: 09/21/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. MATERIAL AND METHODS An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. RESULTS Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. DISCUSSION Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. CONCLUSIONS The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future.
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Affiliation(s)
- J Mateo-Negreira
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España.
| | - P López-Cuello
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - I Pipa-Muñiz
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - N Rodríguez García
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España
| | - A Murcia-Mazón
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España; Facultad de Medicina y Ciencia de la Salud, Universidad de Oviedo
| | - M A Suárez-Suárez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Cabueñes, Gijón, Asturias, España; Facultad de Medicina y Ciencia de la Salud, Universidad de Oviedo
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Putzer D, Fuchs J, Coraça-Huber D, Christoph A, Liebensteiner M, Nogler M. BAG-S53P4 as an additive to bone allografts: A laboratory study using an uniaxial compression test. J Orthop Res 2015; 33:1875-9. [PMID: 26016590 DOI: 10.1002/jor.22953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/21/2015] [Indexed: 02/04/2023]
Abstract
We want to address the clinical issue of too sparse supply of allograft in total hip replacement and ambitions of controlling the grain size distribution. Bioglass BAG-S53P4 was evaluated as a bone graft additive to chemically treated allografts with controlled grain size distribution. Allografts were chemically cleaned (CG) and mixed with BAG-S53P4 additive (BG) for comparison. All samples were compacted with a dropped weight apparatus and then underwent a uniaxial compression test. The yield limit was determined by a uniaxial compression test and density was recorded while flowability was calculated. There was no difference between the yield stress limit of BG and CG after compaction (p=0.432). Adding BAG-S53P4 reduced flowability and could indicate better interlocking mechanism between particles. Adding BAG-S53P4 seems to have no impact on the yield stress limit. The extended allografts withstand the compaction equally good which makes it a valid bone substitute in total hip replacement. An in vivo loaded study is needed before clinical use can be recommended.
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Affiliation(s)
- David Putzer
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Johannes Fuchs
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Débora Coraça-Huber
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Ammann Christoph
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Michael Liebensteiner
- Department of Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Michael Nogler
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
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15
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Hermansen LL, Sørensen M, Barckman J, Bechtold JE, Søballe K, Baas J. Incorporation of raloxifene-impregnated allograft around orthopedic titanium implants impairs early fixation but improves new bone formation. Acta Orthop 2015; 86:127-33. [PMID: 25175661 PMCID: PMC4366660 DOI: 10.3109/17453674.2014.958808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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 The anti-osteoporotic drug raloxifene reduces the risk of vertebral fractures by increasing bone mass density. We investigated whether raloxifene offers any benefits in augmenting early fixation of orthopedic implants in the setting of impaction bone grafting. METHODS 24 non-weight-bearing grafted gap implants were inserted bilaterally into the tibia of 12 dogs. The 2.5-mm peri-implant gap was filled with either raloxifene-impregnated or untreated bone allograft. Implants were harvested after 28 days. Implant fixation was assessed by mechanical testing and histomorphometric evaluation. RESULTS Raloxifene-treated allograft reduced early implant fixation compared to untreated allograft, as measured by inferior maximum shear strength (p < 0.001) and apparent shear stiffness (p = 0.001). We found that the raloxifene group had more newly formed bone in the gap around the implant (p = 0.02), but also less allograft (p = 0.03). INTERPRETATION The accelerated allograft resorption in the raloxifene group explained the impaired early fixation, despite its stimulation of new bone formation. Our results with local and possible high-dose treatment are not consistent with current theory regarding the mechanism of how systemic raloxifene administration counteracts the decrease in BMD in postmenopausal women. Instead of being solely anti-resorptive as generally held, our results indicate a possible anabolic side of raloxifene.
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Affiliation(s)
- Lars L Hermansen
- Othopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Sørensen
- Othopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Jeppe Barckman
- Othopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Joan E Bechtold
- Orthopedic Biomechanics Laboratory, Minneapolis Medical Research Foundation, University of Minnesota and Excelen Center for Bone and Joint Research and Education, Minneapolis, MN, USA
| | - Kjeld Søballe
- Othopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Baas
- Othopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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16
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Birkin PR, Offin DG, Vian CJB, Howlin RP, Dawson JI, Secker TJ, Hervé RC, Stoodley P, Oreffo ROC, Keevil CW, Leighton TG. Cold water cleaning of brain proteins, biofilm and bone – harnessing an ultrasonically activated stream. Phys Chem Chem Phys 2015. [DOI: 10.1039/c5cp02406d] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The ability of acoustically active bubbles to remove a range of biological contaminants is demonstrated in an ultrasonically activated stream.
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Affiliation(s)
| | | | | | - R. P. Howlin
- National Centre for Advanced Tribology at Southampton
- University of Southampton
- UK
| | - J. I. Dawson
- Centre for Human Development
- Stem Cells and Regeneration
- Medicine
- University of Southampton
- UK
| | - T. J. Secker
- Centre for Biological Sciences
- University of Southampton
- UK
| | - R. C. Hervé
- Centre for Biological Sciences
- University of Southampton
- UK
| | - P. Stoodley
- National Centre for Advanced Tribology at Southampton
- University of Southampton
- UK
| | - R. O. C. Oreffo
- Centre for Human Development
- Stem Cells and Regeneration
- Medicine
- University of Southampton
- UK
| | - C. W. Keevil
- Centre for Biological Sciences
- University of Southampton
- UK
| | - T. G. Leighton
- Institute of Sound and Vibration Research
- University of Southampton
- UK
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17
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Putzer D, Coraça-Huber D, Wurm A, Schmoelz W, Nogler M. Optimizing the grain size distribution of allografts in bone impaction grafting. J Orthop Res 2014; 32:1024-9. [PMID: 24797323 DOI: 10.1002/jor.22635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/31/2014] [Indexed: 02/04/2023]
Abstract
In bone impaction grafting, allografts in the form of bone chips are used for reconstruction of defects and to induce bone remodeling. Optimizing grain size distribution of this allograft material should help prevent implant subsidence by achieving higher primary stability of the graft. We evaluated the influence of grain size distribution on the mechanical stability of allograft material. Bone tissue was rinsed, and the grain size distribution of the allograft material was determined by performing a sieve analysis. Uniaxial compression tests were carried out before and after a standardized compaction procedure for samples with controlled grain size distribution and a control group. Allografts with controlled grain size distribution showed a yield limit almost twice as high as in the control group after a standardized compaction procedure. A better interlocking between bone particles was observed compared to the control group. Thus, grain size distribution has a major impact on the mechanical stability of bone grafts. By controlling the grain size distribution of allograft material, a tighter packing can be achieved and subsequently implant subsidence of implants could be avoided.
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Affiliation(s)
- David Putzer
- Experimental Orthopaedics, Department of Orthopaedics, Innsbruck Medical University, Innrain 36, 6020, Innsbruck, Austria
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18
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The mechanical stability of allografts after a cleaning process: comparison of two preparation modes. J Arthroplasty 2014; 29:1642-6. [PMID: 24793889 DOI: 10.1016/j.arth.2014.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 02/12/2014] [Accepted: 03/24/2014] [Indexed: 02/01/2023] Open
Abstract
In revision hip arthroplasty, bone loss can be compensated by impacting allograft material. Cleaning processes reduce the risk of bacterial and viral contamination. Cleaned allograft material was compared to native untreated allografts by using a uniaxial compression test. 30 measurements were performed for each group before and after compaction. Grain size distribution and weight loss were determined. A reduction in the amount of large bone fragments and a higher compaction rate were observed in the cleaned bone grafts. The cleaned bone chips presented with a better mechanical resistance to a compression force and a reduced flowability. The benefit of a cleaner and a mechanical stable graft material comes with the drawback that higher initial amounts of graft material are needed.
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19
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Chomrikh L, Gebuhr P, Bierling R, Lind U, Zwart HJJ. Age-dependent fracture risk in hip revisions with radial impaction grafting technique: a 5-10 year medium-term follow-up study. J Arthroplasty 2014; 29:443-7. [PMID: 23891061 DOI: 10.1016/j.arth.2013.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/02/2013] [Accepted: 06/13/2013] [Indexed: 02/01/2023] Open
Abstract
Radial impaction grafting (RIG) potentially improves the durability and reliability of cementing the femoral components in revision total hip arthroplasty (THA). In this multicenter, prospective study, 88 revision THAs (87 patients) with RIG technique were performed. The average follow-up time was 7.0 years (range, 5.0-10.2). There were 14 femur fractures: 2 intraoperative, 5 within 3 months after surgery, and 7 later in the postoperative stage (range, 5-84 months). Sixteen patients were lost to follow-up and 20 died without stem re-revision. None of the patients have been re-revised for any reason during follow-up. Age was observed to be a significant factor for determining fracture risk. In conclusion, RIG can be considered a reliable surgical technique, especially for younger patients.
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Affiliation(s)
- Laila Chomrikh
- Department of Orthopaedics, Annatommie, Rijswijk, Netherlands
| | - Peter Gebuhr
- Department of Orthopaedics, Hvidovre Hospital, Hvidovre, Denmark
| | - Roelf Bierling
- Department of Orthopaedics, Haukeland University Hospital, Kysthospitalet i Hagevik, Hagevik, Norway
| | - Ulla Lind
- Department of Orthopaedics, Södersjukhuset, Stockholm, Sweden
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20
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Morsellised sawbones is an acceptable experimental substitute for the in vitro elastic and viscoelastic mechanical characterisation of morsellised cancellous bone undergoing impaction grafting. Med Eng Phys 2013; 36:26-31. [PMID: 24075067 DOI: 10.1016/j.medengphy.2013.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/29/2013] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Impaction grafting using morsellised bone chips is widely used during surgery to mitigate the effects of bone loss. The technique typically involves the packing of morsellised allograft cancellous bone into bone defects, and has found extensive application in revision hip and knee surgery. In the ideal situation, the presence of the bone graft prevents subsidence of the revised prosthesis in the short term, and integrates with the host bone in the longer term. However, the configuration of particles within the graft remains to be optimised, and is highly likely to vary across potential sites and loading conditions. Human bone, for use in experimental investigation, is often difficult to obtain with properties that are relevant from a clinical point of view. This study, therefore, has explored the mechanical response of a Sawbones based experimental substitute. An established confined compression technique was used to characterise the morsellised Sawbones material. Comparison of the results with published values for bovine and human bone indicate that the mechanical response of the morsellised Sawbones material map well onto the elastic and viscoelastic response of bone of a biological origin.
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21
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Abstract
Bone allografts are widely used in the U.K. in joint revision surgery. Despite this widespread usage, there remain concerns among the surgical community regarding the safety of allografts, in terms of the risk of transmission of infection, together with a persistent misconception that allografts are in limited availability. In this paper we discuss the precautions taken to ensure that allografts are safe, and review the residual risks. We also demonstrate that the availability of allograft in the U.K., both actual and potential, greatly exceeds the current clinical demand.
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22
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Smith JO, Sengers BG, Aarvold A, Tayton ER, Dunlop DG, Oreffo ROC. Tantalum trabecular metal - addition of human skeletal cells to enhance bone implant interface strength and clinical application. J Tissue Eng Regen Med 2012; 8:304-13. [PMID: 22674820 DOI: 10.1002/term.1525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/19/2012] [Accepted: 04/02/2012] [Indexed: 11/10/2022]
Abstract
The osteo-regenerative properties of allograft have recently been enhanced by addition of autogenous human bone marrow stromal cells (HBMSCs). Limitations in the use of allograft have prompted the investigation of tantalum trabecular metal (TTM) as a potential alternative. TTM is already in widespread orthopaedic use, although in applications where there is poor initial stability, or when TTM is used in conjunction with bone grafting, initial implant loading may need to be limited. The aim of this study was to evaluate the osteo-regenerative potential of TTM with HBMSCs, in direct comparison to human allograft and autograft. HBMSCs were cultured on blocks of TTM, allograft or autograft in basal and osteogenic media. Molecular profiling, confocal and scanning electron microscopy (SEM) and biochemical assays were used to characterize cell adherence, proliferation and phenotype. Mechanical testing was used to define the tensile characteristics of the constructs. HBMSCs displayed adherence and proliferation throughout TTM, evidenced by immunocytochemistry and SEM, with significant cellular ingrowth and matrix production through TTM. In contrast to cells cultured with allograft, cell proliferation assays showed significantly higher activity with TTM (p < 0.001), although molecular profiling confirmed no significant difference in expression of osteogenic genes. In contrast to acellular constructs, mechanical testing of cell-TTM constructs showed enhanced tensile characteristics, which compared favourably to cell-allograft constructs. These studies demonstrated the ability of TTM to support HBMSC growth and osteogenic differentiation comparable to allograft. Thus, TTM represents an alternative to allograft for osteo-regenerative strategies, extending its clinical applications as a substitute for allograft.
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Affiliation(s)
- J O Smith
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Human Development and Health, Institute of Developmental Sciences, University Hospital Southampton, UK
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Abstract
INTRODUCTION Total hip replacement is increasingly used to treat diseased and damaged joints. With time, some joint replacements may require revision, mainly because of instability and mechanical loosening, and this is of particularly significance to younger patients. A major problem in revision surgery is the loss of bone stock and the consequent difficulty in reconstructing a stable joint. Loss of bone stock has been widely treated using bone autografts and allografts but supplies are limited. Use of bone graft substitutes in combination with, or as a substitute for, human bone is a possible alternative. AIM To identify empirical studies of bone graft substitutes in hip revision surgery. METHODS Systematic review based on Cochrane and MOOSE methods. We searched MEDLINE and EMBASE to December 2010 with terms relating to hip replacement and bone graft substitutes, and checked key citations in ISI Web of Science and reference lists. We considered all human studies irrespective of study design. RESULTS Searches identified 397 articles. Screening of abstracts and full text articles identified 7 studies reporting outcomes of bone-graft substitute combined with autograft or allograft, and 6 studies reporting outcomes of bone graft substitute exclusively. One economic evaluation compared costs of femoral head banking with costs of bone graft substitutes. No randomised controlled trials evaluating bone graft substitute effectiveness were identified. Studies generally included small numbers of patients with a follow up too short to assess outcomes relating to implant survival. However, excepting those based on glass ceramic, ceramic bone graft substitutes show promise as an alternative to use of exclusive autograft or allograft. In the case of calcium phosphate ceramic bone graft substitute, potential cost savings were evident. CONCLUSION With increased allograft shortage, bone graft substitutes will be required in hip revision surgery. However, appropriately designed randomised controlled trials are required to compare use of existing and new bone graft substitutes with established practice. As well as prosthesis related outcomes, studies should explore the patient experience of revision hip replacement with bone graft substitute material.
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Schuberth JM, Christensen JC, Rialson JA. Metal-reinforced cement augmentation for complex talar subsidence in failed total ankle arthroplasty. J Foot Ankle Surg 2011; 50:766-72. [PMID: 21816637 DOI: 10.1053/j.jfas.2011.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/16/2011] [Indexed: 02/03/2023]
Abstract
There are limited options for failed total ankle arthroplasty (TAA) with major talar bone loss and component subsidence. Surgical options for this condition include revision arthroplasty, salvage arthrodesis, or amputation. Revision arthroplasty generally has been considered in situations of loose components with minimal bone loss or use of expensive custom-fabricated prosthetic components with elongated stems. Historically, failure that involves major talar bone loss has been considered resistant to reconstruction, and responsive only to complex arthrodesis or amputation. In this report, we describe a unique method of restoring talar support and preserving ankle function after failed TAA with major talar bone loss and component subsidence. Talar reconstruction using metal-reinforced bone cement augmentation is combined with the Inbone (Wright Medical Technology, Inc., Arlington, TN) total ankle system to restore talar height and ligamentous support. This technique has been used successfully in the last 4 years for various patterns of talar bone loss and obviates the need for custom components. When successfully performed, the revision technique results in restoration of mechanical alignment, anatomic height, and component support, in addition to providing substantial symptomatic relief.
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Affiliation(s)
- John M Schuberth
- The Permanente Medical Group, Department of Orthopaedic Surgery, San Francisco, CA, USA.
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25
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Abstract
In revision total hip replacement, bone loss can be managed by impacting porous bone chips. In order to guarantee sufficient mechanical strength, the bone chips have to be compacted. The aim of this study was to determine in an in vitro simulation whether the use of a pneumatic hammer leads to higher primary stability than manual impaction. Bone mass characteristics were measured by force and distance variation of a penetrating punch, which was lowered into a plastic cup filled with bone chips. From these measurements bulk density, contact stiffness, impaction hardness and penetration resistance were calculated for different durations of impaction. We found that the pneumatic method reached higher values of impaction hardness, contact stiffness and bulk density suggesting an increase in stability of the implant. No significant differences were found between the two different methods concerning the penetration resistance. The pneumatic method might reduce the risk of fracture in vivo, as force peaks are smaller and applied for a shorter period. Results from manual impaction showed higher variability and depend much on the experience of the surgeon. The pneumatic hammer is a suitable tool to standardise the impaction process.
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Affiliation(s)
- D. Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Salurnerstrasse 15, Innsbruck 6020, Austria
| | - E. Mayr
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Salurnerstrasse 15, Innsbruck 6020, Austria
| | - C. Haid
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Salurnerstrasse 15, Innsbruck 6020, Austria
| | - A. Reinthaler
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Salurnerstrasse 15, Innsbruck 6020, Austria
| | - M. Nogler
- Department of Experimental Orthopaedics, Medical University of Innsbruck, Salurnerstrasse 15, Innsbruck 6020, Austria
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26
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Smith JO, Aarvold A, Tayton ER, Dunlop DG, Oreffo ROC. Skeletal tissue regeneration: current approaches, challenges, and novel reconstructive strategies for an aging population. TISSUE ENGINEERING PART B-REVIEWS 2011; 17:307-20. [PMID: 21615329 DOI: 10.1089/ten.teb.2011.0143] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Loss of skeletal tissue as a consequence of trauma, injury, or disease is a significant cause of morbidity with often wide-ranging socioeconomic impacts. Current approaches to replace or restore significant quantities of lost bone come with substantial limitations and inherent disadvantages that may in themselves cause further disability. In addition, the spontaneous repair capacity of articular cartilage is limited; thus, investigation into new cartilage replacement and regeneration techniques are warranted. Along with the challenges of an increasingly aging demographic, changing clinical scenarios and rising functional expectations provide the imperative for new, more reliable skeletal regeneration strategies. The science of tissue engineering has expanded dramatically in recent years, notably in orthopedic applications, and it is clear that new approaches for de novo skeletal tissue formation offer exciting opportunities to improve the quality of life for many, particularly in the face of increasing patient expectations. However, significant scientific, financial, industrial, and regulatory challenges should be overcome before the successful development of an emergent tissue engineering strategy can be realized. We outline current practice for replacement of lost skeletal tissue and the innovative approaches in tissue regeneration that have so far been translated to clinical use, along with a discussion of the significant hurdles that are presented in the process of translating research strategies to the clinic.
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Affiliation(s)
- James Oliver Smith
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Human Development and Health, Institute of Developmental Sciences, Southampton, United Kingdom
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