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Essibayi MA, Mortezaei A, Azzam AY, Bangash AH, Eraghi MM, Fluss R, Brook A, Altschul DJ, Yassari R, Chandra RV, Cancelliere NM, Pereira VM, Jennings JW, Gilligan CJ, Bono CM, Hirsch JA, Dmytriw AA. Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures: a network meta-analysis of randomized controlled trials. Eur Radiol 2024:10.1007/s00330-024-10807-3. [PMID: 38811388 DOI: 10.1007/s00330-024-10807-3] [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: 03/08/2024] [Revised: 03/08/2024] [Accepted: 04/06/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Percutaneous vertebroplasty and kyphoplasty are common interventions for osteoporotic vertebral compression fractures. However, there is concern about an increased risk of adjacent-level fractures after treatment. This study aimed to compare the risk of adjacent-level fractures after vertebroplasty and kyphoplasty with the natural history after osteoporotic vertebral compression fractures. MATERIALS AND METHODS A network meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to the natural history after osteoporotic vertebral compression fractures. Frequentist network meta-analysis was conducted using the "netmeta" package, and heterogeneity was assessed using Q statistics. The pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using random effects. RESULTS Twenty-three RCTs with a total of 2838 patients were included in the analysis. The network meta-analysis showed comparable risks of adjacent-level fractures between vertebroplasty, kyphoplasty, and natural history after osteoporotic vertebral compression fractures with a mean follow-up of 21.2 (range: 3-49.4 months). The pooled RR for adjacent-level fractures after kyphoplasty compared to natural history was 1.35 (95% CI, 0.78-2.34, p = 0.23) and for vertebroplasty compared to natural history was 1.16 (95% CI, 0.62-2.14) p = 0.51. The risk of bias assessment showed a low to moderate risk of bias among included RCTs. CONCLUSION There was no difference in the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to natural history after osteoporotic vertebral compression fractures. The inclusion of a large patient number and network meta-analysis of RCTs serve evidence-based clinical practice. CLINICAL RELEVANCE STATEMENT The risk of adjacent-level fracture following percutaneous vertebroplasty or kyphoplasty is similar to that observed in the natural history after osteoporotic vertebral compression fractures. KEY POINTS RCTs have examined the risk of adjacent-level fracture after intervention for osteoporotic vertebral compression fractures. There was no difference between vertebroplasty and kyphoplasty patients compared to the natural disease history for adjacent compression fractures. This is strong evidence that interventional treatments for these fractures do not increase the risk of adjacent fractures.
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Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, Mayo Clinic, Rochester, NY, USA
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ali Mortezaei
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ahmed Y Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ali Haider Bangash
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohammad Mirahmadi Eraghi
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rose Fluss
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Allan Brook
- Department of Neuroradiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ronil V Chandra
- Department of Interventional Neuroradiology, Monash Health, Clayton, VIC, Australia
- Department of Image, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, VIC, Australia
| | - Nicole M Cancelliere
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jack W Jennings
- Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Christopher M Bono
- Department of Orthopedics, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua A Hirsch
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Senior affiliate research fellow, The Harvey L. Neiman Health Policy Institute, Reston, Virginia, USA
| | - Adam A Dmytriw
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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2
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Bone regeneration in osteoporosis: opportunities and challenges. Drug Deliv Transl Res 2023; 13:419-432. [PMID: 35994158 DOI: 10.1007/s13346-022-01222-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 12/30/2022]
Abstract
Osteoporosis is a bone disorder characterised by low bone mineral density, reduced bone strength, increased bone fragility, and impaired mineralisation of bones causing an increased risk of bone fracture. Several therapies are available for treating osteoporosis which include bisphosphonates, anti-resorptive agents, oestrogen modulators, etc. These therapies primarily focus on decreasing bone resorption and do not assist in bone regeneration or offering permanent curative solutions. Additionally, these therapies are associated with severe adverse events like thromboembolism, increased risk of stroke, and hypocalcaemia. To overcome these limitations, bone regenerative pathways and approaches are now considered to manage osteoporosis. The bone regenerative pathways involved in bone regeneration include wingless-related integration site/β-catenin signalling pathway, notch signalling pathway, calcium signalling, etc. The various regenerative approaches which possess potential to heal and replace the bone defect site include scaffolds, cements, cell therapy, and other alternative medicines. The review focuses on describing the challenges and opportunities in bone regeneration for osteoporosis.
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Chuan D, Zhang L, Leng C, Chen Q, Miyazaki T, Liu J. Setting behavior, apatite-forming ability, mechanical strength of polymethylmethacrylate bone cement through bioactivity modification of phosphate functional groups combined with Ca 2+ ions. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2020; 31:2128-2151. [PMID: 32666901 DOI: 10.1080/09205063.2020.1795459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Bioactivity modification helps polymethylmethacrylate (PMMA) bone cement to reinforce its interfacial adhesion to bone tissues through the chemical bonding of apatite. Since Si-OH groups combined with Ca2+ ions have succeeded in inducing apatite formation, more combinations of functional groups and active ions are being explored. In this study, Bis[2-(methacryloyloxy)ethyl] phosphate (B2meP) containing phosphate (=PO4H) groups and Ca(CH3COO)2 supplying Ca2+ ion were adopted to investigate the feasibility of equipping PMMA bone cement with apatite-forming ability in vitro, more effects under designed contents on setting behavior, injectability, contact angle, cytotoxicity and mechanical strength were also investigated. Results showed B2meP copolymerized with MMA and became one section of PMMA chains, surface = PO4H groups and released Ca2+ ions pushed spherical apatite individuals nucleating and agglomerating into layer horizontally, Increasing B2meP content lowered the contact angle and the peak temperature, enhanced the cell viability of MC3T3-E1, but prolonged apatite forming period. Injectability rate performed a similar trend to setting time. Lower adding content and deposited apatite layer contributed to reduce the strength loss in soaking. Taking biological performance and other properties into balance, cement added with B2meP of 10 wt% in MMA and Ca(CH3COO)2 of 20 wt% in PMMA performed better.
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Affiliation(s)
- Dingze Chuan
- Faculty of Materials Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Ling Zhang
- R&D Center of China Tabacco Yunnan Industrial Co., Ltd, Kunming, Yunnan, China
| | - Chongyan Leng
- Faculty of Materials Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Qinghua Chen
- Faculty of Materials Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Toshiki Miyazaki
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu-shi, Japan
| | - Jinkun Liu
- Faculty of Materials Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
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Yousefi AM. A review of calcium phosphate cements and acrylic bone cements as injectable materials for bone repair and implant fixation. J Appl Biomater Funct Mater 2020; 17:2280800019872594. [PMID: 31718388 DOI: 10.1177/2280800019872594] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Treatment of bone defects caused by trauma or disease is a major burden on human healthcare systems. Although autologous bone grafts are considered as the gold standard, they are limited in availability and are associated with post-operative complications. Minimally invasive alternatives using injectable bone cements are currently used in certain clinical procedures, such as vertebroplasty and balloon kyphoplasty. Nevertheless, given the high incidence of fractures and pathologies that result in bone voids, there is an unmet need for injectable materials with desired properties for minimally invasive procedures. This paper provides an overview of the most common injectable bone cement materials for clinical use. The emphasis has been placed on calcium phosphate cements and acrylic bone cements, while enabling the readers to compare the opportunities and challenges for these two classes of bone cements. This paper also briefly reviews antibiotic-loaded bone cements used in bone repair and implant fixation, including their efficacy and cost for healthcare systems. A summary of the current challenges and recommendations for future directions has been brought in the concluding section of this paper.
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Affiliation(s)
- Azizeh-Mitra Yousefi
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, USA
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Cimatti B, Santos MAD, Brassesco MS, Okano LT, Barboza WM, Nogueira-Barbosa MH, Engel EE. Safety, osseointegration, and bone ingrowth analysis of PMMA-based porous cement on animal metaphyseal bone defect model. J Biomed Mater Res B Appl Biomater 2017; 106:649-658. [PMID: 28276202 DOI: 10.1002/jbm.b.33870] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 01/17/2017] [Accepted: 02/13/2017] [Indexed: 12/28/2022]
Abstract
Bone defects created after curettage of benign bone tumors are customarily filled with solid poly(methyl methacrylate) (PMMA) or other bone substitutes. In this study, we depicted a porous PMMA-based cement (produced by mixing sodium bicarbonate and citric acid) and evaluated the prospect of its clinic application. Cement samples were characterized by high-performance liquid chromatography (HPLC) coupled to mass spectrometry and its cytotoxicity evaluated in fibroblast cultures. Implantation in rabbits allowed the histologic analysis of bone, kidneys, and liver for toxicity and coagulation tests, and MRI images for hemostasis evaluation. Osseointegration was analyzed through radiography, microtomography (micro-CT), SEM, and histology of sheep specimens. Rabbit specimens were analyzed 1, 4, and 7 days after implantation of porous or solid bone cement in 6.0 mm femoral defects. Sheep specimens were analyzed 3 and 6 months after implantation or not of porous or solid cement in 15.0 mm subchondral tibial defects. The production process did not release any detectable toxic substance but slightly reduced fibroblast proliferation in vitro. Until 7 days after surgery, no local or systemic alterations could be detected in histology, or hematoma formation in histology or MRI. Sheep implants showed 6 mm linear ingrowth from the bone-cement interface and 20% bone ingrowth considering the whole defect area. Radiography, micro-CT, SEM, and histology confirmed these findings. We conclude that our porous PMMA-based cement is an attractive alternative treatment for bone defect filling that combines osseointegration and early weight bearing. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 649-658, 2018.
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Affiliation(s)
- Bruno Cimatti
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mariana Avelino Dos Santos
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Sol Brassesco
- Department of Biology, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Laura Tiemi Okano
- Department of Chemistry, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wendell Monteiro Barboza
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Edgard Eduard Engel
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Abstract
BACKGROUND The rising incidence of osteoporotic fractures requires novel treatment strategies. OBJECTIVE Implant augmentation with bone cement is considered to be a promising approach but the benefits and risks need to be carefully evaluated. METHODS Experimental investigation of the biomechanical potential and the associated risks with special reference to the osteoporotic proximal femur and proximal humerus. RESULTS Even small amounts of bone cement (3 ml) applied to the proximal femur in combination with intramedullary nailing led to more than a 50% increase in the number of test cycles before failure. The heat and pressure generated in the bone did not exceed critical thresholds. Short to midterm effects of subchondral cement placement on the adjacent cartilage can be excluded. The risk for cement leakage needs to be considered. CONCLUSION Implant augmentation offers high biomechanical potential to prevent mechanical complications after fracture fixation in osteoporotic bone. Early and confident mobilization of elderly patients therefore appears to be possible. With appropriate handling, associated risks seem controllable; however, implant augmentation cannot be applied as a routine concept for osteoporotic fracture management. The application requires careful evaluation on a case by case basis under comprehensive consideration of mechanical and biological factors.
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Affiliation(s)
- M Windolf
- AO Forschungsinstitut Davos, Clavadelerstrasse 8, 7270, Davos, Schweiz,
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Rothstock S, Saadatmand M, Vollmer M, Paech A, Jürgens C, Nassutt R, Morlock MM. Influence of cooling on curing temperature distribution during cementing of modular cobalt-chromium and monoblock polyethylene acetabular cups. Surg Innov 2013; 20:607-13. [PMID: 23470557 DOI: 10.1177/1553350613479177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total hip replacements for older patients are usually cemented to ensure high postoperative primary stability. Curing temperatures vary with implant material and cement thickness (30°C to 70°C), whereas limits for the initiation of thermal bone damage are reported at 45°C to 55°C. Thus, optimizing surgical treatment and the implant material are possible approaches to lower the temperature. The aim of this study was to investigate the influence of water cooling on the temperature magnitude at the acetabulum cement interface during curing of a modular cobalt-chromium cup and a monoblock polyethylene acetabular cup. The curing temperature was measured for SAWBONE and human acetabuli at the cement-bone interface using thermocouples. Peak temperature for the uncooled condition reached 70°C for both cup materials but was reduced to below 50°C in the cooled condition for the cobalt-chromium cup (P = .027). Cooling is an effective method to reduce curing temperature with metal implants, thereby avoiding the risk of thermal bone damage.
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