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Ziroglu N, Koluman A, Kaleci B, Tanriverdi B, Tanriverdi G, Kural A, Bilgili MG. Modified and alternative bone cements can improve the induced membrane: Critical size bone defect model in rat femur. Injury 2024; 55:111627. [PMID: 38834011 DOI: 10.1016/j.injury.2024.111627] [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: 03/14/2024] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND As a two-stage surgical procedure, Masquelet's technique has been used to care for critical-size bone defects (CSD). We aimed to determine the effects of modified and altered bone cement with biological or chemical enriching agents on the progression of Masquelet's induced membrane (IM) applied to a rat femur CSD model, and to compare the histopathological, biochemical, and immunohistochemical findings of these cements to enhance IM capacity. METHODS Thirty-five male rats were included in five groups: plain polymethyl methacrylate (PMMA), estrogen-impregnated PMMA (E+PMMA), bone chip added PMMA (BC+PMMA), hydroxyapatite-coated PMMA (HA) and calcium phosphate cement (CPC). The levels of bone alkaline phosphatase (BALP), osteocalcin (OC), and tumor necrosis factor-alpha (TNF-α) were analyzed in intracardiac blood samples collected at the end of 4 weeks of the right femur CSD intervention. All IMs collected were fixed and prepared for histopathological scoring. The tissue levels of rat-specific Transforming Growth Factor-Beta (TGF-β), Runt-related Transcription Factor 2 (Runx2), and Vascular Endothelial Growth Factor (VEGF) were analyzed immunohistochemically. RESULTS Serum levels of BALP and OC were significantly higher in E+PMMA and BC+PMMA groups than those of other groups (P = 0.0061 and 0.0019, respectively). In contrast, TNF-α levels of all groups with alternative bone cement significantly decreased compared to bare PMMA (P = 0.0116). Histopathological scores of E+PMMA, BC+PMMA, and CPC groups were 6.86 ± 1.57, 4.71 ± 0.76, and 6.57 ± 1.51, respectively, which were considerably higher than those of PMMA and HA groups (3.14 ± 0.70 and 1.86 ± 0.69, respectively) (P < 0.0001). Significant increases in TGF-β and VEGF expressions were observed in E+PMMA and CPC groups (P = 0.0001 and <0.0001, respectively) whereas Runx2 expression significantly increased only in the HA group compared to other groups (P < 0.0001). CONCLUSIONS The modified PMMA with E and BC, and CPC as an alternative spacer resulted in a well-differentiated IM and increased IM progression by elevating BALP and OC levels in serum and by mediating expressions of TGF-β and VEGF at the tissue level. Estrogen-supplemented cement spacer has yielded promising findings between modified and alternative bone cement.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey.
| | - Alican Koluman
- Department of Orthopedics and Traumatology, Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Belisa Kaleci
- Department of Histology and Embryology, Istanbul University-Cerrahpasa Istanbul, Turkey; Faculty of Medical Sciences, Albanian University, Tirane, Albania
| | - Bulent Tanriverdi
- Department of Orthopedics and Traumatology, Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gamze Tanriverdi
- Department of Histology and Embryology, Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Alev Kural
- Department of Biochemistry, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Gokhan Bilgili
- Department of Orthopedics and Traumatology, Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Miao A, Li Q, Tang G, Lu Q. Alginate-containing 3D-printed hydrogel scaffolds incorporated with strontium promotes vascularization and bone regeneration. Int J Biol Macromol 2024; 273:133038. [PMID: 38857724 DOI: 10.1016/j.ijbiomac.2024.133038] [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: 01/28/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
Bone defects persist as a significant challenge in the field of clinical orthopedics. This study focuses on the fabrication and characterization of 3D-printed composite hydrogel scaffolds composed of sodium alginate, gelatin, and α-tricalcium phosphate (α-TCP) with varying ratios of Strontium ions (Sr2+). These scaffolds aim to address the clinical challenges associated with bone defect repair by providing mechanical support and promoting bone formation and vascularization. The degradation, swelling, mechanical properties, and release profiles of Sr2+ from the hydrogel scaffolds were comprehensively characterized. In vitro tests were conducted to assess cell viability and proliferation, as well as osteogenic and angiogenic gene expression, to investigate the osteogenic and pro-angiogenic potential of the composite hydrogel scaffolds. Furthermore, skull defect simulations were performed, and composite scaffolds with varying Sr2+ ratios were implanted to evaluate their effectiveness in bone repair. This research establishes a foundation for advancing bone tissue engineering through composite scaffolds containing biological macromolecules and strontium, with alginate serving as a key element in enhancing performance and expanding clinical applicability.
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Affiliation(s)
- Afeng Miao
- Department of Orthopaedics, Taizhou People's Hospital, Taizhou, Jiangsu, China; Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Qingsong Li
- Department of Orthopaedics, Taizhou People's Hospital, Taizhou, Jiangsu, China; Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Genling Tang
- Department of Orthopaedics, Taizhou People's Hospital, Taizhou, Jiangsu, China; Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Qifeng Lu
- Department of Orthopaedics, Taizhou People's Hospital, Taizhou, Jiangsu, China; Affiliated Taizhou People's Hospital of Nanjing Medical University, Jiangsu, China.
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Pattisapu N, Huang DT, Porter G, Owhonda R, Charlton T, Gross C, Thordarson D, Metzger MF. Polymethylmethacrylate (PMMA) Augmentation Enhances the Mechanical Characteristics of Midfoot Beam Constructs in Charcot Neuroarthropathy Cadaver Model. Foot Ankle Int 2024; 45:648-655. [PMID: 38501724 DOI: 10.1177/10711007241237804] [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] [Indexed: 03/20/2024]
Abstract
BACKGROUND Even with the best conservative care, patients with Charcot neuroarthropathy (CN) of the foot and ankle often ulcerate, increasing their risk of infection, amputation, and death. Surgical fixation has been associated with risk of recurrent ulceration, potentially due to poor bone quality prone to recurrent deformity and ulceration. We propose midfoot beam reconstruction with PMMA augmentation as a novel means of improving fixation. METHODS A protocol was developed to create characteristic CN midfoot fragmentation both visually and fluoroscopically in each of 12 matched-pair cadaveric feet. Afterward, the pairs were divided into 2 groups: (1) midfoot beam fusion surgery alone, and (2) midfoot beam fusion surgery augmented with PMMA. A solid 7.0-mm beam was placed into the medial column and a solid 5.5-mm beam was placed across the lateral column. In the PMMA group, 8 to 10 mL of PMMA was inserted into the medial column. The hindfoot of each specimen was potted and the metatarsal heads were cyclically loaded for 1800 cycles, followed by load to failure while load and displacement were continually recorded. RESULTS One specimen in the beam alone group failed before reaching the 1800th cycle and was not included in the failure analysis. The midfoot beam only group demonstrated greater mean displacement during cycle testing compared with the PMMA group, P < .05. The maximum force (N), stiffness (N/mm), and toughness (Nmm) were all significantly greater in the group augmented with PMMA, P < .05. CONCLUSION In a CN cadaveric model, PMMA augmentation significantly decreased gapping during cyclic loading and nearly doubled the load to failure compared with midfoot beams alone. CLINICAL RELEVANCE The results of this biomechanical study demonstrate that augmentation of midfoot beams with PMMA increases the strength and stiffness of the fusion construct. This increased mechanical toughness may help reduce the risk of nonunion and infection in patients with neuropathic midfoot collapse.
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Affiliation(s)
- Naveen Pattisapu
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dave T Huang
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Giselle Porter
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Rebisi Owhonda
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Timothy Charlton
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Christopher Gross
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston SC, USA
| | - David Thordarson
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Melodie F Metzger
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Williams TD, Adler T, Smokoff L, Kaur A, Rodriguez B, Prakash KJ, Redzematovic E, Baker TS, Rapoport BI, Yoon ES, Beall DP, Dordick JS, De Leacy RA. Bone Cements Used in Vertebral Augmentation: A State-of-the-art Narrative Review. J Pain Res 2024; 17:1029-1040. [PMID: 38505504 PMCID: PMC10949389 DOI: 10.2147/jpr.s437827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/26/2024] [Indexed: 03/21/2024] Open
Abstract
Vertebral compression fractures (VCFs) are common in osteoporotic patients, with a frequency projected to increase alongside a growing geriatric population. VCFs often result in debilitating back pain and decreased mobility. Cement augmentation, a minimally invasive surgical technique, is widely used to stabilize fractures and restore vertebral height. Acrylic-based cements and calcium phosphate cements are currently the two primary fill materials utilized for these procedures. Despite their effectiveness, acrylic bone cements and calcium phosphate cements have been associated with various intraoperative and postoperative incidents impacting VCF treatment. Over the past decade, discoveries in the field of biomedical engineering and material science have shown advancements toward addressing these limitations. This narrative review aims to assess the potential pitfalls and barriers of the various types of bone cements.
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Affiliation(s)
- Tyree D Williams
- Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
| | - Talia Adler
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Columbia University School of General Studies, New York, NY, USA
| | - Lindsey Smokoff
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Columbia University School of General Studies, New York, NY, USA
| | - Anmoldeep Kaur
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neuroscience, Smith College, Northampton, MA, USA
| | - Benjamin Rodriguez
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Turner S Baker
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin I Rapoport
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
| | | | | | | | - Reade A De Leacy
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
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Sui P, Yu T, Sun S, Chao B, Qin C, Wang J, Wang E, Zheng C. Advances in materials used for minimally invasive treatment of vertebral compression fractures. Front Bioeng Biotechnol 2023; 11:1303678. [PMID: 37954022 PMCID: PMC10634476 DOI: 10.3389/fbioe.2023.1303678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Vertebral compression fractures are becoming increasingly common with aging of the population; minimally invasive materials play an essential role in treating these fractures. However, the unacceptable processing-performance relationships of materials and their poor osteoinductive performance have limited their clinical application. In this review, we describe the advances in materials used for minimally invasive treatment of vertebral compression fractures and enumerate the types of bone cement commonly used in current practice. We also discuss the limitations of the materials themselves, and summarize the approaches for improving the characteristics of bone cement. Finally, we review the types and clinical efficacy of new vertebral implants. This review may provide valuable insights into newer strategies and methods for future research; it may also improve understanding on the application of minimally invasive materials for the treatment of vertebral compression fractures.
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Affiliation(s)
| | | | | | | | | | | | | | - Changjun Zheng
- Orthopaedic Medical Center, Second Hospital of Jilin University, Changchun, China
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In Vitro and In Vivo Evaluation of Injectable Strontium-Modified Calcium Phosphate Cement for Bone Defect Repair in Rats. Int J Mol Sci 2022; 24:ijms24010568. [PMID: 36614010 PMCID: PMC9820753 DOI: 10.3390/ijms24010568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Calcium phosphate cement (CPC) has been widely studied, but its lack of osteoinductivity and inadequate mechanical properties limit its application, while strontium is able to promote bone formation and inhibit bone resorption. In this study, different proportions of tristrontium silicate were introduced to create a novel strontium-modified calcium phosphate cement (SMPC). The physicochemical properties of SMPC and CPC were compared, and the microstructures of the bone cements were characterized with scanning electron microscopy assays. Then, the effect of SMPC on cell proliferation and differentiation was examined. Furthermore, local inflammatory response and osteogenesis after SMPC implantation were also confirmed in the study. Finally, a rat model of isolated vertebral defects was used to test the biomechanical properties of the cements. The results showed that SMPC has better injectability and a shorter setting time than CPC. Meanwhile, the addition of tristrontium silicate promoted the mechanical strength of calcium phosphate cement, and the compressive strength of 5% SMPC increased to 6.00 ± 0.74 MPa. However, this promotion effect gradually diminished with an increase in tristrontium silicate, which was also found in the rat model of isolated vertebral defects. Furthermore, SMPC showed a more preferential role in promoting cell proliferation and differentiation compared to CPC. Neither SMPC nor CPC showed significant inflammatory responses in vivo. Histological staining suggested that SMPCs were significantly better than CPC in promoting new bone regeneration. Importantly, this osteogenesis effect of SMPC was positively correlated with the ratio of tristrontium silicate. In conclusion, 5% SMPC is a promising substitute material for bone repair with excellent physicochemical properties and biological activity.
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Clinical Applications of Poly-Methyl-Methacrylate in Neurosurgery: The In Vivo Cranial Bone Reconstruction. J Funct Biomater 2022; 13:jfb13030156. [PMID: 36135591 PMCID: PMC9504957 DOI: 10.3390/jfb13030156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Biomaterials and biotechnology are becoming increasingly important fields in modern medicine. For cranial bone defects of various aetiologies, artificial materials, such as poly-methyl-methacrylate, are often used. We report our clinical experience with poly-methyl-methacrylate for a novel in vivo bone defect closure and artificial bone flap development in various neurosurgical operations. Methods: The experimental study included 12 patients at a single centre in 2018. They presented with cranial bone defects after various neurosurgical procedures, including tumour, traumatic brain injury and vascular pathologies. The patients underwent an in vivo bone reconstruction from poly-methyl-methacrylate, which was performed immediately after the tumour removal in the tumour group, whereas the trauma and vascular patients required a second surgery for cranial bone reconstruction due to the bone decompression. The artificial bone flap was modelled in vivo just before the skin closure. Clinical and surgical data were reviewed. Results: All patients had significant bony destruction or unusable bone flap. The tumour group included five patients with meningiomas destruction and the trauma group comprised four patients, all with severe traumatic brain injury. In the vascular group, there were three patients. The average modelling time for the artificial flap modelling was approximately 10 min. The convenient location of the bone defect enabled a relatively straightforward and fast reconstruction procedure. No deformations of flaps or other complications were encountered, except in one patient, who suffered a postoperative infection. Conclusions: Poly-methyl-methacrylate can be used as a suitable material to deliver good cranioplasty cosmesis. It offers an optimal dural covering and brain protection and allows fast intraoperative reconstruction with excellent cosmetic effect during the one-stage procedure. The observations of our study support the use of poly-methyl-methacrylate for the ad hoc reconstruction of cranial bone defects.
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Wang Y, Liu C, Liu H, Fu H, Li C, Yang L, Sun H. A Novel Calcium Phosphate-Based Nanocomposite for Augmentation of Cortical Bone Trajectory Screw Fixation. Int J Nanomedicine 2022; 17:3059-3071. [PMID: 35844971 PMCID: PMC9278980 DOI: 10.2147/ijn.s365149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of cement augmentation of cortical bone trajectory (CBT) screws using a novel calcium phosphate–based nanocomposite (CPN). Material and Methods CBT screws were placed into cadaveric lumbar vertebrae. Depending on the material used for augmentation, they were divided into the following three groups: CPN, polymethylmethacrylate (PMMA), and control. Radiological imaging was used to evaluate the cement dispersion. Biomechanical tests were conducted to measure the stability of CBT screws. A rat cranial defect model was used to evaluate biodegradation and osseointegration of the CPN. Results After cement augmentation, the CPN tended to disperse into the distal part of the screws, whereas PMMA remained limited to the proximal part of the screws (P < 0.05). As for cement morphology, the CPN tended to form a concentrated mass, whereas PMMA arranged itself as a scattered cement cloud, but the difference was not significant (P > 0.05). The axial pullout test showed that the average maximal pullout force (Fmax) of CPN-augmented CBT screws was similar to that of the PMMA group (CPN, 1639.56 ± 358.21 N vs PMMA, 1778.45 ± 399.83 N; P = 0.745) and was significantly greater than that of the control group (1019.01 ± 371.98 N; P < 0.05). The average torque value in the CPN group was higher than that in the control group (CPN, 1.51 ± 0.78 N∙m vs control, 0.97 ± 0.58 N∙m) and lower than that in the PMMA group (1.93 ± 0.81 N∙m), but there were no statistically significant differences (P > 0.05). The CPN could be biodegraded and gradually replaced by newly formed bone tissue after 12 weeks in a rat cranial defect model. Conclusion The biocompatible CPN could be a valuable augmentation material to enhance CBT screw stability.
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Affiliation(s)
- Yuetian Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Chun Liu
- Medical Research Centre, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, People's Republic of China
| | - Huiling Liu
- Institute of Orthopedics, Department of Orthopedics, Soochow University, Suzhou, People's Republic of China
| | - Haoyong Fu
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Chunde Li
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Lei Yang
- Institute of Orthopedics, Department of Orthopedics, Soochow University, Suzhou, People's Republic of China.,Center for Health Sciences and Engineering (CHSE), School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, People's Republic of China
| | - Haolin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
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Injectable bioactive polymethyl methacrylate–hydrogel hybrid bone cement loaded with BMP-2 to improve osteogenesis for percutaneous vertebroplasty and kyphoplasty. Biodes Manuf 2022. [DOI: 10.1007/s42242-021-00172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Krenzlin H, Foelger A, Mailänder V, Blase C, Brockmann M, Düber C, Ringel F, Keric N. Novel Biodegradable Composite of Calcium Phosphate Cement and the Collagen I Mimetic P-15 for Pedicle Screw Augmentation in Osteoporotic Bone. Biomedicines 2021; 9:biomedicines9101392. [PMID: 34680509 PMCID: PMC8533375 DOI: 10.3390/biomedicines9101392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
Osteoporotic vertebral fractures often necessitate fusion surgery, with high rates of implant failure. We present a novel bioactive composite of calcium phosphate cement (CPC) and the collagen I mimetic P-15 for pedicle screw augmentation in osteoporotic bone. Methods involved expression analysis of osteogenesis-related genes during osteoblastic differentiation by RT-PCR and immunostaining of osteopontin and Ca2+ deposits. Untreated and decalcified sheep vertebrae were utilized for linear pullout testing of pedicle screws. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA). Expression of ALPI II (p < 0.0001), osteopontin (p < 0.0001), RUNX2 (p < 0.0001), and osteocalcin (p < 0.0001) was upregulated after co-culture of MSC with CPC-P-15. BMD was decreased by 28.75% ± 2.6%. Pullout loads in untreated vertebrae were 1405 ± 6 N (p < 0.001) without augmentation, 2010 ± 168 N (p < 0.0001) after augmentation with CPC-P-15, and 2112 ± 98 N (p < 0.0001) with PMMA. In decalcified vertebrae, pullout loads were 828 ± 66 N (p < 0.0001) without augmentation, 1324 ± 712 N (p = 0.04) with PMMA, and 1252 ± 131 N (p < 0.0078) with CPC-P-15. CPC-P-15 induces osteoblastic differentiation of human MES and improves pullout resistance of pedicle screws in osteoporotic and non-osteoporotic bone.
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Affiliation(s)
- Harald Krenzlin
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
- Correspondence:
| | - Andrea Foelger
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
| | - Volker Mailänder
- Max Planck Institute for Polymer Research, 55128 Mainz, Germany;
- Center for Translational Nanomedicine, University Medical Center Mainz, 55131 Maniz, Germany
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany;
| | - Marc Brockmann
- Department of Neuroradiology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Christoph Düber
- Department of Radiology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
| | - Naureen Keric
- Department of Neurosurgery, University Medical Center Mainz, 55131 Mainz, Germany; (A.F.); (F.R.); (N.K.)
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Tian Y, Liu H, He L, Zhang R, Lu Q, Liu C, Dang N, Hu H, Ma X, Chen D, Sun H, Zhou H, Yang L, Bai Y, Yang H. Calcium phosphate-based composite cement: Impact of starch type and starch pregelatinization on its physicochemical properties and performance in the vertebral fracture surgical models in vitro. J Biomed Mater Res B Appl Biomater 2021; 109:2068-2078. [PMID: 34028188 DOI: 10.1002/jbm.b.34855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/14/2021] [Accepted: 04/24/2021] [Indexed: 12/30/2022]
Abstract
Calcium phosphate cement (CPC) modified with native and pregelatinized normal corn and waxy maize starches was studied. Effects of starch pregelatinization and starch type on the physicochemical properties of CPC were investigated. CPC modified with pregelatinized normal corn starch (CPB-PNC) or pregelatinized waxy maize starch (CPB-PW) was evaluated by two vertebral fracture surgical models in vitro. Both granular and pregelatinized starches significantly improved the setting times and injectability of CPC, but only the pregelatinized starches improved the anti-collapsibility and compressive strength of CPC significantly. CPB-PW, whose micro-structure was compact and uniform, showed the best physicochemical properties. Addition of starch did not inhibit the hydro-reaction of CPC. Unmodified CPC had very poor dispersibility and could not apply in the tests of the surgical models. Pregelatinized starch especially waxy maize starch improved the dispersibility of CPC and showed good dispersion area, volume, improved pull-out force and maximum torque in the Sawbones sponge model. Similarly, in the minimally invasive kyphoplasty model, CPB-PNC and CPB-PW could disperse in the osteoporotic sheep vertebrae and improve the compressive strength of the sheep vertebral body. In conclusion, starch pregelatinization and starch botanical source affect the physicochemical properties of CPC significantly. Bone cements modified by different starches also performed differently in surgical models for osteoporotic vertebral fracture. Pregelatinized waxy maize starch may be a better candidate for CPC modification comparing to the pregelatinized normal corn starch.
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Affiliation(s)
- Yixing Tian
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Huiling Liu
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Linwei He
- School of Public Health, Medical College, Soochow University, Suzhou, China
| | - Rui Zhang
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Qifeng Lu
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Chun Liu
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Ningqi Dang
- School of Public Health, Medical College, Soochow University, Suzhou, China
| | - Hui Hu
- School of Public Health, Medical College, Soochow University, Suzhou, China
| | - Xuan Ma
- School of Public Health, Medical College, Soochow University, Suzhou, China
| | - Dandan Chen
- Division of Medical Devices, National Institute for Food and Drug Control, Beijing, China
| | - Haolin Sun
- Department of Orthopedic, Peking University First Hospital, Beijing, China
| | - Huan Zhou
- Center for Health Sciences and Engineering, Tianjin, China.,School of Mechanical Engineering, Jiangsu University of Technology, Changzhou, China
| | - Lei Yang
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China.,Center for Health Sciences and Engineering, Tianjin, China
| | - Yanjie Bai
- School of Public Health, Medical College, Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopedics, Orthopedic Institute, The First Affiliated Hospital, Soochow University, Suzhou, China
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Zuo XH, Chen YB, Xie P, Zhang WD, Xue XY, Zhang QX, Shan B, Zhang XB, Bao HG, Si YN. Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fractures. J Orthop Surg Res 2021; 16:138. [PMID: 33588890 PMCID: PMC7885256 DOI: 10.1186/s13018-021-02225-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.,Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Yin-Bing Chen
- Department of Orthopedic Surgery, The Affiliated Haian Hospital of Nantong University, Haian, 226600, China
| | - Peng Xie
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Wen-Dong Zhang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xiang-Yun Xue
- Department of Pain Management, Yancheng No.1 People's Hospital, Yancheng, 224000, China
| | - Qian-Xi Zhang
- Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Ben Shan
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Xiao-Bing Zhang
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China.
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yan-Na Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Kirillova A, Nillissen O, Liu S, Kelly C, Gall K. Reinforcement and Fatigue of a Bioinspired Mineral-Organic Bioresorbable Bone Adhesive. Adv Healthc Mater 2021; 10:e2001058. [PMID: 33111508 DOI: 10.1002/adhm.202001058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/25/2020] [Indexed: 12/21/2022]
Abstract
Bioresorbable bone adhesives may provide remarkable clinical solutions in areas ranging from fixation and osseointegration of permanent implants to the direct healing and fusion of bones without permanent fixation hardware. Mechanical properties of bone adhesives are critical for their successful application in vivo. Reinforcement of a tetracalcium phosphate-phosphoserine bone adhesive is investigated using three degradable reinforcement strategies: poly(lactic-co-glycolic) (PLGA) fibers, PLGA sutures, and chitosan lactate. All three approaches lead to higher compressive strengths of the material and better fatigue performance. Reinforcement with PLGA fibers and chitosan lactate results in a 100% probability of survival of samples at 20 MPa maximum compressive stress level, which is almost ten times higher compared to compressive loads observed in the intervertebral discs of the spine in vivo. High adhesive shear strength of 5.1 MPa is achieved for fiber-reinforced bone adhesive by tuning the surface architecture of titanium samples. Finally, biological and biomechanical performance of the fiber-reinforced adhesive is evaluated in a rabbit distal femur osteotomy model, showing the potential of the bone adhesive for clinical use.
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Affiliation(s)
- Alina Kirillova
- Department of Mechanical Engineering and Materials Science Pratt School of Engineering Duke University Durham NC 27708 USA
| | - Olivia Nillissen
- Department of Biomedical Engineering Pratt School of Engineering Duke University Durham NC 27708 USA
| | - Samuel Liu
- Department of Mechanical Engineering and Materials Science Pratt School of Engineering Duke University Durham NC 27708 USA
| | - Cambre Kelly
- Department of Biomedical Engineering Pratt School of Engineering Duke University Durham NC 27708 USA
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science Pratt School of Engineering Duke University Durham NC 27708 USA
- Department of Biomedical Engineering Pratt School of Engineering Duke University Durham NC 27708 USA
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Chen XS, Jiang JM, Sun PD, Zhang ZF, Ren HL. How the clinical dosage of bone cement biomechanically affects adjacent vertebrae. J Orthop Surg Res 2020; 15:370. [PMID: 32867845 PMCID: PMC7457480 DOI: 10.1186/s13018-020-01906-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/20/2020] [Indexed: 01/29/2023] Open
Abstract
Objective This study evaluated the biomechanical changes in the adjacent vertebrae under a physiological load (500 N) when the clinically relevant amount of bone cement was injected into fractured cadaver vertebral bodies. Methods The embalmed cadaver thoracolumbar specimens in which each vertebral body (T12–L2) had a BMD of < 0.75 g/cm2 were used for the experiment. For establishing a fracture model, the upper one third of the L1 vertebra was performed wedge osteotomy and the superior endplate was kept complete. Stiffness of specimens was measured in different states. Strain of the adjacent vertebral body and intervertebral disc were measured in pre-fracture, post-fracture, and after augmentation by non-contact optical strain measurement system. Results The average amount of bone cement was 4.4 ml (3.8–5.0 ml). The stiffness of after augmentation was significantly higher than the stiffness of post-fracture (p < 0.05), but still lower than pre-fracture stiffness (p < 0.05). After augmentation, the adjacent upper vertebral strain showed no significant difference (p > 0.05) with pre-fracture, while the strain of adjacent lower vertebral body was significantly higher than that before fracture (p < 0.05). In flexion, T12/L1 intervertebral disc strain was significantly greater after augmentation than after the fracture (p < 0.05), but there was no significant difference from that before the fracture (p > 0.05); L1/2 vertebral strain after augmentation was significantly less than that after the fracture (p < 0.05), but there was no significant difference from that before the fracture (p > 0.05). Conclusions PVP may therefore have partially reversed the abnormal strain state of adjacent vertebral bodies which was caused by fracture.
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Affiliation(s)
- Xu-Shi Chen
- Department of Spinal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong, China
| | - Jian-Ming Jiang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Pei-Dong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhao-Fei Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, Guangdong, China.
| | - Hai-Long Ren
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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de Lacerda Schickert S, Pinto JC, Jansen J, Leeuwenburgh SCG, van den Beucken JJJP. Tough and injectable fiber reinforced calcium phosphate cement as an alternative to polymethylmethacrylate cement for vertebral augmentation: a biomechanical study. Biomater Sci 2020; 8:4239-4250. [PMID: 32579633 DOI: 10.1039/d0bm00413h] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vertebral compression fractures (VCFs) are a very common problem among the elderly, which ultimately result in severe pain and a drastically reduced quality of life. An effective treatment for VCFs is the minimally invasive augmentation of the damaged vertebrae through vertebroplasty and/or kyphoplasty. These surgical procedures treat the affected vertebrae by injection of poly(methyl methacrylate) cement (PMMA) into the vertebral body. However, clinical use of PMMA cement is associated with major drawbacks. Bioceramic cements such as injectable calcium phosphate cements (CPC) exhibit a superior osteocompatibility over PMMA cements, but are too brittle for load-bearing applications. Here, we evaluated the handling and mechanical properties of a recently developed CPC formulation containing both poly(vinyl alcohol) (PVA) fibers and carboxymethyl cellulose (CMC) as an alternative to PMMA cement for vertebro- and kyphoplasty. Our results demonstrate that the addition of CMC rendered fiber-reinforced CPC injectable without negatively affecting its mechanical properties. Further, an ex vivo mechanical analysis clearly showed that extravasation of PVA fiber-reinforced CPC with CMC into trabecular bone was limited as compared to PMMA. Finally, we observed that the ex vivo biomechanical performance of vertebrae treated with CMC and PVA fibers was similar to PMMA-treated vertebrae. The obtained data suggests that PVA fiber-reinforced CPCs with CMC possesses adequate handling, mechanical and structural characteristics for vertebro- and kyphoplasty procedures. These data pave the way for future preclinical studies on the feasibility of treating vertebral compression fractures using PVA fiber-reinforced CPC with CMC.
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Affiliation(s)
- Sónia de Lacerda Schickert
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - João Castro Pinto
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - John Jansen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - Sander C G Leeuwenburgh
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - Jeroen J J P van den Beucken
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
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