1
|
Lun DX, Li SY, Li NN, Mou LM, Li HQ, Zhu WP, Li HF, Hu YC. Limitations and modifications in the clinical application of calcium sulfate. Front Surg 2024; 11:1278421. [PMID: 38486794 PMCID: PMC10937423 DOI: 10.3389/fsurg.2024.1278421] [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: 08/16/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Calcium sulfate and calcium sulfate-based biomaterials have been widely used in non-load-bearing bone defects for hundreds of years due to their superior biocompatibility, biodegradability, and non-toxicity. However, lower compressive strength and rapid degradation rate are the main limitations in clinical applications. Excessive absorption causes a sharp increase in sulfate ion and calcium ion concentrations around the bone defect site, resulting in delayed wound healing and hypercalcemia. In addition, the space between calcium sulfate and the host bone, resulting from excessively rapid absorption, has adverse effects on bone healing or fusion techniques. This issue has been recognized and addressed. The lack of sufficient mechanical strength makes it challenging to use calcium sulfate and calcium sulfate-based biomaterials in load-bearing areas. To overcome these defects, the introduction of various inorganic additives, such as calcium carbonate, calcium phosphate, and calcium silicate, into calcium sulfate is an effective measure. Inorganic materials with different physical and chemical properties can greatly improve the properties of calcium sulfate composites. For example, the hydrolysis products of calcium carbonate are alkaline substances that can buffer the acidic environment caused by the degradation of calcium sulfate; calcium phosphate has poor degradation, which can effectively avoid the excessive absorption of calcium sulfate; and calcium silicate can promote the compressive strength and stimulate new bone formation. The purpose of this review is to review the poor properties of calcium sulfate and its complications in clinical application and to explore the effect of various inorganic additives on the physicochemical properties and biological properties of calcium sulfate.
Collapse
Affiliation(s)
- Deng-xing Lun
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Si-ying Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Nian-nian Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Le-ming Mou
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Hui-quan Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Wan-ping Zhu
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Hong-fei Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Yong-cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| |
Collapse
|
2
|
Guo R, Zhang R, Liu S, Yang Y, Dong W, Wang M, Mi H, Liu M, Sun J, Zhang X, Su Y, Liu Y, Huang D, Li R. Biomimetic, biodegradable and osteoinductive treated dentin matrix/α-calcium sulphate hemihydrate composite material for bone tissue engineering. Regen Biomater 2023; 10:rbad061. [PMID: 37501676 PMCID: PMC10369214 DOI: 10.1093/rb/rbad061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/04/2023] [Accepted: 06/10/2023] [Indexed: 07/29/2023] Open
Abstract
It is still a huge challenge for bone regenerative biomaterial to balance its mechanical, biological and biodegradable properties. In the present study, a new composite material including treated dentin matrix (TDM) and α-calcium sulphate hemihydrate (α-CSH) was prepared. The optimal composition ratio between TDM and α-CSH was explored. The results indicate that both components were physically mixed and structurally stable. Its compressive strength reaches up to 5.027 ± 0.035 MPa for 50%TDM/α-CSH group, similar to human cancellous bone tissues. Biological experiments results show that TDM/α-CSH composite exhibits excellent biocompatibility and the expression of osteogenic related genes and proteins (ALP, RUNX2, OPN) is significantly increased. In vivo experiments suggest that the addition of TDM for each group (10%, 30%, 50%) effectively promotes cell proliferation and osteomalacia. In addition, 50% of the TDM/α-CSH combination displays optimal osteoconductivity. The novel TDM/α-CSH composite is a good candidate for certain applications in bone tissue engineering.
Collapse
Affiliation(s)
| | | | - Sirui Liu
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Yanyu Yang
- College of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450000, PR China
| | - Wenhang Dong
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Meiyue Wang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Hongyan Mi
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Mengzhe Liu
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Jingjing Sun
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Xue Zhang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, PR China
| | - Yimeng Su
- Research Center for Nano-biomaterials and Regenerative Medicine, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, PR China
| | - Yiming Liu
- Correspondence address. (R.L.); (Y.L.); (D.H.)
| | - Di Huang
- Correspondence address. (R.L.); (Y.L.); (D.H.)
| | - Rui Li
- Correspondence address. (R.L.); (Y.L.); (D.H.)
| |
Collapse
|
3
|
Tian X, Raina DB, Vater C, Kilian D, Ahlfeld T, Platzek I, Nimtschke U, Tägil M, Lidgren L, Thomas A, Platz U, Schaser KD, Disch AC, Zwingenberger S. Evaluation of an Injectable Biphasic Calcium Sulfate/Hydroxyapatite Cement for the Augmentation of Fenestrated Pedicle Screws in Osteoporotic Vertebrae: A Biomechanical Cadaver Study. J Funct Biomater 2022; 13:jfb13040269. [PMID: 36547529 PMCID: PMC9786089 DOI: 10.3390/jfb13040269] [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: 10/23/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
Cement augmentation of pedicle screws is one of the most promising approaches to enhance the anchoring of screws in the osteoporotic spine. To date, there is no ideal cement for pedicle screw augmentation. The purpose of this study was to investigate whether an injectable, bioactive, and degradable calcium sulfate/hydroxyapatite (CaS/HA) cement could increase the maximum pull-out force of pedicle screws in osteoporotic vertebrae. Herein, 17 osteoporotic thoracic and lumbar vertebrae were obtained from a single fresh-frozen human cadaver and instrumented with fenestrated pedicle screws. The right screw in each vertebra was augmented with CaS/HA cement and the un-augmented left side served as a paired control. The cement distribution, interdigitation ability, and cement leakage were evaluated using radiographs. Furthermore, pull-out testing was used to evaluate the immediate mechanical effect of CaS/HA augmentation on the pedicle screws. The CaS/HA cement presented good distribution and interdigitation ability without leakage into the spinal canal. Augmentation significantly enhanced the maximum pull-out force of the pedicle screw in which the augmented side was 39.0% higher than the pedicle-screw-alone side. Therefore, the novel biodegradable biphasic CaS/HA cement could be a promising material for pedicle screw augmentation in the osteoporotic spine.
Collapse
Affiliation(s)
- Xinggui Tian
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Deepak B. Raina
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 22184 Lund, Sweden
| | - Corina Vater
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - David Kilian
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Tilman Ahlfeld
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Ivan Platzek
- Department of Radiology, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Ute Nimtschke
- Institute of Anatomy, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 22184 Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 22184 Lund, Sweden
| | - Alexander Thomas
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Uwe Platz
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Klaus-Dieter Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Alexander C. Disch
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Stefan Zwingenberger
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence:
| |
Collapse
|
4
|
Raina DB, Markevičiūtė V, Stravinskas M, Kok J, Jacobson I, Liu Y, Sezgin EA, Isaksson H, Zwingenberger S, Tägil M, Tarasevičius Š, Lidgren L. A New Augmentation Method for Improved Screw Fixation in Fragile Bone. Front Bioeng Biotechnol 2022; 10:816250. [PMID: 35309986 PMCID: PMC8926351 DOI: 10.3389/fbioe.2022.816250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
Pertrochanteric fractures (TF) due to osteoporosis constitute nearly half of all proximal femur fractures. TFs are treated with a surgical approach and fracture fixation is achieved using metallic fixation devices. Poor quality cancellous bone in osteoporotic patients makes anchorage of a fixation device challenging, which can lead to failure of the fracture fixation. Methods to reinforce the bone-implant interface using bone cement (PMMA) and other calcium phosphate cements in TFs have been described earlier but a clear evidence on the advantage of using such biomaterials for augmentation is weak. Furthermore, there is no standardized technique for delivering these biomaterials at the bone-implant interface. In this study, we firstly describe a method to deliver a calcium sulphate/hydroxyapatite (CaS/HA) based biomaterial for the augmentation of a lag-screw commonly used for TF fixation. We then used an osteoporotic Sawbones model to study the consequence of CaS/HA augmentation on the immediate mechanical anchorage of the lag-screw to osteoporotic bone. Finally, as a proof-of-concept, the method of delivering the CaS/HA biomaterial at the bone-implant interface as well as spreading of the CaS/HA material at this interface was tested in patients undergoing treatment for TF as well as in donated femoral heads. The mechanical testing results indicated that the CaS/HA based biomaterial increased the peak extraction force of the lag-screw by 4 times compared with un-augmented lag-screws and the results were at par with PMMA. The X-ray images from the patient series showed that it was possible to inject the CaS/HA material at the bone-implant interface without applying additional pressure and the CaS/HA material spreading was observed at the interface of the lag-screw threads and the bone. Finally, the spreading of the CaS/HA material was also verified on donated femoral heads and micro-CT imaging indicated that the entire length of the lag-screw threads was covered with the CaS/HA biomaterial. In conclusion, we present a novel method for augmenting a lag-screw in TFs, which could potentially reduce the risk of fracture fixation failure and reoperation in fragile osteoporotic patients.
Collapse
Affiliation(s)
- Deepak Bushan Raina
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
- *Correspondence: Deepak Bushan Raina,
| | - Vetra Markevičiūtė
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Stravinskas
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Joeri Kok
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Ida Jacobson
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Yang Liu
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Erdem Aras Sezgin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Stefan Zwingenberger
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedic, Trauma and Plastic Surgery, Dresden, Germany
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Šarūnas Tarasevičius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
5
|
Kok J, Törnquist E, Raina DB, Le Cann S, Novak V, Širka A, Lidgren L, Grassi L, Isaksson H. Fracture behavior of a composite of bone and calcium sulfate/hydroxyapatite. J Mech Behav Biomed Mater 2022; 130:105201. [DOI: 10.1016/j.jmbbm.2022.105201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022]
|
6
|
Kok J, Širka A, Liu Y, Tarasevičius Š, Belickas J, Tägil M, Lidgren L, Isaksson H, Raina DB. Augmenting a dynamic hip screw with a calcium sulfate/hydroxyapatite biomaterial. Med Eng Phys 2021; 92:102-109. [PMID: 34167704 DOI: 10.1016/j.medengphy.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
Internal fixation failure in hip fractures can lead to reoperation. Calcium sulfate/hydroxyapatite (CaS/HA) is a biomaterial that can be used for augmenting fracture fixation. We aimed to determine whether an injection of 2 ml CaS/HA increases the fixation of a dynamic hip screw inserted in synthetic and human trabecular bone. The study consists of two parts: 1) synthetic bone blocks (n = 74), with three subgroups: empty (cannulated screw, no injection), cannulated, and fenestrated; and 2) osteoporotic human femoral heads (n = 29), with the same subgroups. The heads were imaged using µCT. Bone volume fraction, insertion angle, and head diameter were measured. Pullout tests were performed and peak force, stiffness, and work were measured. The fenestrated group showed increases in pullout strength compared to no injection in the synthetic blocks. The cannulated group showed a higher pullout strength in low-density blocks. In the femoral heads, the variation was larger and there were no significant differences between groups. The bone volume fraction correlated with the peak force and work, and the insertion angle correlated with the stiffness. CaS/HA can improve the fixation of a dynamic hip screw. For clinical use, spreading of the material around the threads of the screw must be ensured.
Collapse
Affiliation(s)
- Joeri Kok
- Department of Biomedical Engineering, Lund University, Box 118, 22100 Lund, Sweden.
| | - Aurimas Širka
- Department of Orthopedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu ave.2, Kaunas, Lithuania.
| | - Yang Liu
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Šarūnas Tarasevičius
- Department of Orthopedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu ave.2, Kaunas, Lithuania.
| | - Juozas Belickas
- Department of Orthopedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu ave.2, Kaunas, Lithuania.
| | - Magnus Tägil
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Lars Lidgren
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, 22100 Lund, Sweden; Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Deepak Bushan Raina
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| |
Collapse
|
7
|
Chang H, Xiang H, Yao Z, Yang S, Tu M, Zhang X, Yu B. Strontium-substituted calcium sulfate hemihydrate/hydroxyapatite scaffold enhances bone regeneration by recruiting bone mesenchymal stromal cells. J Biomater Appl 2020; 35:97-107. [PMID: 32233720 DOI: 10.1177/0885328220915816] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fabrication of osteoconductive scaffold with osteoinductive capability and appropriate resorption rate is of great significance for treating bone defects. To achieve this aim, strontium-substituted calcium sulfate hemihydrate (Sr-CSH) and hydroxyapatite (HA) were mixed to develop a novel composite. Sr-CSH containing 5% and 10% strontium was mixed with HA at the weight ratio of 6:4, respectively. Female Sprague-Dawley rats underwent bone defect surgery in left tibia were randomly assigned to three different treatment groups filled with CSH/HA, 5% and 10% Sr-CSH/HA. Micro-CT analysis showed increased new bone formation in 10% Sr-CSH/HA group compared to CSH/HA group. In addition, histological analysis showed large amounts of chondrocytes and osteoblasts within the pores of Sr-CSH/HA composites as a result of the CSH resorption. Further, CFU-F assay demonstrated the increased amount of bone marrow mesenchymal stromal cells (BMSCs) colonies in 10% Sr-CSH/HA group. In primary BMSCs, extraction from Sr-CSH/HA composite significantly increased the migration of cells, up-regulated the expression of osteoblastic marker genes, and increased the area of mineralized nodules. Together, Sr-CSH/HA may promote bone formation by recruiting and stimulating osteogenic differentiation of BMSCs. Therefore, this composite may be proposed as an ideal substitute to repair bone defects.
Collapse
Affiliation(s)
- Hong Chang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Orthopaedics, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Haibo Xiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zilong Yao
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenyu Yang
- Laboratory of Materials Science and Engineering, Academy of Chemistry and Materials, Jinan University, Guangzhou, China
| | - Mei Tu
- Laboratory of Materials Science and Engineering, Academy of Chemistry and Materials, Jinan University, Guangzhou, China
| | - Xianrong Zhang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
8
|
Fouad H, AlFotawi R, Alothman OY, Alshammari BA, Alfayez M, Hashem M, Mahmood A. Porous Polyethylene Coated with Functionalized Hydroxyapatite Particles as a Bone Reconstruction Material. MATERIALS 2018; 11:ma11040521. [PMID: 29596358 PMCID: PMC5951367 DOI: 10.3390/ma11040521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
In this study, porous polyethylene scaffolds were examined as bone substitutes in vitro and in vivo in critical-sized calvarial bone defects in transgenic Sprague-Dawley rats. A microscopic examination revealed that the pores appeared to be interconnected across the material, making them suitable for cell growth. The creep recovery behavior of porous polyethylene at different loads indicated that the creep strain had two main portions. In both portions, strain increased with increased applied load and temperature. In terms of the thermographic behavior of the material, remarkable changes in melting temperature and heat fusion were revealed with increased the heating rates. The tensile strength results showed that the material was sensitive to the strain rate and that there was adequate mechanical strength to support cell growth. The in vitro cell culture results showed that human bone marrow mesenchymal stem cells attached to the porous polyethylene scaffold. Calcium sulfate–hydroxyapatite (CS–HA) coating of the scaffold not only improved attachment but also increased the proliferation of human bone marrow mesenchymal stem cells. In vivo, histological analysis showed that the study groups had active bone remodeling at the border of the defect. Bone regeneration at the border was also evident, which confirmed that the polyethylene acted as an osteoconductive bone graft. Furthermore, bone formation inside the pores of the coated polyethylene was also noted, which would enhance the process of osteointegration.
Collapse
Affiliation(s)
- H Fouad
- Applied Medical Science Department, Community College, King Saud University, Riyadh 11437, Saudi Arabia.
- Department of Biomedical Engineering, Faculty of Engineering, Helwan University, Helwan 11792, Egypt.
| | - Randa AlFotawi
- Maxillofacial Surgery Department, Dental Faculty, King Saud University, Riyadh 11545, Saudi Arabia.
| | - Othman Y Alothman
- Chemical Engineering Department, King Saud University, Riyadh 11421, Saudi Arabia.
- Deanship of Graduate Studies, Saudi Electronic University, Riyadh 11637, Saudi Arabia.
| | - Basheer A Alshammari
- Material Science Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia.
| | - Musaad Alfayez
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
| | - Mohamed Hashem
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11437, Saudi Arabia.
| | - Amer Mahmood
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
| |
Collapse
|
9
|
Sato T, Kikuchi M, Aizawa M. Preparation of hydroxyapatite/collagen injectable bone paste with an anti-washout property utilizing sodium alginate. Part 1: influences of excess supplementation of calcium compounds. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:49. [PMID: 28181101 DOI: 10.1007/s10856-017-5853-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/12/2017] [Indexed: 06/06/2023]
Abstract
The anti-washout property, viscosity, and cytocompatibility to an osteoblastic cell line, MG-63, of anti-washout pastes were investigated. Mixing a hydroxyapatite/collagen bone-like nanocomposite (HAp/Col), an aqueous solution of sodium alginate (Na-Alg), which is a paste hardening and lubricant agent, and supplementation of calcium carbonate or calcium citrate (Ca-Cit) as a calcium resource for the hardening reaction realized an injectable bone paste. Adding Ca-Cit at a concentration greater than eight times the Ca2+ ion concentration to Na-Alg improved the anti-washout property. Although the viscosity test indicated a gradual increase in the paste viscosity as the calcium compounds increased, pastes with excess supplementation of calcium compounds exhibited injectability through a syringe with a 1.8 mm inner diameter, realizing an injectable bone filler. Furthermore, the anti-washout pastes with Ca-Cit had almost the same cell proliferation rate as that of the HAp/Col dense body. Therefore, HAp/Col injectable anti-washout pastes composed of the HAp/Col, Na-Alg, and Ca-Cit are potential candidates for bioresorbable bone filler pastes.
Collapse
Affiliation(s)
- Taira Sato
- Department of Applied Chemistry, Graduated School of Science and Technology, Meiji University, Kawasaki, 214-8571, Japan
| | - Masanori Kikuchi
- Bioceramics Group, National Institute for Materials Science, Tsukuba, 305-0044, Japan.
| | - Mamoru Aizawa
- Department of Applied Chemistry, Graduated School of Science and Technology, Meiji University, Kawasaki, 214-8571, Japan.
| |
Collapse
|
10
|
A Biphasic Calcium Sulphate/Hydroxyapatite Carrier Containing Bone Morphogenic Protein-2 and Zoledronic Acid Generates Bone. Sci Rep 2016; 6:26033. [PMID: 27189411 PMCID: PMC4870695 DOI: 10.1038/srep26033] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/26/2016] [Indexed: 12/27/2022] Open
Abstract
In orthopedic surgery, large amount of diseased or injured bone routinely needs to be replaced. Autografts are mainly used but their availability is limited. Commercially available bone substitutes allow bone ingrowth but lack the capacity to induce bone formation. Thus, off-the-shelf osteoinductive bone substitutes that can replace bone grafts are required. We tested the carrier properties of a biphasic, calcium sulphate and hydroxyapatite ceramic material, containing a combination of recombinant human bone morphogenic protein-2 (rhBMP-2) to induce bone, and zoledronic acid (ZA) to delay early resorption. In-vitro, the biphasic material released 90% of rhBMP-2 and 10% of ZA in the first week. No major changes were found in the surface structure using scanning electron microscopy (SEM) or in the mechanical properties after adding rhBMP-2 or ZA. In-vivo bone formation was studied in an abdominal muscle pouch model in rats (n = 6/group). The mineralized volume was significantly higher when the biphasic material was combined with both rhBMP-2 and ZA (21.4 ± 5.5 mm3) as compared to rhBMP-2 alone (10.9 ± 2.1 mm3) when analyzed using micro computed tomography (μ-CT) (p < 0.01). In the clinical setting, the biphasic material combined with both rhBMP-2 and ZA can potentially regenerate large volumes of bone.
Collapse
|
11
|
Nilsson M, Zheng MH, Tägil M. The composite of hydroxyapatite and calcium sulphate: a review of preclinical evaluation and clinical applications. Expert Rev Med Devices 2014; 10:675-84. [PMID: 24053255 DOI: 10.1586/17434440.2013.827529] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent publications have shown that the combination of α-calcium sulfate hemihydrate, the densest form of hydrates and hydroxyapatite (HA) particles gives good clinical outcome in various applications. It has large potential as bone substitute since the material transforms to bone throughout the entire volume and not only by creeping substitution, from the surface toward the inside. Release of important proteins for osteogenesis has been observed around implanted material and is speculated to be due to fast dissolution of the calcium sulfate phase in combination with the osteoconductive and bioactive nature of HA. In diabetic foot infection, the osteoconductive HA/calcium sulfate material has been successfully used loaded with antibiotics and since it is injectable, the application is minimally invasive, easy and precise. It is a bone substitute for the future.
Collapse
Affiliation(s)
- Malin Nilsson
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | | |
Collapse
|
12
|
Chen WL, Chen CK, Lee JW, Lee YL, Ju CP, Lin JHC. Structure, properties and animal study of a calcium phosphate/calcium sulfate composite cement. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 37:60-7. [PMID: 24582223 DOI: 10.1016/j.msec.2013.12.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/19/2013] [Accepted: 12/24/2013] [Indexed: 12/16/2022]
Abstract
In-vitro and in-vivo studies have been conducted on an in-house-developed tetracalcium phosphate (TTCP)/dicalcium phosphate anhydrous (DCPA)/calcium sulfate hemihydrate (CSH)-derived composite cement. Unlike most commercial calcium-based cement pastes, the investigated cement paste can be directly injected into water and harden without dispersion. The viability value of cells incubated with a conditioned medium of cement extraction is >90% that of Al2O3 control and >80% that of blank medium. Histological examination reveals excellent bonding between host bone and cement without interposition of fibrous tissues. At 12 weeks-post implantation, significant remodeling activities are found and a new bone network is developed within the femoral defect. The 26-week samples show that the newly formed bone becomes more mature, while the interface between residual cement and the new bone appears less identifiable. Image analysis indicates that the resorption rate of the present cement is much higher than that of TTCP or TTCP/DCPA-derived cement under similar implantation conditions.
Collapse
Affiliation(s)
- Wei-Luen Chen
- Department of Materials Science and Engineering, National Cheng-Kung University, 70101 Tainan City, Taiwan, ROC
| | - Chang-Keng Chen
- Department of Materials Science and Engineering, National Cheng-Kung University, 70101 Tainan City, Taiwan, ROC
| | - Jing-Wei Lee
- Section of Plastic Surgery, Department of Surgery, National Cheng-Kung University Medical College and Hospital, 70403 Tainan, Taiwan, ROC
| | - Yu-Ling Lee
- Department of Materials Science and Engineering, National Cheng-Kung University, 70101 Tainan City, Taiwan, ROC
| | - Chien-Ping Ju
- Department of Materials Science and Engineering, National Cheng-Kung University, 70101 Tainan City, Taiwan, ROC
| | - Jiin-Huey Chern Lin
- Department of Materials Science and Engineering, National Cheng-Kung University, 70101 Tainan City, Taiwan, ROC.
| |
Collapse
|
13
|
Qi X, Li H, Qiao B, Li W, Hao X, Wu J, Su B, Jiang D. Development and characterization of an injectable cement of nano calcium-deficient hydroxyapatite/multi(amino acid) copolymer/calcium sulfate hemihydrate for bone repair. Int J Nanomedicine 2013; 8:4441-52. [PMID: 24293996 PMCID: PMC3839801 DOI: 10.2147/ijn.s54289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A novel injectable bone cement was developed by integration of nano calcium-deficient hydroxyapatite/multi(amino acid) copolymer (n-CDHA/MAC) and calcium sulfate hemihydrate (CSH; CaSO4 · 1/2H2O). The structure, setting time, and compressive strength of the cement were investigated. The results showed that the cement with a liquid to powder ratio of 0.8 mL/g exhibited good injectability and appropriate setting time and mechanical properties. In vitro cell studies indicated that MC3T3-E1 cells cultured on the n-CDHA/MAC/CSH composite spread well and showed a good proliferation state. The alkaline phosphatase activity of the MC3T3-E1 cells cultured on the n-CDHA/MAC/CSH composite was significantly higher than that of the cells on pure CSH at 4 and 7 days of culture. The n-CDHA/MAC/CSH cement was implanted into critical size defects of the femoral condyle in rabbits to evaluate its biocompatibility and osteogenesis in vivo. Radiological and histological results indicated that introduction of the n-CDHA/MAC into CSH enhanced new bone formation, and the n-CDHA/MAC/CSH cement exhibited good biocompatibility and degradability. In conclusion, the injectable n-CDHA/MAC/CSH composite cement has a significant clinical advantage over pure CSH cement, and may be a promising bone graft substitute for the treatment of bone defects.
Collapse
Affiliation(s)
- Xiaotong Qi
- Department of Orthopedics, The First Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Alfotawi R, Naudi K, Dalby MJ, Tanner KE, McMahon JD, Ayoub A. Assessment of cellular viability on calcium sulphate/hydroxyapatite injectable scaffolds. J Tissue Eng 2013; 4:2041731413509645. [PMID: 24555009 PMCID: PMC3927750 DOI: 10.1177/2041731413509645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/30/2013] [Indexed: 12/23/2022] Open
Abstract
Cements for maxillofacial reconstruction of jaw defects through calcification of rotated muscle have been tested. The objective of this study was to investigate the visibility of loading of two types of commercially available cements, Cerament(™) Spine Support and Cerament Bone Void Filler with mesenchymal cells and cytokines (bone morphogenetic protein) to act as a biomimetic scaffolding for future clinical application. Determination of basic biocompatibility (cell viability) using methyl thiazolyl tetrazolium and live/dead assay was carried out using MG-63 cells at various time points. Next, in order to inform potential subsequent in vivo experiments, a collagen tissue mimic was used for characterization of rabbit mesenchymal stromal cells using immunofluorescent cytoskeleton staining, and simultaneous and then sequential injection of Cerament Spine Support cement and cells into collagen gels. Results indicated that Cerament Spine Support was more biocompatible and that sequential injection of cement and then rabbit mesenchymal stromal cells into the tissue mimics is an optimal approach for clinical applications.
Collapse
Affiliation(s)
- Randa Alfotawi
- Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - Kurt Naudi
- Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - Matthew J Dalby
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Jeremy D McMahon
- Regional Maxillofacial Unit, Southern General Hospital, Glasgow, UK
| | - Ashraf Ayoub
- Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| |
Collapse
|
15
|
Evaluation of a setting reaction pathway in the novel composite TiHA–CSD bone cement by FT-Raman and FT-IR spectroscopy. J Mol Struct 2013. [DOI: 10.1016/j.molstruc.2012.10.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
16
|
He Y, Gao J, Li X, Ma Z, Zhang Y, Li M, Zhang Y, Wang X, Qiu H, Liu Y. Fabrication of Injectable Calcium Sulfate Bone Graft Material. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 21:1313-30. [PMID: 20534187 DOI: 10.1163/092050609x12517190417678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yongqiang He
- a School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Jianping Gao
- b School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Xiulan Li
- c Tianjin Orthopedic Hospital, Tianjin 300211, P. R. China
| | - Zhiqing Ma
- d School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Yang Zhang
- e Tianjin Orthopedic Hospital, Tianjin 300211, P. R. China
| | - Min Li
- f School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Yongli Zhang
- g Tianjin Huanhu Hospital, Tianjin 300060, P. R. China
| | - Xiaodong Wang
- h School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Haixia Qiu
- i School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Yu Liu
- j School of Science, Tianjin University, Tianjin 300072, P. R. China
| |
Collapse
|
17
|
Li Z, Kong W, Li X, Xu C, He Y, Gao J, Ma Z, Wang X, Zhang Y, Xing F, Li M, Liu Y. Antibiotic-Containing Biodegradable Bead Clusters with Porous PLGA Coating as Controllable Drug-Releasing Bone Fillers. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 22:1713-31. [PMID: 20836923 DOI: 10.1163/092050610x521603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zhiliang Li
- a School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Weina Kong
- b School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Xiulan Li
- c Tianjin Orthopedic Hospital, Tianjin 300211, P. R. China
| | - Chen Xu
- d Beijing 302 Hospital, Beijing 300060, P. R. China
| | - Yongqiang He
- e School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Jianping Gao
- f School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Zhiqing Ma
- g School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Xiaodong Wang
- h School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Yang Zhang
- i Tianjin Orthopedic Hospital, Tianjin 300211, P. R. China
| | - Fubao Xing
- j School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Min Li
- k School of Science, Tianjin University, Tianjin 300072, P. R. China
| | - Yu Liu
- l School of Science, Tianjin University, Tianjin 300072, P. R. China.
| |
Collapse
|
18
|
Optimising implant anchorage (augmentation) during fixation of osteoporotic fractures: is there a role for bone-graft substitutes? Injury 2011; 42 Suppl 2:S72-6. [PMID: 21839441 DOI: 10.1016/j.injury.2011.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
When stabilising a fracture the contact between the screw and the surrounding bone is crucial for mechanical strength. Through development of screws with new thread designs, as well as optimisation of other properties, improved screw purchase has been gained. Other alternatives to improve screw fixation in osteoporotic bone, as well as normal bone if needed, includes the use of various coatings on the screw that will induce a bonding between the implant surface and the bone implant, as well as application of drugs such as bisphosphonates locally in the screw hole to induce improved screw anchorage through their anticatabolic effect on the bone tissue. As failure of internal fixation of fractures in osteoporotic bone typically occurs through breakage of the bone that surrounds the implant, rather than the implant itself, an alternative strategy in osteoporotic bone can include augmentation of the bone around the screw. This is useful when screws alone are being used for fixation, as it will increase pull-out resistance, but also when conventional plates and screws are used. In angularly stable plate-screw systems, screw back-out is not a problem if the locking mechanism between the screws and the plate works. However, augmentation that will strengthen the bone around the screws can also be useful in conjunction with angle-stable plate-screw systems, as the augmentation will provide valuable support when subjected to loading that might cause cut-out. For many years conventional bone cement, polymethylmethacrylate (PMMA), has been used for augmentation, but due to side effects--including great difficulties if removal becomes necessary--the use of PMMA has never gained wide acceptance. With the introduction of bone substitutes, such as calcium phosphate cement, it has been shown that augmentation around screws can be achieved without the drawbacks seen with PMMA. When dealing with fixation of fractures in osteoporotic bone where screw stability might be inadequate, it therefore seems an attractive option to include bone substitutes for augmentation around screws as part of the armamentarium. Clinical studies now are needed to determine the indications in which bone augmentation with bone-graft substitutes (BGSs) would merit clinical usage.
Collapse
|
19
|
Larsson S, Hannink G. Injectable bone-graft substitutes: current products, their characteristics and indications, and new developments. Injury 2011; 42 Suppl 2:S30-4. [PMID: 21839446 DOI: 10.1016/j.injury.2011.06.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
More than a decade has passed since the first injectable bone substitutes were introduced for use in orthopaedic trauma, and over recent years the number of commercial products has increased dramatically. Despite the fact that these bone substitutes have been on the market for many years, knowledge amongst potential users on how and when they might be useful is still fairly limited. Most injectable bone substitutes belong to one of two major groups: by far the largest group contains products based on various calcium phosphate (CP) mixtures, whilst the smaller group consists of calcium sulphate (CS) compounds. Following mixing, the CP or CS paste can be injected into--for instance--a fracture space for augmentation as an alternative to bone graft, or around a screw for augmentation if the bone is weak. Within minutes an in situ process makes the substitute hard; the mechanical strength in compression resembles that of cancellous bone, whereas the strength in bending and shear is lower. Over time, CP products undergo remodelling through a cell-mediated process that seems to mimic the normal bone remodelling, whilst CS products are dissolved through a faster process that is not cell-mediated. For CP, a number of clinical studies have shown that it can be useful for augmentation of metaphyseal fractures when a space is present. Randomised studies have verified that CP works especially well in tibial plateau fractures when compared with conventional bone grafting. So far the number of clinical studies on CS products is very low. Development at present seems to be heading towards premixed or directly mixed products as well as new compounds that contain fibres or other components to enhance bending and shear strength. Products that are based on combinations of CP and CS are also being developed to combine the fast-dissolving CS with the stronger and more slowly remodelling CP. Injectable bone substitutes, and especially CS, have also been targeted as potentially good carriers for antibiotics and growth factors.
Collapse
Affiliation(s)
- Sune Larsson
- Department of Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden.
| | | |
Collapse
|
20
|
Lewis G. Viscoelastic properties of injectable bone cements for orthopaedic applications: State-of-the-art review. J Biomed Mater Res B Appl Biomater 2011; 98:171-91. [DOI: 10.1002/jbm.b.31835] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/08/2010] [Accepted: 02/10/2011] [Indexed: 02/05/2023]
|
21
|
Gao M, Lei W, Wu Z, Liu D, Shi L. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation. Clin Biomech (Bristol, Avon) 2011; 26:238-44. [PMID: 21084138 DOI: 10.1016/j.clinbiomech.2010.10.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 10/08/2010] [Accepted: 10/27/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The expansive pedicle screw was originally developed to be installed in the bone of compromised quality, but there are some concerns whether it can provide enough fixation strength in the spine with osteoporosis or severe osteoporosis. METHODS Twelve fresh human cadaver spines were stratified into four levels: normal, osteopenia, osteoporosis and severe osteoporosis. The vertebra was bilaterally instrumented with pedicle screws according to four protocols, including conventional pedicle screw without augmentation, expansive pedicle screw without augmentation, conventional screw with augmentation and expansive screw with augmentation. Screw pullout tests were conducted. FINDINGS Given the same specimen, the fixation strength of expansive screw was significantly higher than that of the conventional screw. When the same type of screw was used, the fixation strength of the calcium based cement augmented group was stronger than that of the non-augmented group. The pullout strength and stiffness of the expansive screw, augmented conventional screw and augmented expansive screw groups at the osteoporotic level were comparable to those of the conventional pedicle screw group at the osteopenic level. However, under the severely osteoporotic bone environment, the pullout strength of pedicle screw with whatever placement protocol was significantly lower than that of the conventional screw group at the osteopenic level. INTERPRETATION Our results demonstrate that (i) the expansive pedicle screw appears feasible and safe in either osteopenic or osteoporotic spine; (ii) calcium based cement augmentation can offer improved initial fixation strength of pedicle screws.; and (iii) no screw placement protocol we examined is efficacious in the bone at the severely osteoporotic level.
Collapse
Affiliation(s)
- Mingxuan Gao
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 17 West Changle Road, Xi'an, Shaanxi Province, China
| | | | | | | | | |
Collapse
|
22
|
Truedsson A, Wang JS, Lindberg P, Gordh M, Sunzel B, Warfvinge G. Bone substitute as an on-lay graft on rat tibia. Clin Oral Implants Res 2010; 21:424-9. [DOI: 10.1111/j.1600-0501.2009.01875.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
23
|
Abramo A, Geijer M, Kopylov P, Tägil M. Osteotomy of distal radius fracture malunion using a fast remodeling bone substitute consisting of calcium sulphate and calcium phosphate. J Biomed Mater Res B Appl Biomater 2010; 92:281-6. [PMID: 19904822 DOI: 10.1002/jbm.b.31524] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Autologous iliac crest bone graft is often used to fill the gap, but the procedure is associated with donor site morbidity. In this study a novel fast resorbing biphasic bone substitute consisting of a mixture of calcium sulphate and calcium phosphate is used (Cerament BoneSupport AB, Sweden). Fifteen consecutive patients, with a mean age of 52 (27-71) years were included. All had a malunion after a distal radius fracture and underwent an osteotomy. A fragment specific fixation system, TriMed (TriMed, Valencia, CA), consisting of a Buttress Pin and a Radial Pin Plate were used for fixation and a calcium sulphate and calcium phosphate mixture as bone substitute. The patients were followed for 1 year. Grip strength increased from 61 (28-93)% of the contralateral hand to 85 (58-109)%, p < 0.001. DASH scores decreased from 37 (22-61) to 24 (2-49) p = 0.003. Radiographically all osteotomies healed. An increase of ulnar variance was noted during healing from 1.8 mm immediately postoperatively to 2.6 mm at final follow up. Osteotomy can increase grip strength and decease disability after a malunited fracture. In the present series the bone substitute was replaced by bone, but a minor loss of the achieved radiographic correction was noted in some patients during osteotomy healing. A more rigid fixation may improve the radiographic outcome with this kind of bone substitute.
Collapse
Affiliation(s)
- Antonio Abramo
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden.
| | | | | | | |
Collapse
|
24
|
Abstract
The objective of this work was to study the production of hydroxyapatite (HA) from bovine teeth. Hydroxyapatite (HA) was produced from bovine teeth powder after calcination at 1150 °C. It was discovered that the sample preparation process influences its properties, so, crystal structure and thermal stability of HA were investigated. The X-Ray diffraction analysis (XRD) results confirmed that HA has been successfully produced. Fourier transform infrared spectroscopic (FT-IR) study confirmed the presence of hydroxyl (OH) and phosphate (PO4−3) functional groups. The scanning electronic microscope (SEM) was employed to identify the surface morphology of HA, and showed the nanoporous structure throughout the matrix. The sample constituents such as Ca, P, K … etc., and their values were determined by Energy dispersive X-Ray (EDX).
Collapse
Affiliation(s)
- Aida Elkayar
- Chemical Engineering Department, Faculty of Engineering, Alexandria University, Alexandria 21544, Egypt
| | - Yehia Elshazly
- Chemical Engineering Department, Faculty of Engineering, Alexandria University, Alexandria 21544, Egypt
| | - Mariana Assaad
- Engineering Department, Bibliotheca Alexandrina, Chatby-Alexandria 21526, Egypt
| |
Collapse
|
25
|
Woo KM, Yu B, Jung HM, Lee YK. Comparative evaluation of different crystal-structured calcium sulfates as bone-filling materials. J Biomed Mater Res B Appl Biomater 2009; 91:545-554. [PMID: 19507143 DOI: 10.1002/jbm.b.31428] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The mechanical and handling properties and biological performances of two types of calcium sulfate (betaCS and alphaCS) as bone-filling materials were compared. The influence of two modifiers such as hydroxypropylmethylcellose (HPMC) and fibrin was also examined. alphaCS showed higher strength than, and similar setting time and injectability to those of betaCS. The degradation of CS in a simulated body fluid (SBF) was checked by measuring the amount of calcium released to SBF. alphaCS showed reduced calcium release than betaCS. The modifiers tended to increase the calcium release. The MC3T3-E1 preosteoblasts cultured on alphaCS showed higher levels of alkaline phosphatase (ALP) activity than those cultured on betaCS. alphaCS strongly promoted gene expression of osteoblast phenotypes including Runx2, alpha1(I) collagen, osteocalcin, and bone sialoprotein. There was no significant difference in cell adhesion and proliferation between two types of CS. The addition of modifiers to CS increased cell proliferation, ALP activity, and the gene expression. The osteoclastic differentiation of RAW264.7 monocytes was checked. The cells on both types of CS produced tartrate-resistant acid phosphatase (TRAP) activity with no significant difference. These cell response results indicated that alphaCS promoted osteoblast differentiation over betaCS but not osteoclast differentiation. Conclusively, a particular form of commercially available alphaCS possesses superior properties to betaCS in terms of mechanical properties and supports for osteoblast differentiation, suggesting that alphaCS could be an alternative to the conventionally used betaCS. The addition of HPMC and fibrin could further improve the feasibility of alphaCS as a bone-filling material.
Collapse
Affiliation(s)
- Kyung Mi Woo
- Department of Cell and Developmental Biology, Dental Research Institute and BK21 Program, School of Dentistry, Seoul National University, Seoul 110-749, Republic of Korea
| | - Bin Yu
- Department of Dental Biomaterials Science, Dental Research Institute and BK21 Program, School of Dentistry, Seoul National University, Seoul 110-749, Republic of Korea
| | - Hong-Moon Jung
- Department of Cell and Developmental Biology, Dental Research Institute and BK21 Program, School of Dentistry, Seoul National University, Seoul 110-749, Republic of Korea
| | - Yong-Keun Lee
- Department of Dental Biomaterials Science, Dental Research Institute and BK21 Program, School of Dentistry, Seoul National University, Seoul 110-749, Republic of Korea
| |
Collapse
|
26
|
Jalota S, Bhaduri SB, Tas AC. Using a synthetic body fluid (SBF) solution of 27 mM HCO3− to make bone substitutes more osteointegrative. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2008. [DOI: 10.1016/j.msec.2007.10.058] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
27
|
Li DX, Fan HS, Zhu XD, Tan YF, Xiao WQ, Lu J, Xiao YM, Chen JY, Zhang XD. Controllable release of salmon-calcitonin in injectable calcium phosphate cement modified by chitosan oligosaccharide and collagen polypeptide. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2007; 18:2225-31. [PMID: 17619977 DOI: 10.1007/s10856-007-3084-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 04/30/2007] [Indexed: 05/16/2023]
Abstract
The aim of this research is to study the effect of the controlled releasing character of the salmon calcitonin (S-CT) loaded injectable calcium phosphate cement (CPC) modified by adding organic phase, chitosan oligosaccharide (CO) and collagen polypeptide (CP). The uniform design was used to determine the basic formulation with suitable injectable time for clinical application, and then the changes of the physical characters, the controlled releasing character of the modified CPC along with the ratio of the organic phase were also evaluated in vitro. The surface morphous of the modified CPC been implanted in the abdominal cavity or soaked into the serum of rat was also observed by scanning electron microscope (SEM). The result shows that a suitable formulation of modified CPC could be got, and the injectable time is 12 min, the compressive strength is 12 MPa, and the final setting time is 40 min. Comparing with the CPC without organic phase, the releasing rate of S-CT would increase along with the increase of the organic phase after 7th day. Therefore, a novel S-CT loaded bioactive injectable CPC for treating osteoporosis induced bone defect was obtained, and the release of the containing S-CT was controlled easily through adjusting the ratio of CO and CP.
Collapse
Affiliation(s)
- D X Li
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kofron MD, Cooper JA, Kumbar SG, Laurencin CT. Novel tubular composite matrix for bone repair. J Biomed Mater Res A 2007; 82:415-25. [PMID: 17295242 DOI: 10.1002/jbm.a.31148] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tissue engineering develops organ replacements to overcome the limitations associated with autografts and allografts. The work presented here details the development of biodegradable, porous, three-dimensional polymer-ceramic-sintered microsphere matrices to support bone regeneration. Poly(lactide-co-glycolide)/hydroxyapatite microspheres were formed using solvent evaporation technique. Individual microspheres were placed in a cylindrical mold and sintered at various temperatures. Scaffolds were characterized using scanning electron microscopy, mercury porosimetry, and mechanical testing in compression. After varying the temperature of sintering, a single temperature was selected and the time of sintering was varied. Mechanical testing indicated that as the sintering temperature or time was increased, the elastic modulus, compressive strength, maximum compressive load, and energy at failure significantly increased. Furthermore, increasing the sintering temperature or time resulted in a decreased porosity and the spherical morphology of the microspheres was lost as the microspheres blended together. To more closely mimic the bone marrow cavity observed in native bone tissue, tubular composite-sintered microsphere matrices were formed. These scaffolds demonstrated no statistically significant difference in compressive mechanical properties when compared with cylindrical composite-sintered microsphere matrices of the same dimension. One potential application for these scaffolds is bone regeneration.
Collapse
Affiliation(s)
- M D Kofron
- Department of Biomedical Engineering, University of Virginia, PO Box 800759, Charlottesville, Virginia 22908, USA
| | | | | | | |
Collapse
|
29
|
Abstract
Injectable bone substitutes (IBS) based on calcium phosphate (CaP) and/or calcium sulphate (CaS) are used as fillers in bone defects to stimulate bone integration and allow mechanical loading. Two types of IBS, IBS-1 is CaP+20%CaS and IBS-2 is CaS+40% hydroxyapatite, were investigated. The materials were injected into holes in the femur and tibia in rabbits. After 10 weeks the femora were subjected to indentation testing and tibiae were prepared for histology evaluation. IBS-1 lead to an higher indentation load compared to control, that is no material inserted, while IBS-2 showed no significant difference between material and control. Histology showed that with IBS-1, the bone penetrated into and integrated with the material in the defect. With IBS-2, new bone grew into the outer 0.5-1.0 mm. The materials could be used for different indications, such as to support fracture healing or in contained cavities.
Collapse
|