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Ruffilli A, Barile F, Fiore M, Manzetti M, Viroli G, Mazzotti A, Govoni M, De Franceschi L, Dallari D, Faldini C. Allogenic bone grafts and postoperative surgical site infection: are positive intraoperative swab cultures predictive for a higher infectious risk? Cell Tissue Bank 2023; 24:627-637. [PMID: 36571669 DOI: 10.1007/s10561-022-10061-1] [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: 03/22/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Abstract
In spine surgery, allogenic bone grafts are often required to ensure bone fusion, however, the main concern regarding their use is the infection risk: therefore, an intraoperative swab for culture test is performed. The cost-effectiveness of these swabs and their influence on the patients' postoperative course have often been questioned. This study aims at determining whether positive spine allograft culture results are predictive of an increased risk of surgical site infection and whether they influence the surgeon's choices in postoperative management. The records of 340 patients who received allogenic bone graft during spinal fusion surgery in our institution were reviewed, for a total of 677 allografts. Each graft was swabbed intraoperatively. All patients were followed clinically for postoperative complications. Infection was diagnosed based on clinical data, blood tests and radiographic images, all assessed by an infectious disease specialist. Only 4 of the 677 allografts used (0.6%) resulted positive at the intraoperative swab culture. Three cultures were positive for Staphylococcus epidermidis and one culture for S. warneri. No clinical infection occurred in any of these patients. Twenty-eight of the 340 patients (8.2%) developed an infection, but none of them had a positive intraoperative swab culture. The most common microbiologic pathogen isolated from this cohort was S. aureus. According to our series, intraoperative swab culture results were not predictive for higher risk of infection and did not affect the clinical behavior of the surgeons in postoperative management.
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Affiliation(s)
- Alberto Ruffilli
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy.
| | - Michele Fiore
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
| | - Marco Manzetti
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
| | - Giovanni Viroli
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
| | - Antonio Mazzotti
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques Clinic - Musculoskeletal Tissue Bank, IRCCS Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Lucia De Franceschi
- Reconstructive Orthopaedic Surgery and Innovative Techniques Clinic - Musculoskeletal Tissue Bank, IRCCS Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques Clinic - Musculoskeletal Tissue Bank, IRCCS Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Alma Mater Studiorum - University of Bologna, Via Zamboni 33, 40126, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy
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Yang C, Zhuo W, Li Q, Huang C, Yan H, Jin D. Preliminary outcomes of allograft and hydroxyapatite as substitutes for autograft in anterior cervical discectomy and fusion with self-locking standalone cages. J Orthop Surg Res 2021; 16:123. [PMID: 33557893 PMCID: PMC7869215 DOI: 10.1186/s13018-021-02257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/20/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose To investigate the efficacy and safety of allograft and hydroxyapatite (HA) as substitutes for autograft in anterior cervical discectomy and fusion (ACDF). Methods In this study, 49 patients (80 segments) treated with ACDF were included and allocated into three groups [group A, autogenous iliac bone, n = 18; group B, allogeneic bone, n = 16; group C, HA, n = 15]. The clinical efficacy and fusion status were compared among each group. Complications were recorded in detail, and the Bazaz classification and Voice Handicap Index-10 (VHI-10) were used to detect dysphagia and dysphonia. Results Patients exhibited similar clinical efficacy among the groups during the final follow-up. All patients in groups A and B achieved fusion compared to only 73.3% of patients in group C. Groups A and B had similar fusion score, both of which greater than that of group C. No cage subsidence was observed in group A; however, 6.3% of patients in group B and 53.3% in group C had cage subsidence. Two patients in group A (11.1%) had persistent pain at the donor site. One patient in group B had dysphagia and dysphonia (6.3%), while one patient in group C had dysphonia (6.7%). Conclusion In ACDF, the autogenous iliac bone was the most ideal bone graft. The allogeneic bone was an acceptable substitute but risked cage subsidence and dysphagia. HA had a much lower fusion rate and a high risk of cage subsidence. Better substitutes should be further explored for ACDF.
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Affiliation(s)
- Changsheng Yang
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Wentao Zhuo
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Qingchu Li
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Caiqiang Huang
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Huibo Yan
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dadi Jin
- Department of Orthopedics, Academy of Orthopedics of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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Ishida W, Ramhmdani S, Xia Y, Kosztowski TA, Xu R, Choi J, De la Garza Ramos R, Elder BD, Theodore N, Gokaslan ZL, Sciubba DM, Witham TF, Bydon A, Wolinsky JP, Lo SFL. Use of Recombinant Human Bone Morphogenetic Protein-2 at the C1-C2 Lateral Articulation without Posterior Structural Bone Graft in Posterior Atlantoaxial Fusion in Adult Patients. World Neurosurg 2018; 123:e69-e76. [PMID: 30448576 DOI: 10.1016/j.wneu.2018.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/07/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Posterior atlantoaxial fusion is an important armamentarium for neurosurgeons to treat several pathologies involving the craniovertebral junction. Although the potential advantages of recombinant human bone morphogenetic protein-2 (rhBMP-2) are well documented in the lumbar spine, its indication for C1-C2 fusion has not been well characterized. In our institution, we apply rhBMP-2 to the C1-C2 joint either alone or with hydroxyapatite, locally harvested autograft chips, and/or morselized allogenic bone graft for selected cases-without conventional posterior structural bone graft. We report the clinical outcomes of the surgical technique to elucidate its feasibility. METHODS We performed a single-center, retrospective review of data from 2008 to 2016 and identified 69 patients who had undergone posterior atlantoaxial fusion with rhBMP-2. The clinical records of these patients were reviewed, and the baseline characteristics, operative data, and postoperative complications were collected and statistically analyzed. RESULTS The average age of the 69 patients was 60.8 ± 4.5 years, and 55.1% were women. With an average follow-up period of 21.1 ± 4.2 months, the C1-C2 fusion rate was 94.3% (65 of 69), and the average time to fusion was 11.4 ± 2.6 months (range, 5-23). The overall reoperation rate was 10.1% (7 of 69), with instrumentation failure in 7 patients (10.1%), adjacent segment disease in 2 (2.9%), and postoperative dysphagia and dyspnea in 2 patients (2.9%). No ectopic bone formation or soft tissue edema developed. CONCLUSIONS Although retrospective and from a single center, our study has shown that rhBMP-2 usage at the C1-C2 joint without posterior structural bone grafting is a safe and reasonable surgical option.
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Affiliation(s)
- Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Seba Ramhmdani
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Thomas A Kosztowski
- Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Risheng Xu
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - John Choi
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Theodore
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Jean-Paul Wolinsky
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
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Abstract
Surgical site infection (SSI) following spine surgery can be devastating for both the patient and the surgeon. It leads to significant morbidity and associated health care costs, from readmissions, reoperations, and subsequent poor clinical outcomes. Complications associated with SSI following spine surgery include pseudarthrosis, neurological deterioration, sepsis, and death. Its management can be very challenging. The diagnosis of SSI involves the interpretation of combined clinical, laboratory, and occasionally radiologic findings. Most infections can be treated with an appropriate course of antibiotics and bracing if required. Surgical intervention is usually reserved for infections resistant to medical management, the need for open biopsy/culture, evolving spinal instability or deformity, and neurologic deficit or deterioration. A thorough knowledge of associated risk factors is required and patients should be stratified for risk preoperatively. The multifaceted approach of risk stratification, early diagnosis and effective treatment, is essential for successful prevention and effective treatment and crucial for a satisfactory outcome.
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Sims L, Kulyk P, Woo A. Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review. Can J Surg 2017; 60:94-100. [PMID: 28234217 DOI: 10.1503/cjs.008016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Obtaining intraoperative cultures of allograft bone just before use in orthopedic procedures is standard practice in many centres; however, the association between positive cultures and subsequent surgical infections is unknown. Our study had 3 goals: to determine the prevalence of positive intraoperative allograft culture and subsequent infection; to determine if, in cases of subsequent infection, organisms isolated at reoperation were the same as those cultured from the allograft at the time of the index procedure; and to assess the costs associated with performing intraoperative allograft cultures. METHODS In this retrospective case series, we obtained data on patients receiving allograft bone between 2009 and 2012. Patients receiving allograft with positive cultures were reviewed to identify cases of significant infection. Organisms isolated at reoperation were compared with the allograft culture taken at the time of implantation, and we performed a cost assessment. RESULTS Of the 996 allograft bone grafts used, 43 (4.3%) had positive intraoperative cultures and significant postoperative infections developed in 2, requiring reoperation. Antibiotics based on culture results were prescribed in 24% of cases. Organisms cultured at the time of reoperation differed from those isolated initially. The cost of performing 996 allograft cultures was $169 320. CONCLUSION This series suggests that rates of positive intraoperative bone allograft culture are low, and subsequent infection is rare. In cases of postoperative infection, primary allograft culture and secondary tissue cultures isolated different organisms. Costs associated with performing cultures are high. Eliminating initial culture testing could save $42 500 per year in our health region.
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Affiliation(s)
- Laura Sims
- From the Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - Paul Kulyk
- From the Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - Allan Woo
- From the Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Sask
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Aurégan JC, Pietton R, Bégué T, Anract P, Biau D. Effect of anatomic site and irradiation on the rates of revision and infection of allograft-prosthesis composites after resection of a primary bone tumor: a meta-analysis. Arch Orthop Trauma Surg 2016; 136:1371-80. [PMID: 27515453 DOI: 10.1007/s00402-016-2549-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Allograft-prosthesis composite reconstruction after resection of a primary bone tumor may have theoretical advantages, such as restoration of bone stock and soft tissue attachments. However, the reported results of APC of different anatomical sites differ widely. We conducted a meta-analysis to estimate the revision and infection rates associated with allograft-prosthesis composite (APC) reconstructions after resection of a primary bone tumor. We looked for variables, such as anatomic sites and irradiation of the allograft, associated with these outcomes. MATERIALS AND METHODS We searched Medline, EMBASE, and Cochrane Library. The primary outcome was the revision rate, and the secondary outcome was the infection rate. Random effects meta-analyses of single proportions were used to estimate pooled rates of events. Meta-regression models were built to assess the effect of moderators on relevant both outcomes. RESULTS Thirty-one studies were included: 9 about acetabulum APC, 9 about proximal femur APC, 4 about proximal tibia APC, and 9 about proximal humerus APC. The revision rates ranged from 16 % (95 % CI 10-25 %) for proximal humerus to 38 % (95 % CI 26-52 %) for acetabulum, and were significantly different between anatomic sites (p = 0.028). The infection rates ranged from 8 % (95 % CI 4-16 %) for proximal humerus to 23 % (95 % CI 16-33 %) for proximal tibia and 23 % (95 % CI 15-35 %) acetabulum APCs, and were significantly different between anatomic sites (p = 0.008). Finally, we found that irradiation of the allograft was significantly associated with revision rates (p = 0.033) and infection rates (p < 0.001). CONCLUSIONS Results of an APC reconstruction after resection of a primary malignant bone tumor vary significantly between anatomic sites and after irradiation of the allograft.
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Affiliation(s)
- Jean-Charles Aurégan
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Raphaël Pietton
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Thierry Bégué
- Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Philippe Anract
- Department of Orthopedic Surgery and Traumatology, Cochin Teaching Hospital, AP-HP, Paris Descartes University, INSERM U1153, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - David Biau
- Department of Orthopedic Surgery and Traumatology, Cochin Teaching Hospital, AP-HP, Paris Descartes University, INSERM U1153, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
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Clevenger TN, Luna G, Fisher SK, Clegg DO. Strategies for bioengineered scaffolds that support adipose stem cells in regenerative therapies. Regen Med 2016; 11:589-99. [PMID: 27484203 DOI: 10.2217/rme-2016-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Regenerative medicine possesses the potential to ameliorate damage to tissue that results from a vast range of conditions, including traumatic injury, tumor resection and inherited tissue defects. Adult stem cells, while more limited in their potential than pluripotent stem cells, are still capable of differentiating into numerous lineages and provide feasible allogeneic and autologous treatment options for many conditions. Adipose stem cells are one of the most abundant types of stem cell in the adult human. Here, we review recent advances in the development of synthetic scaffolding systems used in concert with adipose stem cells and assess their potential use for clinical applications.
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Affiliation(s)
- Tracy N Clevenger
- Center for Stem Cell Biology & Engineering, University of California, Santa Barbara, CA, USA.,Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Department of Molecular, Cellular & Developmental Biology, University of California, Santa Barbara, CA, USA.,Institute for Collaborative Biotechnologies, University of California, Santa Barbara, CA, USA
| | - Gabriel Luna
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Center for Bio-Image Informatics, University of California, Santa Barbara, CA, USA
| | - Steven K Fisher
- Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Center for Bio-Image Informatics, University of California, Santa Barbara, CA, USA
| | - Dennis O Clegg
- Center for Stem Cell Biology & Engineering, University of California, Santa Barbara, CA, USA.,Neuroscience Research Institute, University of California, Santa Barbara, CA, USA.,Department of Molecular, Cellular & Developmental Biology, University of California, Santa Barbara, CA, USA.,Institute for Collaborative Biotechnologies, University of California, Santa Barbara, CA, USA
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Radcliff KE, Neusner AD, Millhouse PW, Harrop JD, Kepler CK, Rasouli MR, Albert TJ, Vaccaro AR. What is new in the diagnosis and prevention of spine surgical site infections. Spine J 2015; 15:336-47. [PMID: 25264181 DOI: 10.1016/j.spinee.2014.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 05/06/2014] [Accepted: 09/15/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical site infection (SSI) after spinal surgery can result in several serious secondary complications, such as pseudoarthrosis, neurological injury, paralysis, sepsis, and death. There is an increasing body of literature on risk factors, diagnosis, and specific intraoperative interventions, including attention to sterility of instrumentation, application of minimally invasive fusion techniques, intraoperative irrigation, and application of topical antibiotics, that hold the most promise for reduction of SSI. PURPOSE The purpose of this review is to identify and summarize the recent literature on the incidence, risk factors, diagnosis, prevention, and treatment of SSIs after adult spine surgery. STUDY DESIGN The study design included systematic review and literature synthesis. METHODS For the systematic reviews, a search was performed in Medline and Scopus using keywords derived from a preliminary review of the literature and Medline MeSH terms. These studies were then manually filtered to meet the study criteria outlined in each section. Studies were excluded via predetermined criteria, and the majority of articles reviewed were excluded. RESULTS There are a number of patient- and procedure-specific risk factors for SSI. Surgical site infection appears to have significant implications from the patients' perspective on outcome of care. Diagnosis of SSI appears to rely primarily on clinical factors, while laboratory values such as C-reactive protein are not universally sensitive. Similarly, novel methods of perioperative infection prophylaxis such as local antibiotic administration appear to be modestly effective. CONCLUSIONS Surgical site infections are a common multifactorial problem after spine surgery. There is compelling evidence that improved risk stratification, detection, and prevention will reduce SSIs.
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Affiliation(s)
- Kris E Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
| | - Alexander D Neusner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA; Department of Surgery, Temple University Hospital, 3401 N. Broad St, Suite 400, Philadelphia, PA 19140, USA
| | - Paul W Millhouse
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - James D Harrop
- Department of Neurosurgery, Thomas Jefferson University, 1015 Walnut St, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Mohammad R Rasouli
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Todd J Albert
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
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Yang P, Huang X, Wang C, Dang X, Wang K. Repair of bone defects using a new biomimetic construction fabricated by adipose-derived stem cells, collagen I, and porous beta-tricalcium phosphate scaffolds. Exp Biol Med (Maywood) 2013; 238:1331-43. [PMID: 24157587 DOI: 10.1177/1535370213505827] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Adipose derived stem cells (ASCs) with multilineage differentiation capacities have been demonstrated as an alternative cell candidate for in vitro and in vivo bone regeneration. This suggests that they may be a potential candidate to repair the bone defects. We attempted to demonstrate the use of new biomimetic constructions of undifferentiated rabbit adipose-derived stem cells (rASCs) with fully interconnected porous beta-tricalcium phosphate (β-TCP) scaffolds encapsulated by collagen I hydrogel in the regeneration of a critical-sized defect of rabbit radii. Critical-sized defects in the left radii of rabbits were prepared and inserted with rASCs/collagen I/β-TCP scaffold composites or collagen I/β-TCP scaffold composites. The results were evaluated by histology, radiographs, micro-CT, Emission Computed Tomography (ECT), fluorochrome labeling, western blot, and mechanical testing at 4, 8, and 12 weeks postsurgery. Twelve weeks after implantation, the defects were almost completely repaired as confirmed by the presence of the cortical bone and medullary cavity, which was evaluated through radiologic, histologic, and biomechanical examination. Biodegradation of the biomaterials may be attributed to extracellular liquid dissolution together with cell-mediated phagocytosis. Our study shows that a greater number of rASCs in the porous β-TCP scaffold encapsulated by collagen I gel enhanced osteogenesis in critical-sized defects. We hope to garner new insight into the engineering of rASCs-based bone tissue for clinical application.
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Affiliation(s)
- Pei Yang
- Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710004, China
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