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Lindtner RA, Wurm A, Pirchner E, Putzer D, Arora R, Coraça-Huber DC, Schirmer M, Badzoka J, Kappacher C, Huck CW, Pallua JD. Enhancing Bone Infection Diagnosis with Raman Handheld Spectroscopy: Pathogen Discrimination and Diagnostic Potential. Int J Mol Sci 2023; 25:541. [PMID: 38203710 PMCID: PMC10778662 DOI: 10.3390/ijms25010541] [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: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Osteomyelitis is a bone disease caused by bacteria that can damage bone. Raman handheld spectroscopy has emerged as a promising diagnostic tool for detecting bone infection and can be used intraoperatively during surgical procedures. This study involved 120 bone samples from 40 patients, with 80 samples infected with either Staphylococcus aureus or Staphylococcus epidermidis. Raman handheld spectroscopy demonstrated successful differentiation between healthy and infected bone samples and between the two types of bacterial pathogens. Raman handheld spectroscopy appears to be a promising diagnostic tool in bone infection and holds the potential to overcome many of the shortcomings of traditional diagnostic procedures. Further research, however, is required to confirm its diagnostic capabilities and consider other factors, such as the limit of pathogen detection and optimal calibration standards.
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Affiliation(s)
- Richard Andreas Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Alexander Wurm
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
- Praxis Dr. Med. Univ. Alexander Wurm FA für Orthopädie und Traumatologie, Koflerweg 7, 6275 Stumm, Austria
| | - Elena Pirchner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - David Putzer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Débora Cristina Coraça-Huber
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
| | - Michael Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Jovan Badzoka
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Christoph Kappacher
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Christian Wolfgang Huck
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Johannes Dominikus Pallua
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.A.L.); (A.W.); (E.P.); (D.P.); (R.A.); (D.C.C.-H.)
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Lindtner R, Wurm A, Kugel K, Kühn J, Putzer D, Arora R, Coraça-Huber DC, Zelger P, Schirmer M, Badzoka J, Kappacher C, Huck CW, Pallua JD. Comparison of Mid-Infrared Handheld and Benchtop Spectrometers to Detect Staphylococcus epidermidis in Bone Grafts. Bioengineering (Basel) 2023; 10:1018. [PMID: 37760120 PMCID: PMC10525239 DOI: 10.3390/bioengineering10091018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Bone analyses using mid-infrared spectroscopy are gaining popularity, especially with handheld spectrometers that enable on-site testing as long as the data quality meets standards. In order to diagnose Staphylococcus epidermidis in human bone grafts, this study was carried out to compare the effectiveness of the Agilent 4300 Handheld Fourier-transform infrared with the Perkin Elmer Spectrum 100 attenuated-total-reflectance infrared spectroscopy benchtop instrument. The study analyzed 40 non-infected and 10 infected human bone samples with Staphylococcus epidermidis, collecting reflectance data between 650 cm-1 and 4000 cm-1, with a spectral resolution of 2 cm-1 (Agilent 4300 Handheld) and 0.5 cm-1 (Perkin Elmer Spectrum 100). The acquired spectral information was used for spectral and unsupervised classification, such as a principal component analysis. Both methods yielded significant results when using the recommended settings and data analysis strategies, detecting a loss in bone quality due to the infection. MIR spectroscopy provides a valuable diagnostic tool when there is a tissue shortage and time is of the essence. However, it is essential to conduct further research with larger sample sizes to verify its pros and cons thoroughly.
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Affiliation(s)
- Richard Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
| | - Alexander Wurm
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
- Praxis Dr. Med. Univ. Alexander Wurm FA für Orthopädie und Traumatologie, Koflerweg 7, 6275 Stumm, Austria
| | - Katrin Kugel
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
| | - Julia Kühn
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
| | - David Putzer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
| | - Débora Cristina Coraça-Huber
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
| | - Philipp Zelger
- University Clinic for Hearing, Voice and Speech Disorders, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Michael Schirmer
- Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Jovan Badzoka
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Christoph Kappacher
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Christian Wolfgang Huck
- Institute of Analytical Chemistry and Radiochemistry, University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria; (J.B.); (C.K.); (C.W.H.)
| | - Johannes Dominikus Pallua
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (R.L.); (K.K.); (J.K.); (D.P.); (R.A.); (D.C.C.-H.); (J.D.P.)
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Fölsch C, Preu S, Ulloa CF, Kühn K, Rickert M, Jahnke A. Palmitic acid coating of allogeneic cancellous bone for local antibiotic treatment: A porcine impaction bone grafting model. J Orthop 2023; 35:24-30. [PMID: 36345327 PMCID: PMC9636015 DOI: 10.1016/j.jor.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The worldwide rising number of joint replacements results in increasing revision surgery including a relevant portion of septic loosening accompanied by bone deficiencies. Loading of allogeneic bone with antibiotics provides high local antibiotic concentrations and might eradicate bacteria which appear resistant to systemic antibiotic application. Hydrophobic palmitic acid was shown to be a suitable carrier for antibiotics and prevents biofilm. Methods Cancellous bone derived from 6 to 7 months old piglets was used for a standardized in vitro impaction bone grafting model according to previous studies. The specimens were either thermodisinfected or remained native and palmitic acid with one third and two third partial weight were added and compared with control. Shear force at the interface prosthesis to cement and between cement and bone was measured. The relative micromovements were measured with 6 inductive sensors with a resolution of 0.1 μm at three different measuring heights up to a maximum movement of 150 μm between cement and bone. Taking into account the corresponding applied torque the measured values were normalized in μm/Nm. Statistical analysis was done with SPSS Statistics® Version 26.0 IBM. Results Smallest movement was measured for thermodisinfected cancellous bone and a not significant decrease of shear force resistance with addition of palmitic acid was found since supplementing native cancellous bone reduced shear force resistance significantly depending on the weight percentage of palmitic acid. Conclusion Supplementation of porcine cancellous bone with palmitic acid did not significantly reduce shear force resistance of thermodisinfected bone since adding palmitic acid to native bone decreased it significantly depending on the volume added. Palmitic acid seems to be a suitable coating for allogeneic cancellous bone to deliver high local antibiotic concentrations and thermodisinfected cancellous bone might be able to store larger volumes of palmitic acid than native bone without relevant influence on shear force resistance.
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Affiliation(s)
- C. Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Gießen and Marburg (UKGM), Justus-Liebig-University, Klinikstraße 33, 35392, Gießen, Germany
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - S. Preu
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - C.A. Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - K.D. Kühn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Auenbruggerstraße 5, Graz, Austria
| | - M. Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Gießen and Marburg (UKGM), Justus-Liebig-University, Klinikstraße 33, 35392, Gießen, Germany
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - A. Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
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Wurm A, Kühn J, Kugel K, Putzer D, Arora R, Coraça-Huber DC, Zelger P, Badzoka J, Kappacher C, Huck CW, Pallua JD. Raman microscopic spectroscopy as a diagnostic tool to detect Staphylococcus epidermidis in bone grafts. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 280:121570. [PMID: 35779474 DOI: 10.1016/j.saa.2022.121570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/02/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Raman microscopic spectroscopyis a new approach for further characterization and detection of molecular features in many pathological processes. This technique has been successfully applied to scrutinize the spatial distribution of small molecules and proteins within biological systems by in situ analysis. This study uses Raman microscopic spectroscopyto identify any in-depth benefits and drawbacks in diagnosing Staphylococcus epidermidis in human bone grafts. MATERIAL AND METHODS 40 non-infected human bone samples and 10 human bone samples infected with Staphylococcus epidermidis were analyzed using Raman microscopic spectroscopy. Reflectance data were collected between 200 cm-1 and 3600 cm-1 with a spectral resolution of 4 cm-1 using a Senterra II microscope (Bruker, Ettlingen, Germany). The acquired spectral information was used for spectral and unsupervised classification, such as principal component analysis. RESULTS Raman measurements produced distinct diagnostic spectra that were used to distinguish between non-infected human bone samples and Staphylococcus epidermidis infected human bone samples by spectral and principal component analyses. A substantial loss in bone quality and protein conformation was detected by human bone samples co-cultured with Staphylococcus epidermidis. The mineral-to-matrix ratio using the phosphate/Amide I ratio (p = 0.030) and carbonate/phosphate ratio (p = 0.001) indicates that the loss of relative mineral content in bones upon bacterial infection is higher than in non-infected human bones. Also, an increase of alterations in the collagen network (p = 0.048) and a decrease in the structural organization and relative collagen in infected human bone could be detected. Subsequent principal component analyses identified Staphylococcus epidermidis in different spectral regions, respectively, originating mainly from CH2 deformation (wagging) of protein (at 1450 cm-1) and bending and stretching modes of C-H groups (∼2800-3000 cm-1). CONCLUSION Raman microscopic spectroscopyis presented as a promising diagnostic tool to detect Staphylococcus epidermidis in human bone grafts. Further studies in human tissues are warranted.
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Affiliation(s)
- A Wurm
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - J Kühn
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - K Kugel
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - D Putzer
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - R Arora
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - D C Coraça-Huber
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - P Zelger
- University Clinic for Hearing, Voice and Speech Disorders, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - J Badzoka
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
| | - C Kappacher
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
| | - C W Huck
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
| | - J D Pallua
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Fölsch C, Sahm P, Ulloa CAF, Krombach GA, Kampschulte M, Rickert M, Pruss A, Jahnke A. Effect of synthetic bone replacement material of different size on shear stress resistance within impacted native and thermodisinfected cancellous bone: an in vitro femoral impaction bone grafting model. Cell Tissue Bank 2021; 22:651-664. [PMID: 33893901 PMCID: PMC8558171 DOI: 10.1007/s10561-021-09924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/03/2021] [Indexed: 11/06/2022]
Abstract
Antibiotic carrier particles of variable size might influence mechanic properties within impacted thermodisinfected and native cancellous bone different. Herafill®G containing calciumsulfate and calciumcarbonate provides high local concentrations of gentamicin being important for revision surgery in infected joint replacements. Native and thermodisinfected cancellous bone derived from 6 to 7 months old piglets was used for in vitro impaction bone grafting and supplemented each with Herafill®G granules of two different sizes. Micromovement of implants related to shear force was measured in 29 specimens distributed in 6 groups. Thermodisinfected cancellous bone revealed a significant higher shear force resistance than native bone with a mean difference of 423.8 mdeg/Nm (p < 0.001) ranging within 95% confidence interval from 181.5 to 666.0 mdeg/Nm. Adding small granules to thermodisinfected bone did not reduce shear force resistance significantly since adding large granules to native bone improved it by 344.0 mdeg/Nm (p < 0.003). Shear force resistance was found higher at the distal region of the implant compared to a proximal point of measurement throughout all specimens. Less impaction impulses were necessary for thermodisinfected bone. Thermodisinfected cancellous bone might achieve a higher degree of impaction compared with native bone resulting in increased resistance against shear force since impaction was found increased distally. Supplementation of thermodisinfected bone with small granules of Herafill®G might be considered for application of local antibiotics. Large granules appeared more beneficial for supplementation of native bone. Heterogeneity of bone graft and technical aspects of the impaction procedure have to be considered regarding the reproducibility of femoral impaction bone grafting.
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Affiliation(s)
- C Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Gießen, Germany.
| | - P Sahm
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| | - C A Fonseca Ulloa
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Kampschulte
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Gießen, Germany
| | - A Pruss
- Institute of Transfusion Medicine, University Tissue Bank, Charité University Medical School, Charitéplatz 1, 10117, Berlin, Germany
| | - A Jahnke
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
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Fölsch C, Bok J, Krombach GA, Rickert M, Ulloa CAF, Ahmed GA, Kampschulte M, Jahnke A. Influence of antibiotic pellets on pore size and shear stress resistance of impacted native and thermodisinfected cancellous bone: An in vitro femoral impaction bone grafting model. J Orthop 2020; 22:414-421. [PMID: 33029046 DOI: 10.1016/j.jor.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022] Open
Abstract
Introduction Morphology and mechanic properties of impacted cancellous bone are affected by carrier substances which provide high local concentrations of antibiotics. Methods Bone chips were taken from the femoral head of 6-7 months old piglets. One half was thermodisinfected and the other remained native. Ten specimens each were mixed with Herafill® antibiotic pellets and a control group of each 10 specimens respectively was examined. The cancellous bone was impacted according to Exeter technique and the implants were cemented. The distribution of the particles and the pores were defined with three dimensional computertomographic scan and shear force resistance was measured until failure. Results Shear force resistance was not measured significantly less for thermodisinfected (2.7 Nm) compared with native bone (3.5 Nm) and addition of antibiotic pellets reduced shear force resistance in both groups since this was significant for the native group. The average pore volume of the native bone specimens appeared significant smaller compared to the thermodisinfected group (p = 0.011) and the pore volume showed a negative correlation with shear force resistance (p = 0.044). Pore volume around the pellets was found significantly increased and it appeared smaller for native bone. The number of pellets located next to the implant showed a negative correlation with shear force resistance (p = 0.034) and the negative correlation increased for pellets below the tip of the shaft model (p = 0.024). Conclusion Adding antibiotic pellets to native and thermodisinfected impacted cancellous bone increased pore volume since the area around the pellets showed increased porosity which correlated with reduced shear force resistance. Computertomographic three dimensional measurement of porosity might predict shear force resistance of impacted cancellous bone and improve impaction of bone grafting intraoperatively.
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Affiliation(s)
- C Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - J Bok
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - C A Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - G A Ahmed
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - M Kampschulte
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - A Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
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Dankl L, Mayr A, Kaufmann G, Thaler M, Nogler M, Putzer D. Measuring bone defects for acetabular revision surgery for choosing an appropriate reconstruction strategy: A concept study on plastic models. Comput Biol Med 2019; 111:103336. [PMID: 31276945 DOI: 10.1016/j.compbiomed.2019.103336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/20/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone defects can be filled with autografts, allografts and artificial bone-materials. The aim of this study was to evaluate whether the digitization of known defect models with a navigation system is a reliable measurement method for estimating the size of a bone defect. METHODS Six preformed, cylindrical and cone-shaped defects on an artificial hip-bone were digitalized by six different observers. Reference volumes were gathered by measuring the depth of the defects, using an alginate impression material to fill out the defects and calculating the volumes from a CT scan. RESULTS One out of the six preformed defects showed a statistically significant difference between the digitalization and the calculation, four showed a significant difference between the digitalization and the mould as well as between the digitalization and the CT calculation. CONCLUSIONS This technique offers satisfactory results and consistent reproducibility when digitalizing big defects with relatively simple shape. Decreasing size and increasing complexity of the defects leads to more imprecise measurements.
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Affiliation(s)
- Lukas Dankl
- Medical University of Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Medical University of Innsbruck, Department of Radiology, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gerhard Kaufmann
- Orthopaedic and Foot Center, Innsbruck, Innrain 2, 6020, Innsbruck, Austria
| | - Martin Thaler
- Medical University of Innsbruck, Department of Orthopaedic Surgery, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michael Nogler
- Medical University of Innsbruck, Department of Orthopaedics - Experimental Orthopaedics, Innrain 36, 6020, Innsbruck, Austria
| | - David Putzer
- Medical University of Innsbruck, Department of Orthopaedics - Experimental Orthopaedics, Innrain 36, 6020, Innsbruck, Austria.
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[Influence of thermodisinfection on impaction of cancellous bone : An in vitro model of femoral impaction bone grafting]. DER ORTHOPADE 2019; 47:39-51. [PMID: 29238859 DOI: 10.1007/s00132-017-3509-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The reconstruction of bony defects during endoprosthesis revision surgery using "impaction bone grafting" leads to the possibility of a longstanding osseous integration to achieve good clinical results. Native allogeneic cancellous bone is often used for the procedure. This study examines the influence of thermodisinfection on the impaction behaviour of cancellous bone of different geometries and on the cement distribution. METHODS The cancellous bone was obtained from the femoral heads of 7‑month old pigs. One half of the head was thermodisinfected while the other remained native. Bone chips with sizes of 3-5, 5-8 and 8-10 mm were produced. The impaction was performed in a cylinder model with an internal diameter of 30 mm and with standardized impaction force using an impactor with a weight of 1450 g. The best particle combination was used for the subsequent computer tomography examination of the cement distribution and the contact surface to the bone in different parts of the shaft in seven investigations. For statistic measurements two-dimensional variance analysis including repetitions of measurement and Bonferroni correction, the LSD post-hoc-zest and the Mann Whitney U Test were used. The error probability was set at α = 5%. The SPSS® for Windows software was used for the statistical analysis. RESULTS The distribution of the cancellous and compacted bone also along the shaft revealed no significant difference between thermodisinfected and native cancellous bone at different levels (p > 0.05). Impacted native cancellous bone showed less inclusion of air, which resulted in a better distribution of density compared with thermodisinfected bone overall (p < 0.001). In the distal shaft area the cement volume was significantly larger in conjunction with the native bone. The overall area of cement penetration appeared to be significantly larger for native cancellous bone (p < 0.001). CONCLUSIONS The impaction of thermodisinfected and native cancellous bone showed greater deformation of the processed bone without any significant difference in the maximum density reached at different levels. Cement volume and cement penetration were pronounced proximally in native and processed cancellous bone. The cement distribution was significantly more distal for the native bone. Distally, the stabilization of the shaft appears to be increasingly dependent on the density of the impacted spongiosa, while proximally, the penetration of the cement into cancellous bone seems to correlate with porosity.
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Putzer D, Scholl F, Dankl L, Dammerer D, Thaler M, Nogler M. Intraoperative bone defect measurement in the acetabulum using a navigation system: The influence of bone porosity on the digitalization process. Med Eng Phys 2018; 59:75-80. [PMID: 30001979 DOI: 10.1016/j.medengphy.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate how bone porosity affects intraoperative volume measurement of the acetabulum in a plastic bone model study and to validate the measurement method on cadaveric acetabula. Point cloud collection was performed using a navigation system and compared to CT measurements as well as theoretical calculations on sawbones with different porosities and validated on cadaveric specimens. The grade of porosity had a significant influence on the volume measurement. In high porous materials volume calculation (61.5 cm²) was overestimated when using a digitalizer, while in materials with low porosity the volume was underestimated (57.0 cm²) in comparison to the known size of the defect (59.4 cm²). Digitalization time of the acetabulum was between 1 and 4 min. Validating the measurement on cadaveric bones no statistical significant difference could be found between digitalized volumes and theoretically calculated volumes. As digitalization of the acetabulum can be carried out in a reasonable time it could be used as a measurement tool to estimate the amount of allografts needed for filling bone defects.
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Affiliation(s)
- David Putzer
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria.
| | - Florian Scholl
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria
| | - Lukas Dankl
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Medical University of Innsbruck, Department of Orthopaedics, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Thaler
- Medical University of Innsbruck, Department of Orthopaedics, Anichstraße 35, 6020 Innsbruck, Austria
| | - Michael Nogler
- Department of Orthopaedics - Experimental Orthopaedics, Medical University of Innsbruck, Innrain 36, 6020 Innsbruck, Austria
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Coraça-Huber DC, Nogler M, Kühn KD. [Potential of allogeneic bone grafts as antibiotic carriers : Effect of different preparation processes on efficacy]. DER ORTHOPADE 2017; 47:30-38. [PMID: 29230489 DOI: 10.1007/s00132-017-3507-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The rising number of primary joint replacements worldwide is causing an increase of endoprosthetic revision surgery due bacterial infection. Revision surgery using non-cemented implants seems beneficial for the long-term outcome, and the use of antibiotic-impregnated bone grafts might control the infection and provide a good support for the implant. In this study, we evaluated the release of antibiotics from fresh-frozen and lyophilized allogeneic bone grafts. METHODS Heat-treated, lyophilized and fresh frozen cryopreserved bone chips were impregnated with gentamicin sulphate, gentamicin palmitate and vancomycin, and calcium carbonate/calcium sulphate treated with antibiotics. The efficacy of each preparation was measured by drug release tests and bacterial susceptibility using B. subtilis, S. aureus and methicillin-resistant Staphylococcus aureus. RESULTS The release of gentamicin from lyophilized bone was similar to the release rate from fresh frozen bone during the entire experiment. This might be related to the similar porosity and microstructure of the bone chips. The release of gentamicin from lyophilized and fresh frozen bone was high on the first and second days, then decreased and stayed at a low rate until the end of the second week. CONCLUSION Depending on the surgical strategy, either polymethylmethacrylate or allogeneic bone are able to deliver sufficient concentrations of gentamicin to achieve bacterial inhibition within 2 weeks after surgery. In the case of uncemented revision of joint replacements, allogeneic bone can deliver therapeutic doses of gentamicin and peak levels immediately and a fortnight after implantation.
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Affiliation(s)
- D C Coraça-Huber
- Experimentelle Orthopädie, Department für Orthopädie, Medizinische Universität Innsbruck, Innrain 36, 6020, Innsbruck, Österreich.
| | - M Nogler
- Experimentelle Orthopädie, Department für Orthopädie, Medizinische Universität Innsbruck, Innrain 36, 6020, Innsbruck, Österreich
| | - K-D Kühn
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
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Putzer D, Ammann CG, Coraça-Huber D, Lechner R, Schmölz W, Nogler M. The Influence of Liquids on the Mechanical Properties of Allografts in Bone Impaction Grafting. Biopreserv Biobank 2017; 15:410-416. [PMID: 28686464 DOI: 10.1089/bio.2017.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Allografts are used to compensate for bone defects resulting from revision surgery, tumor surgery, and reconstructive bone surgery. Although it is well known that the reduction of fat content of allografts increases mechanical properties, the content of liquids with a known grain size distribution has not been assessed so far. The aim of the study was to compare the mechanical properties of dried allografts (DA) with allografts mixed with a saline solution (ASS) and with allografts mixed with blood (AB) having a similar grain size distribution. Fresh-frozen morselized bone chips were cleaned chemically, sieved, and reassembled in specific portions with a known grain size distribution. A uniaxial compression was used to assess the yield limit, initial density, density at yield limit, and flowability of the three groups before and after compaction with a fall hammer apparatus. No statistically significant difference could be found for the yield limit between DA and ASS (p = 0.339) and between ASS and AB (p = 0.554). DA showed a statistically significant higher yield limit than AB (p = 0.022). Excluding the effect of the grain size distribution on the mechanical properties, it was shown that allografts have a lower yield limit when lipids are present. The liquid content of allografts seems to play an inferior role as no statistically significant difference could be found between DA and ASS. It is suggested, in accordance with other studies, to chemically clean allografts before implantation to reduce the contamination risk and the fat content.
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Affiliation(s)
- David Putzer
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Christoph Gert Ammann
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Débora Coraça-Huber
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
| | - Ricarda Lechner
- 2 Department of Orthopedic Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Werner Schmölz
- 3 Department of Trauma Surgery, Medical University of Innsbruck , Innsbruck, Austria
| | - Michael Nogler
- 1 Department of Orthopedic Surgery, Experimental Orthopedics, Medical University of Innsbruck , Innsbruck, Austria
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Coraça-Huber DC, Ammann CG, Nogler M, Fille M, Frommelt L, Kühn KD, Fölsch C. Lyophilized allogeneic bone tissue as an antibiotic carrier. Cell Tissue Bank 2016; 17:629-642. [PMID: 27631323 PMCID: PMC5116047 DOI: 10.1007/s10561-016-9582-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/01/2016] [Indexed: 01/05/2023]
Abstract
The rising number of primary joint replacements worldwide causes an increase of revision surgery of endoprostheses due bacterial infection. Revision surgery using non-cemented implants seems beneficial for the long-term outcome and the use of antibiotic-impregnated bone grafts might control the infection and give a good support for the implant. In this study we evaluated the release of antibiotics from fresh-frozen and lyophilized allogeneic bone grafts. Lyophilized bone chips and fresh frozen bone chips were mixed with gentamicin sulphate, gentamicin palmitate, vancomycin, calcium carbonate/calcium sulphate impregnated with gentamicin sulphate, and calcium carbonate/calcium sulphate bone substitute material impregnated with vancomycin. The efficacy of each preparation was measured by drug release tests and bacterial susceptibility using B. subtilis, S. aureus and methicillin-resistant Staphylococcus aureus. The release of gentamicin from lyophilized bone was similar to the release rate from fresh frozen bone during all the experimental time. That fact might be related to the similar porosity and microstructure of the bone chips. The release of gentamicin from lyophilized and fresh frozen bone was high in the first and second day, decreasing and keeping a low rate until the end of the second week. Depending on the surgical strategy either polymethylmethacrylate or allogeneic bone are able to deliver sufficient concentrations of gentamicin to achieve bacterial inhibition within two weeks after surgery. In case of uncemented revision of joint replacements allogeneic bone is able to deliver therapeutic doses of gentamicin and peak levels immediately after implantation during a fortnight. The use of lyophilized and fresh frozen bone allografts as antibiotic carriers is recommended for prophylaxis of bone infection.
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Affiliation(s)
- Débora C Coraça-Huber
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria.
| | - Christoph G Ammann
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Michael Nogler
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Manfred Fille
- Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Schöpfstr. 41, 3rd Floor, Innsbruck, Austria
| | - Lars Frommelt
- Institute for Infectiology, Clinical Microbiology and Hospital Care, ENDO Clinic Hamburg, Holstenstraße 2, Hamburg, Germany
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Auenbruggerplatz 5, Graz, Austria
| | - Christian Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Giessen, Baldingerstraße, Marburg, Germany
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Fölsch C, Kellotat A, Rickert M, Ishaque B, Ahmed G, Pruss A, Jahnke A. Effect of thermodisinfection on mechanic parameters of cancellous bone. Cell Tissue Bank 2016; 17:427-37. [PMID: 27344440 DOI: 10.1007/s10561-016-9567-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
Revision surgery of joint replacements is increasing and raises the demand for allograft bone since restoration of bone stock is crucial for longevity of implants. Proceedings of bone grafts influence the biological and mechanic properties differently. This study examines the effect of thermodisinfection on mechanic properties of cancellous bone. Bone cylinders from both femoral heads with length 45 mm were taken from twenty-three 6-8 months-old piglets, thermodisinfected at 82.5 °C according to bone bank guidelines and control remained native. The specimens were stored at -20 °C immediately and were put into 21 °C Ringer's solution for 3 h before testing. Shear and pressure modulus were tested since three point bending force was examined until destruction. Statistical analysis was done with non-parametric Wilcoxon, t test and SPSS since p < 0.05 was significant. Shear modulus was significantly reduced by thermodisinfection to 1.02 ± 0.31 GPa from 1.28 ± 0.68 GPa for unprocessed cancellous bone (p = 0.029) since thermodisinfection reduced pressure modulus not significantly from 6.30 ± 4.72 GPa for native specimens to 4.97 ± 2.23 GPa and maximum bending force was 270.03 ± 116.68 N for native and 228.80 ± 70.49 N for thermodisinfected cancellous bone. Shear and pressure modulus were reduced by thermodisinfection around 20 % and maximum bending force was impaired by about 15 % compared with native cancellous bone since only the reduction of shear modulus reached significance. The results suggest that thermodisinfection similarly affects different mechanic properties of cancellous bone and the reduction of mechanic properties should not relevantly impair clinical use of thermodisinfected cancellous bone.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Andreas Kellotat
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
| | - Markus Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Bernd Ishaque
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Gafar Ahmed
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Axel Pruss
- University Tissue Bank, Institute of Transfusion Medicine, Charité University Medical School, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander Jahnke
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
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Coraça-Huber D, Hausdorfer J, Fille M, Nogler M, Kühn KD. Calcium carbonate powder containing gentamicin for mixing with bone grafts. Orthopedics 2014; 37:e669-72. [PMID: 25102500 DOI: 10.3928/01477447-20140728-50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023]
Abstract
Bone grafts are used for reconstructing bone defects caused by implant-associated complications, trauma, and tumors. Surgery with bone allografts is complex and time consuming; therefore, it is prone to a higher infection rate (2.0%-2.5%). In the case of site infection, systemically administered antibiotics cannot reach the infected bone graft. This study evaluated the use of resorbable bone graft substitute powder (HERAFILL; Heraeus Medical GmbH, Wehrheim, Germany) as a bone void-filling material as well as an antibiotic carrier for mixing with bone grafts. The antibiotic activity of the bone chips mixed with HERAFILL powder was measured by drug release tests and bacterial susceptibility with Bacillus subtilis, Staphylococcus epidermidis, and Staphylococcus aureus. HERAFILL powder was added to the bone chips (bone chips/HERAFILL; w/w = 1:1), mixed with a spatula, and vortexed for 1 minute. Gentamicin base release was evaluated in phosphate-buffered saline for up to 7 days using B subtilis bioassay. Antimicrobial efficacy was tested with S aureus and S epidermidis. The average amount of gentamicin base released from bone chips mixed with HERAFILL at 0 to 12 hours was 99.66 mg/mL. On day 7, the gentamicin base released 0.42 mg/mL. The elution released from bone chips mixed with HERAFILL promoted the formation of a zone of inhibition on S epidermidis and S aureus plates. This study confirmed the capacity of bone grafts to act as antibiotic carriers once mixed with HERAFILL powder. Bone chips mixed with HERAFILL showed efficacy against S aureus and S epidermidis.
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15
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Putzer D, Coraça-Huber D, Wurm A, Schmoelz W, Nogler M. Optimizing the grain size distribution of allografts in bone impaction grafting. J Orthop Res 2014; 32:1024-9. [PMID: 24797323 DOI: 10.1002/jor.22635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/31/2014] [Indexed: 02/04/2023]
Abstract
In bone impaction grafting, allografts in the form of bone chips are used for reconstruction of defects and to induce bone remodeling. Optimizing grain size distribution of this allograft material should help prevent implant subsidence by achieving higher primary stability of the graft. We evaluated the influence of grain size distribution on the mechanical stability of allograft material. Bone tissue was rinsed, and the grain size distribution of the allograft material was determined by performing a sieve analysis. Uniaxial compression tests were carried out before and after a standardized compaction procedure for samples with controlled grain size distribution and a control group. Allografts with controlled grain size distribution showed a yield limit almost twice as high as in the control group after a standardized compaction procedure. A better interlocking between bone particles was observed compared to the control group. Thus, grain size distribution has a major impact on the mechanical stability of bone grafts. By controlling the grain size distribution of allograft material, a tighter packing can be achieved and subsequently implant subsidence of implants could be avoided.
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Affiliation(s)
- David Putzer
- Experimental Orthopaedics, Department of Orthopaedics, Innsbruck Medical University, Innrain 36, 6020, Innsbruck, Austria
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16
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The mechanical stability of allografts after a cleaning process: comparison of two preparation modes. J Arthroplasty 2014; 29:1642-6. [PMID: 24793889 DOI: 10.1016/j.arth.2014.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 02/12/2014] [Accepted: 03/24/2014] [Indexed: 02/01/2023] Open
Abstract
In revision hip arthroplasty, bone loss can be compensated by impacting allograft material. Cleaning processes reduce the risk of bacterial and viral contamination. Cleaned allograft material was compared to native untreated allografts by using a uniaxial compression test. 30 measurements were performed for each group before and after compaction. Grain size distribution and weight loss were determined. A reduction in the amount of large bone fragments and a higher compaction rate were observed in the cleaned bone grafts. The cleaned bone chips presented with a better mechanical resistance to a compression force and a reduced flowability. The benefit of a cleaner and a mechanical stable graft material comes with the drawback that higher initial amounts of graft material are needed.
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Coraça-Huber DC, Wurm A, Fille M, Hausdorfer J, Nogler M, Kühn KD. Effect of freezing on the release rate of gentamicin palmitate and gentamicin sulfate from bone tissue. J Orthop Res 2014; 32:842-7. [PMID: 24676909 DOI: 10.1002/jor.22602] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/30/2014] [Indexed: 02/04/2023]
Abstract
In this study we evaluated gentamicin palmitate salt and gentamicin sulfate salt mixed with bone chips after storage at -80°C. Different concentration rates of gentamicin sulfate and gentamicin palmitate were mixed with human bone chips and stored for 1-6 months at -80°C. Nonstored samples were used as control. The release of the antibiotics from the bone was carried out in phosphate-buffered saline. Antibiotic concentrations in the elutions were determined with microbiological agar diffusion assay using Bacillus subtilis. Susceptibility tests were carried out using Staphylococci strains. The rate of gentamicin base (GB) released from bone was similar for all gentamicin salts and all storage conditions. The elutions released were efficient on reducing S. aureus and S. epidermidis CFU during all storage time. In resume, the capacity of bone grafts to act as gentamicin carriers has been confirmed in this study. GS + GP showed equivalent efficacy against S. aureus and S. epidermidis compared with GS pure. The lower delivery rate of GS + GP, related to its affinity with fat tissue can be an advantage for longer release times, increasing the local protection against infections. Storage at -80°C does not interfere on the gentamicin salts activity used.
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Morsellised sawbones is an acceptable experimental substitute for the in vitro elastic and viscoelastic mechanical characterisation of morsellised cancellous bone undergoing impaction grafting. Med Eng Phys 2013; 36:26-31. [PMID: 24075067 DOI: 10.1016/j.medengphy.2013.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/29/2013] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Impaction grafting using morsellised bone chips is widely used during surgery to mitigate the effects of bone loss. The technique typically involves the packing of morsellised allograft cancellous bone into bone defects, and has found extensive application in revision hip and knee surgery. In the ideal situation, the presence of the bone graft prevents subsidence of the revised prosthesis in the short term, and integrates with the host bone in the longer term. However, the configuration of particles within the graft remains to be optimised, and is highly likely to vary across potential sites and loading conditions. Human bone, for use in experimental investigation, is often difficult to obtain with properties that are relevant from a clinical point of view. This study, therefore, has explored the mechanical response of a Sawbones based experimental substitute. An established confined compression technique was used to characterise the morsellised Sawbones material. Comparison of the results with published values for bovine and human bone indicate that the mechanical response of the morsellised Sawbones material map well onto the elastic and viscoelastic response of bone of a biological origin.
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Gentamicin palmitate as a new antibiotic formulation for mixing with bone tissue and local release. Cell Tissue Bank 2013; 15:139-44. [PMID: 23793827 DOI: 10.1007/s10561-013-9384-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/14/2013] [Indexed: 01/05/2023]
Abstract
During surgery with bone grafting, the impaction of bone tissue creates an avascular area where local circulation is disrupted. If infections arise, they may prevent systemically administered antibiotics from reaching the infected bone. In this study we evaluated gentamicin palmitate (GP) mixed with gentamicin sulfate (GS) as a coating for bone chips (BCh). The efficacy of the coated BCh was measured by gentamicin base release tests using B. subtilis, S. epidermidis and S. aureus. Gentamicin base release was evaluated in phosphate-buffered saline for up to 7 days using B. subtilis bioassay. Antimicrobial efficacy was tested with S. aureus and S. epidermidis. A significant difference on the release of gentamicin base between GS and GS + GP was observed. S. epidermidis are significantly more susceptible to GS + GP and GS than S. aureus. BCh can act as gentamicin carriers and showed efficacy against S. aureus and S. epidermidis.
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Coraça-Huber DC, Hausdorfer J, Fille M, Nogler M. Effect of storage temperature on gentamicin release from antibiotic-coated bone chips. Cell Tissue Bank 2012; 14:395-400. [PMID: 22936498 DOI: 10.1007/s10561-012-9339-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 08/24/2012] [Indexed: 01/05/2023]
Abstract
Freezing is the most common method for storing bones until use in skeletal reconstruction. However, the effect of freezing on antibiotic delivery from antibiotic-coated bone has not been evaluated. In this study, we compared antibiotic delivery in vitro from gentamicin-coated human bone stored at different temperatures. Bone chips obtained from human femur heads were chemically cleaned and mixed with gentamicin sulfate. Samples were stored for 4 months at -20 °C, 4 months at -80 °C, or evaluated immediately without freezing. Antibiotic release from the bone chips was measured using Bacillus subtilis as an indicator strain. Zones of inhibition and rates of gentamicin release were similar in all three groups. Storage at -20 and -80 °C for bone allografts has no effect on gentamicin release from chemically cleaned bone chips.
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Affiliation(s)
- D C Coraça-Huber
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University Innsbruck, Salurnerstrasse 15, 6020, Innsbruck, Austria.
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Effect of two cleaning processes for bone allografts on gentamicin impregnation and in vitro antibiotic release. Cell Tissue Bank 2012; 14:221-9. [DOI: 10.1007/s10561-012-9314-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/18/2012] [Indexed: 01/05/2023]
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