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Hung GY, Wang CY, Hsiao HY, Tu CS, Mana-Ay H, Chen CT, Lai PL, Feng KC, Chen PY. Composite bone graft of CaO-MgO-SiO 2 glass-ceramics and CaSO 4 ceramics for boosting bone formation rate. J Mater Chem B 2024; 12:6394-6409. [PMID: 38855886 DOI: 10.1039/d4tb00262h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
This study develops a composite bone graft of CaO-MgO-SiO2 glass-ceramic and CaSO4 [abbreviated as (CMS)3-x(CS)x] via the sponge replication technique with weight fractions of x = 0, 1, 1.5, 2, and 3. The (CMS)1.5(CS)1.5 composite displays a superior degradability and, a suitable compressive strength of ∼3 MPa, and excellent cell proliferation and differentiation. The in vivo rat femur test in the hybrid-pore (CMS)1.5(CS)1.5 composite granules achieves a higher rate of bone formation, which is ∼2.7 times better than that of the commercial HAP/β-TCP at 12 weeks. Improved expressions of osteocyte and mature osteocyte marker genes, namely (Spp1, Dmp1, and Fgf23), were observed in the (CMS)1.5(CS)1.5 group, indicating a faster differentiation into mature bone tissue. The ions release of (CMS)1.5(CS)1.5 through the ERK1/2 signaling pathway promotes osteogenic differentiation. The high bone generation rate can be attributed to faster active ions release and modified surface topography. This work highlights an excellent bone graft candidate for clinical applications in orthopedic surgery.
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Affiliation(s)
- Guan-Yi Hung
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Chi-Yun Wang
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Hui-Yi Hsiao
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33305, Taiwan
| | - Chi-Shun Tu
- Department of Physics, Fu Jen Catholic University, New Taipei City 24205, Taiwan
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Haidee Mana-Ay
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Physics, Silliman University, Dumaguete City 6200, Philippines
| | | | - Po-Liang Lai
- Bone and Joint Reserach Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan.
- College of Medicine, Chang Gung Univeristy, Taoyuan City 33305, Taiwan
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Kuei-Chih Feng
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Mechanical Engineering, Ming Chi University of Technology, New Taipei City 24301, Taiwan
| | - Pin-Yi Chen
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Mechanical Engineering, Chang Gung University, Taoyuan City 33302, Taiwan
- Research Center for Intelligent Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan
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Tsai YH, Tseng CC, Lin YC, Nail HM, Chiu KY, Chang YH, Chang MW, Lin FH, Wang HMD. Novel artificial tricalcium phosphate and magnesium composite graft facilitates angiogenesis in bone healing. Biomed J 2024:100750. [PMID: 38838984 DOI: 10.1016/j.bj.2024.100750] [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: 03/31/2023] [Revised: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Bone grafting is the standard treatment for critical bone defects, but autologous grafts have limitations like donor site morbidity and limited availability, while commercial artificial grafts may have poor integration with surrounding bone tissue, leading to delayed healing. Magnesium deficiency negatively impacts angiogenesis and bone repair. Therefore, incorporating magnesium into a synthetic biomaterial could provide an excellent bone substitute. This study aims to evaluate the morphological, mechanical, and biological properties of a calcium phosphate cement (CPC) sponge composed of tetracalcium phosphate (TTCP) and monocalcium phosphate monohydrate (MCPM), which could serve as an excellent bone substitute by incorporating magnesium. METHODS This study aims to develop biomedical materials composed mainly of TTCP and MCPM powder, magnesium powder, and collagen. The materials were prepared using a wet-stirred mill and freeze-dryer methods. The particle size, composition, and microstructure of the materials were investigated. Finally, the biological properties of these materials, including 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay for biocompatibility, effects on bone cell differentiation by alkaline phosphatase (ALP) activity assay and tartrate-resistant acid phosphatase (TRAP) activity assay, and endothelial cell tube formation assay for angiogenesis, were evaluated as well. RESULTS The data showed that the sub-micron CPC powder, composed of TTCP/MCPM in a 3.5:1 ratio, had a setting time shorter than 15 minutes and a compressive strength of 4.39±0.96 MPa. This reveals that the sub-micron CPC powder had an adequate setting time and mechanical strength. We found that the sub-micron CPC sponge containing magnesium had better biocompatibility, including increased proliferation and osteogenic induction effects without cytotoxicity. The CPC sponge containing magnesium also promoted angiogenesis. CONCLUSION In summary, we introduced a novel CPC sponge, which had a similar property to human bone promoted the biological functions of bone cells, and could serve as a promising material used in bone regeneration for critical bone defects.
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Affiliation(s)
- Yuan-Hsin Tsai
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Department of Orthopedic Surgery, Show-Chwan Memorial Hospital, Changhua 500, Taiwan Republic of China
| | - Chun-Chieh Tseng
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Yun-Chan Lin
- Department of Food Science and Biotechnology, National Chung Hsing University, Taichung 402, Taiwan Republic of China
| | - Howida M Nail
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan Republic of China
| | - Kuan-Yu Chiu
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Yen-Hao Chang
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Ming-Wei Chang
- Nanotechnology and Integrated Bioengineering Centre, University of Ulster, Belfast, BT151AB, Northern Ireland, UK
| | - Feng-Huei Lin
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan Republic of China; Institute of Biomedical Engineering and Nano-medicine, National Health Research Institutes, Zhunan, Miaoli 350, Taiwan Republic of China.
| | - Hui-Min David Wang
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan Republic of China; Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung City 404, Taiwan Republic of China.
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Loha T, Bhattacharya R, Pal B, Amis AA. A novel design of hip-stem with reduced strain-shielding. Proc Inst Mech Eng H 2024; 238:471-482. [PMID: 38644528 DOI: 10.1177/09544119241244537] [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] [Indexed: 04/23/2024]
Abstract
The use of uncemented stems in hip arthroplasty has been increasing, even in osteoporotic patients. The major concerns of uncemented hip-stems, however, are peri-prosthetic fracture, thigh pain, and proximal femoral stress-/strain-shielding. In this study, a novel design of uncemented hip-stem is proposed that will reduce such concerns, improve osseointegration, and benefit both osteoporotic and arthritic patients. The stem has a central titanium alloy core surrounded by a set of radial buttresses that are partly porous titanium, as is the stem tip. The aim of the study was to investigate the mechanical behaviour of the proposed partly-porous design, examining load transfer in the short-term, and comparing its strain-shielding behaviour with a solid metal implant. The long-term effect of implant-induced bone remodelling was also simulated. Computed tomography based three-dimensional finite element models of an intact proximal femur, and the same femur implanted with the proposed design, were developed. Peak hip contact and major muscle forces corresponding to level-walking and stair climbing were applied. The proposed partly-porous design had approximately 50% lower strain-shielding than the solid-metal counterpart. Results of bone remodelling simulation indicated that only 16% of the total bone volume is subjected to reduction of bone density. Strain concentrations were observed in the bone around the stem-tip for both solid and porous implants; however, it was less prominent for the porous design. Lower strain-shielding and reduced bone resorption are advantageous for long-term fixation, and the reduced strain concentration around the stem-tip indicates a lower risk of peri-prosthetic fracture.
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Affiliation(s)
- Tanmoy Loha
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, India
| | - Rounak Bhattacharya
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, India
| | - Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, India
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
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Alizade C, Aliyev H, Alizada F. The Concept of Treatment for Surgical Infection in the Hindfoot. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241058. [PMID: 38623152 PMCID: PMC11017820 DOI: 10.1177/24730114241241058] [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] [Indexed: 04/17/2024] Open
Abstract
Background Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence Level IV, case series.
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Affiliation(s)
| | - Huseyn Aliyev
- Azerbaijan Scientific Research Institute of Traumatology and Orthopedics, Baku, Azerbaijan
| | - Farhad Alizada
- Klinikum am Gesundbrunnen (SLK-Kliniken Heilbronn GmbH), Am Gesundbrunnen 20-26, 74078 Heilbronn
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Zaszczyńska A, Kołbuk D, Gradys A, Sajkiewicz P. Development of Poly(methyl methacrylate)/nano-hydroxyapatite (PMMA/nHA) Nanofibers for Tissue Engineering Regeneration Using an Electrospinning Technique. Polymers (Basel) 2024; 16:531. [PMID: 38399909 PMCID: PMC10893281 DOI: 10.3390/polym16040531] [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: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The study explores the in vitro biocompatibility and osteoconductivity of poly(methyl methacrylate)/nano-hydroxyapatite (PMMA/nHA) composite nanofibrous scaffolds for bone tissue engineering (BTE). Electrospun scaffolds, exhibiting both low and high fiber orientation, were investigated. The inclusion of hydroxyapatite nanoparticles enhances the osteoconductivity of the scaffolds while maintaining the ease of fabrication through electrospinning. SEM analysis confirms the high-quality morphology of the scaffolds, with successful incorporation of nHA evidenced by SEM-EDS and FTIR methods. DSC analysis indicates that nHA addition increases the PMMA glass transition temperature (Tg) and reduces stress relaxation during electrospinning. Furthermore, higher fiber orientation affects PMMA Tg and stress relaxation differently. Biological studies demonstrate the composite material's non-toxicity, excellent osteoblast viability, attachment, spreading, and proliferation. Overall, PMMA/nHA composite scaffolds show promise for BTE applications.
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Affiliation(s)
| | | | | | - Paweł Sajkiewicz
- Laboratory of Polymers & Biomaterials, Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawinskiego 5b St., 02-106 Warsaw, Poland; (A.Z.); (D.K.); (A.G.)
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Friedmann A, Liedloff P, Eliezer M, Brincat A, Ostermann T, Diehl D. Reconstructive Approach in Residual Periodontal Pockets with Biofunctionalized Heterografts-A Retrospective Comparison of 12-Month Data from Three Centers. J Funct Biomater 2024; 15:39. [PMID: 38391892 PMCID: PMC10889411 DOI: 10.3390/jfb15020039] [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: 12/28/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
The regenerative capacity of well-preserved blood clots may be enhanced by biologics like enamel matrix derivative (EMD). This retrospective analysis compares outcomes reported by three centers using different heterografts. Center 1 (C1) treated intrabony defects combining cross-linked high-molecular-weight hyaluronic acid (xHyA) with a xenograft; center 2 (C2) used EMD with an allograft combination to graft a residual pocket. Center 3 (C3) combined xHyA with the placement of a resorbable polymer membrane for defect cover. Clinical parameters, BoP reduction, and radiographically observed defect fill at 12-month examination are reported. The 12-month evaluation yielded significant improvements in PPD and CAL at each center (p < 0.001, respectively). Analyses of Covariance revealed significant improvements in all parameters, and a significantly greater CAL gain was revealed for C2 vs. C1 (p = 0.006). Radiographic defect fill presented significantly higher scores for C2 and C3 vs. C1 (p = 0.003 and = 0.014; C2 vs. C3 p = 1.00). Gingival recession increased in C1 and C3 (p = 1.00), while C2 reported no GR after 12 months (C2:C1 p = 0.002; C2:C3 p = 0.005). BoP tendency and pocket closure rate shared similar rates. Within the limitations of the study, a data comparison indicated that xHyA showed a similar capacity to enhance the regenerative response, as known for EMD. Radiographic follow-up underlined xHyA's unique role in new attachment formation.
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Affiliation(s)
- Anton Friedmann
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
| | - Pheline Liedloff
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
| | | | - Arthur Brincat
- Independent Researcher, 83000 Toulon, France
- Department of Periodontology, Service of Odontology, AP-HM, UFR of Odontology, Aix-Marseille University, 13005 Marseille, France
| | - Thomas Ostermann
- Department of Psychology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Daniel Diehl
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
- Institute of Pharmacology and Toxicology, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
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Markel DC, Dietz PR, Wu B, Chen L, Bou-Akl T, Shi T, Ren W. Repair of a rat calvaria defect with injectable strontium (Sr)-doped polyphosphate dicalcium phosphate dehydrate (P-DCPD) ceramic bone grafts. J Biomed Mater Res B Appl Biomater 2024; 112:e35388. [PMID: 38334714 DOI: 10.1002/jbm.b.35388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/07/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
The trace element strontium (Sr) enhances new bone formation. However, delivering Sr, like other materials, in a sustained manner from a ceramic bone graft substitute (BGS) is difficult. We developed a novel ceramic BGS, polyphosphate dicalcium phosphate dehydrate (P-DCPD), which delivers embedded drugs in a sustained pattern. This study assessed the in vitro and in vivo performance of Sr-doped P-DCPD. In vitro P-DCPD and 10%Sr-P-DCPD were nontoxic and eluents from 10%Sr-P-DCPD significantly enhanced osteoblastic MC3T3 cell differentiation. A sustained, zero-order Sr release was observed from 10%Sr-P-DCPD for up to 70 days. When using this BGS in a rat calvaria defect model, both P-DCPD and 10% Sr-P-DCPD were found to be biocompatible and biodegradable. Histologic data from decalcified and undecalcified tissue showed that 10%Sr-P-DCPD had more extensive new bone formation compared with P-DCPD 12-weeks after surgery and the 10%Sr-P-DCPD had more organized new bone and much less fibrous tissue at the defect margins. The new bone was formed on the surface of the degraded ceramic debris within the bone defect area. P-DCPD represented a promising drug-eluting BGS for repair of critical bone defects.
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Affiliation(s)
- David C Markel
- Ascension Providence Hospital, Section of Orthopedic Surgery, Southfield, Michigan, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Paula R Dietz
- Ascension Providence Hospital, Section of Orthopedic Surgery, Southfield, Michigan, USA
| | - Bin Wu
- Ascension Providence Hospital, Section of Orthopedic Surgery, Southfield, Michigan, USA
| | - Liang Chen
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Therese Bou-Akl
- Ascension Providence Hospital, Section of Orthopedic Surgery, Southfield, Michigan, USA
| | - Tong Shi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Weiping Ren
- Ascension Providence Hospital, Section of Orthopedic Surgery, Southfield, Michigan, USA
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
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Zhang M, Xu F, Cao J, Dou Q, Wang J, Wang J, Yang L, Chen W. Research advances of nanomaterials for the acceleration of fracture healing. Bioact Mater 2024; 31:368-394. [PMID: 37663621 PMCID: PMC10474571 DOI: 10.1016/j.bioactmat.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Abstract
The bone fracture cases have been increasing yearly, accompanied by the increased number of patients experiencing non-union or delayed union after their bone fracture. Although clinical materials facilitate fracture healing (e.g., metallic and composite materials), they cannot fulfill the requirements due to the slow degradation rate, limited osteogenic activity, inadequate osseointegration ability, and suboptimal mechanical properties. Since early 2000, nanomaterials successfully mimic the nanoscale features of bones and offer unique properties, receiving extensive attention. This paper reviews the achievements of nanomaterials in treating bone fracture (e.g., the intrinsic properties of nanomaterials, nanomaterials for bone defect filling, and nanoscale drug delivery systems in treating fracture delayed union). Furthermore, we discuss the perspectives on the challenges and future directions of developing nanomaterials to accelerate fracture healing.
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Affiliation(s)
- Mo Zhang
- School of Pharmacy, Key Laboratory of Innovative Drug Development and Evaluation, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Fan Xu
- School of Pharmacy, Key Laboratory of Innovative Drug Development and Evaluation, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Jingcheng Cao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
| | - Qingqing Dou
- School of Pharmacy, Key Laboratory of Innovative Drug Development and Evaluation, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
| | - Jing Wang
- School of Pharmacy, Key Laboratory of Innovative Drug Development and Evaluation, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Lei Yang
- Center for Health Sciences and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, PR China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, PR China
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Dell’Aquila AM, dos Reis GNB, Cuba GT, Targa WHDC, Bongiovanni JC, Durigon TS, Salles MJ, dos Reis FB. Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations. Antibiotics (Basel) 2023; 12:1720. [PMID: 38136754 PMCID: PMC10740565 DOI: 10.3390/antibiotics12121720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the outcome of patients with cavitary chronic osteomyelitis undergoing adjuvant treatment with bioactive glass (BAG) S53P4 and identify the independent risk factors (RFs) for recurrence in 6- and 12-month patient follow-up. METHODS A retrospective, multicentre observational study conducted in tertiary specialised hospitals among patients undergoing the surgical treatment of chronic cavitary osteomyelitis using BAG-S53P4 in a granule and/or putty formulation to assess the clinical outcome and RFs for failure in 6- and 12-month patient follow-up. RESULTS Of the 92 and 78 patients with 6-month and 12-month follow-ups, infection was eradicated in 85.9% and 87.2%, respectively. In the 6-month follow-up, BAG-S53P4 in the granule formulation presented a greater risk of recurrence compared to the bioactive glass putty formulation or combined granules and putty (prevalence ratio (PR) = 3.04; confidence interval 95% [CI95%]: 1.13-10.52) and neoplasia (PR = 5.26; CI95%: 1.17-15.52). In the 12-month follow-up cohort of 78 patients, smoking (PR = 4.0; 95% CI: 1.03-15.52) and nonfermenting GNB infection (PR = 3.87; CI95%: 1.09-13.73) presented a greater risk of recurrence. CONCLUSIONS BAG-S53P4 is a viable option for bone-void filling and the treatment of chronic cavitary osteomyelitis. Formulations of BAG with putty or in combination with granules showed better results.
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Affiliation(s)
- Adriana Macedo Dell’Aquila
- Infectious Diseases Discipline, Department of Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil; (A.M.D.); (G.T.C.)
| | - Gabriela Nagy Baldy dos Reis
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil; (G.N.B.d.R.); (T.S.D.); (F.B.d.R.)
| | - Gabriel Trova Cuba
- Infectious Diseases Discipline, Department of Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil; (A.M.D.); (G.T.C.)
| | | | - José Carlos Bongiovanni
- Department of Orthopedics and Traumatology, Universidade de Mogi das Cruzes, Mogi das Cruzes 08780-911, Brazil;
| | - Thomas Stravinskas Durigon
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil; (G.N.B.d.R.); (T.S.D.); (F.B.d.R.)
| | - Mauro José Salles
- Infectious Diseases Discipline, Department of Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil; (A.M.D.); (G.T.C.)
| | - Fernando Baldy dos Reis
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo 04023-900, Brazil; (G.N.B.d.R.); (T.S.D.); (F.B.d.R.)
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Smolle MA, Murtezai H, Niedrist T, Amerstorfer F, Hörlesberger N, Leitner L, Klim SM, Glehr R, Ahluwalia R, Leithner A, Glehr M. Vancomycin Elution Kinetics of Four Antibiotic Carriers Used in Orthopaedic Surgery: In Vitro Study over 42 Days. Antibiotics (Basel) 2023; 12:1636. [PMID: 37998838 PMCID: PMC10669465 DOI: 10.3390/antibiotics12111636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, osteoconductive antibiotic carriers used in clinical practice within a 42-day in vitro setting. Carriers A and D already contained vancomycin (1.1 g and 0.247 g), whereas carriers B and C were mixed with vancomycin according to the manufacturer's recommendations (B: 0.83 g and C: 0.305 g). At nine time points, 50% (4.5 mL) of the elution sample was removed and substituted with the same amount of PBS. Probes were analysed with a kinetic microparticle immunoassay. Time-dependent changes in vancomycin concentrations for each carrier and differences between carriers were analysed. Mean initial antibiotic levels were highest for carrier A (37.5 mg/mL) and lowest for carrier B (5.4 mg/mL). We observed time-dependent, strongly negative linear elution kinetics for carriers A (-0.835; p < 0.001), C (-0.793; p < 0.001), and D (-0.853; p < 0.001). Vancomycin concentrations increased from 48 h to 7 d and dropped thereafter in carriers C and D whilst constantly decreasing at any time point for carrier A. Carrier B showed a shallower decrease. Mean antibiotics levels at 42 d were 1.5 mg/mL, 2.6 mg/mL, 0.1 mg/mL, and 0.1 mg/mL for carriers A, B, C, and D. Differences in mean initial and final vancomycin concentrations for carrier A were significantly larger in comparison to C (p = 0.040). A carrier consisting of allogenic bone chips showed the highest vancomycin-to-carrier ratio and the largest elution over the study period. Whilst vancomycin concentrations were still measurable at 42 days for all carriers, carrier A provided a higher drug-to-carrier ratio and a more consistent antibiotic-releasing profile.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Hana Murtezai
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
- Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria
| | - Florian Amerstorfer
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Nina Hörlesberger
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian Martin Klim
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Reingard Glehr
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, 8036 Graz, Austria
| | - Raju Ahluwalia
- Orthopaedics, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Mathias Glehr
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
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11
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Kong D, Wang Q, Huang J, Zhang Z, Wang X, Han Q, Shi Y, Ji R, Li Y. Design and manufacturing of biomimetic scaffolds for bone repair inspired by bone trabeculae. Comput Biol Med 2023; 165:107369. [PMID: 37625259 DOI: 10.1016/j.compbiomed.2023.107369] [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: 06/02/2023] [Revised: 07/13/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023]
Abstract
Porous scaffold (PorS) implants, particularly those that mimic the structural features of natural cancellous bone (NCanB), are increasingly essential for the treatment of large-area bone defects. However, the mechanical properties of NCanB-based bionic bone scaffold (BioS) and its performance as a bone repair material have not been fully explored. This study investigates the effect of bionic structure parameters on the mechanical properties and bone reconstruction performance of BioS. Using laser powder bed fusion (L-PBF) technology, different BioS with various structural parameters were created and evaluated using Micro-CT, compression testing, Finite Element (FE) Simulation, and computational fluid dynamics (CFD), and compared to commonly used clinical PorS. Assess the capacity of the BioS scaffold to support and enhance bone reconstruction following implantation through the evaluation of its mechanical properties, permeability, and fluid shear stress (FSS). BioS-85-90 and BioS-80-50 showed suitable mechanical properties, performed well in FE simulation of implantation, demonstrated outstanding abilities for osteoinductive ingrowth and bone tissue differentiation, and proved to be reliable materials for the reconstruction of bone defects. Therefore, BioS shows significant potential for clinical application as a bone reconstruction material, providing a solid foundation for the integration of tissue engineering and bionic design.
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Affiliation(s)
- Deyin Kong
- Key Laboratory of Bionic Engineering, Ministry of Education, College of Biological and Agricultural Engineering, Jilin University, Changchun, China
| | - Qing Wang
- Key Laboratory of Bionic Engineering, Ministry of Education, College of Biological and Agricultural Engineering, Jilin University, Changchun, China
| | - Jiangeng Huang
- Key Laboratory of Bionic Engineering, Ministry of Education, College of Biological and Agricultural Engineering, Jilin University, Changchun, China
| | - Zhihui Zhang
- Key Laboratory of Bionic Engineering, Ministry of Education, College of Biological and Agricultural Engineering, Jilin University, Changchun, China; Liaoning Academy of Materials, Shenyang 110167, China.
| | - Xiebin Wang
- Key Laboratory for Liquid-Solid Structural Evolution and Processing of Materials, Ministry of Education, Shandong University, Jinan, China
| | - Qing Han
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, China
| | - Yanbin Shi
- School of Mechanical & Automotive Engineering, Qilu University of Technology, Shandong Academy of Sciences, Jinan, China
| | - Ran Ji
- Key Laboratory of Bionic Engineering, Ministry of Education, College of Biological and Agricultural Engineering, Jilin University, Changchun, China
| | - Yiling Li
- Key Laboratory of Bionic Engineering, Ministry of Education, College of Biological and Agricultural Engineering, Jilin University, Changchun, China
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12
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Lin Z, Chen Z, Chen Y, Yang N, Shi J, Tang Z, Zhang C, Lin H, Yin J. Hydrogenated silicene nanosheet functionalized scaffold enables immuno-bone remodeling. EXPLORATION (BEIJING, CHINA) 2023; 3:20220149. [PMID: 37933236 PMCID: PMC10624372 DOI: 10.1002/exp.20220149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/03/2023] [Indexed: 11/08/2023]
Abstract
An ideal implant needs to have the ability to coordinate the foreign body response and tissue regeneration. Here, Hydrogenated-silicon nanosheets (H-Si NSs) with favorable biodegradability are integrated and functionalized into a β-tricalcium phosphate scaffold (H-Si TCP) for bone defect healing. H-Si TCP can greatly improve bone regeneration through osteoimmunomodulation-guided biodegradation in vivo. The spatiotemporal regulation of degradation products replenishes sufficient nutrients step by step for the entire process of bone repair. Extracellular and intracellular reactive oxygen species (ROS) are first downregulated by reaction with H-Si NSs, followed by marked M2 polarization, remodeling the micro-environment timely for immune-bone regeneration. The release of primary reaction products awakened bone marrow mesenchymal stem cells (BMSCs), which are converted into osteoblasts anchored on scaffolds. Subsequently, biomineralization is promoted by the final degradation products. The intrinsic ROS-responsive, immunoregulatory, and osteo-promotive capability of 2D H-Si NSs makes such composite H-Si TCP scaffold a highly potential alternative for the treatment of critical bone defect.
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Affiliation(s)
- Zixuan Lin
- Institute of Microsurgery on ExtremitiesDepartment of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Zhixin Chen
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of Ceramics Chinese Academy of SciencesShanghaiP. R. China
| | - Yiwei Chen
- Institute of Microsurgery on ExtremitiesDepartment of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Nan Yang
- Institute of Microsurgery on ExtremitiesDepartment of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of Ceramics Chinese Academy of SciencesShanghaiP. R. China
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineSchool of MedicineTongji UniversityShanghaiP. R. China
| | - Zhongmin Tang
- Departments of Radiology and Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Changqing Zhang
- Institute of Microsurgery on ExtremitiesDepartment of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP. R. China
| | - Han Lin
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of Ceramics Chinese Academy of SciencesShanghaiP. R. China
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineSchool of MedicineTongji UniversityShanghaiP. R. China
| | - Junhui Yin
- Institute of Microsurgery on ExtremitiesDepartment of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiP. R. China
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13
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REIS GABRIELANAGYBALDYDOS, CUBA GABRIELTROVA, TARGA WALTERHAMILTONDECASTRO, MIRAS PAULOSÉRGIOCONTADOR, BONGIOVANNI JOSÉCARLOS, SALLES MAUROJOSÉ, REIS FERNANDOBALDYDOS, DELL’AQUILA ADRIANAMACEDO. S53P4 BIOACTIVE GLASS PUTTY IN THE LOCAL TREATMENT OF CAVITARY CHRONIC OSTEOMYELITIS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e258453. [PMID: 36844131 PMCID: PMC9949206 DOI: 10.1590/1413-785220233101e258453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/28/2022] [Indexed: 02/22/2023]
Abstract
Objective Evaluating the clinical results of bioactive glass S53P4 putty for the treatment of cavitary chronic osteomyelitis. Methods Retrospective observational study, including patients of any age with clinical and radiological diagnosis of chronic osteomyelitis, who underwent surgical debridement and implantation of bioactive glass S53P4 putty (BonAlive® Putty, Turku, Finland). Patients who underwent any plastic surgery on the soft tissues of the affected site or had segmental bone lesions or septic arthritis were excluded. Statistical analysis was performed using Excel®. Demographic data, as well as data on the lesion, treatment, and follow-up, were collected. Outcomes were classified as "disease-free survival," "failure," or "indefinite." Results This study included 31 patients, of which 71% were men and had with a mean age of 53.6 years (SD ± 24.2). In total, 84% were followed-up for at least 12 months and 67.7% had comorbidities. We prescribed combination antibiotic therapy for 64.5% of patients. In 47.1%, Staphylococcus aureus was isolated. Finally, we classified 90.3% of cases as "disease-free survival" and 9.7% as "indefinite." Conclusion Bioactive glass S53P4 putty is safe and effective to treat cavitary chronic osteomyelitis, including infections by resistant pathogens, such as methicillin-resistant S. aureus. Level of Evidence IV, Case Series.
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Affiliation(s)
| | - GABRIEL TROVA CUBA
- Universidade Federal de São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil
| | | | | | - JOSÉ CARLOS BONGIOVANNI
- Universidade de Mogi das Cruzes, Department of Orthopedics and Traumatology, Mogi das Cruzes, SP, Brazil
| | - MAURO JOSÉ SALLES
- Universidade Federal de São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil
| | - FERNANDO BALDY DOS REIS
- Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil
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14
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Pádua AS, Figueiredo L, Silva JC, Borges JP. Chitosan scaffolds with mesoporous hydroxyapatite and mesoporous bioactive glass. Prog Biomater 2023; 12:137-153. [PMID: 36757613 PMCID: PMC10154456 DOI: 10.1007/s40204-023-00217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
Bone regeneration is one of the most well-known fields in tissue regeneration. The major focus concerns polymeric/ceramic composite scaffolds. In this work, several composite scaffolds based on chitosan (CH), with low and high molecular weights, and different concentrations of ceramics like mesoporous bioactive glass (MBG), mesoporous hydroxyapatite (MHAp) and both MBG and MHAp (MC) were produced by lyophilization. The purpose is to identify the best combination regarding optimal morphology and properties. The tests of the scaffolds present a highly porous structure with interconnected pores. The compression modulus increases with ceramic concentration in the scaffolds. Furthermore, the 75%MBG (835 ± 160 kPa) and 50%MC (1070 ± 205 kPa) samples are the ones that mostly enhance increases in mechanical properties. The swelling capacity increases with MBG and MC, respectively, to 700% and 900% and decreases to 400% when MHAp concentration increases. All scaffolds are non-cytotoxic at 12.5 mg/mL. The CHL scaffolds improve cell adhesion and proliferation compared to CHH, and the MC scaffold samples, show better results than those produced with just MBG or MHAp. The composite scaffolds of chitosan with MBG and MHAp, have revealed to be the best combination due to their enhanced performance in bone tissue engineering.
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Affiliation(s)
- Ana Sofia Pádua
- I3N/CENIMAT, Materials Science Department, NOVA School of Science and Technology, New University of Lisbon, Lisbon, Portugal
| | - Lígia Figueiredo
- Bioceramed S.A., Rua José Gomes Ferreira 1, Arm D, São Julião Do Tojal, 2660-360, Loures, Portugal
| | - Jorge Carvalho Silva
- I3N/CENIMAT, Physics Department, NOVA School of Science and Technology, New University of Lisbon, Caparica, Portugal.
| | - João Paulo Borges
- I3N/CENIMAT, Materials Science Department, NOVA School of Science and Technology, New University of Lisbon, Lisbon, Portugal.
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15
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Griffoni C, Tedesco G, Canella V, Nataloni A, Zerbi A, Tosini G, Gasbarrini A, Barbanti-Brodano G. Ceramic bone graft substitute (Mg-HA) in spinal fusion: A prospective pilot study. Front Bioeng Biotechnol 2022; 10:1050495. [PMID: 36532576 PMCID: PMC9748738 DOI: 10.3389/fbioe.2022.1050495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/28/2022] [Indexed: 04/14/2024] Open
Abstract
Background: Iliac crest bone graft (ICBG) is considered the gold standard for spine surgical procedures to achieve a successful fusion due to its known osteoinductive and osteoconductive properties. However, complications related to harvesting procedure and donor site morbidity have been largely reported in the literature, favoring the development of a wide range of alternative products to be used as bone graft extenders or substitutes for spine fusion. Among all, ceramic-based biomaterials have been widely studied and employed in the last years as bone graft substitutes. Methods: We report here the results of a prospective pilot study aimed to evaluating the grade of ossification obtained by the use of an Mg-doped hydroxyapatite (HA) product to achieve postero-lateral fusion in degenerative spine diseases. Results: Results show a successful degree of fusion of about 62% at the 12-month follow-up and an improvement of quality of life and health status following surgery, as evaluated by clinical scores (ODI, VAS, and EQ-5L). No adverse events related to the material were reported. Conclusion: The present pilot study shows the effectiveness and the safety profile of an Mg-doped HA bone graft substitute used to achieve postero-lateral fusion in the treatment of degenerative spine diseases, laying down the basis for further larger clinical investigations.
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Affiliation(s)
- Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Alberto Zerbi
- Istituti Clinici Iseni, Fondazione Iseni y Nervi, Lonate Pozzolo, Italy
| | - Giovanni Tosini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Mayfield CK, Ayad M, Lechtholz-Zey E, Chen Y, Lieberman JR. 3D-Printing for Critical Sized Bone Defects: Current Concepts and Future Directions. Bioengineering (Basel) 2022; 9:680. [PMID: 36421080 PMCID: PMC9687148 DOI: 10.3390/bioengineering9110680] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2023] Open
Abstract
The management and definitive treatment of segmental bone defects in the setting of acute trauma, fracture non-union, revision joint arthroplasty, and tumor surgery are challenging clinical problems with no consistently satisfactory solution. Orthopaedic surgeons are developing novel strategies to treat these problems, including three-dimensional (3D) printing combined with growth factors and/or cells. This article reviews the current strategies for management of segmental bone loss in orthopaedic surgery, including graft selection, bone graft substitutes, and operative techniques. Furthermore, we highlight 3D printing as a technology that may serve a major role in the management of segmental defects. The optimization of a 3D-printed scaffold design through printing technique, material selection, and scaffold geometry, as well as biologic additives to enhance bone regeneration and incorporation could change the treatment paradigm for these difficult bone repair problems.
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Affiliation(s)
- Cory K. Mayfield
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Mina Ayad
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Elizabeth Lechtholz-Zey
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Yong Chen
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angleles, CA 90089, USA
| | - Jay R. Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
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17
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Freischmidt H, Armbruster J, Rothhaas C, Titze N, Guehring T, Nurjadi D, Kretzer JP, Schmidmaier G, Grützner PA, Helbig L. Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions. Biomedicines 2022; 10:biomedicines10102513. [PMID: 36289775 PMCID: PMC9599187 DOI: 10.3390/biomedicines10102513] [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: 09/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/26/2022] Open
Abstract
The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin. The osteoinductive, osteoconductive, and anti-infective effect of HACaS+G has already been demonstrated in clinical studies on patients with chronic osteomyelitis. However, especially for the treatment of infected non-unions with segmental bone defects by HACaS+G, reliable clinical testing is difficult and sufficient experimental data are lacking. We used an already established sequential animal model in infected and non-infected rat femora to investigate the osteoinductive, osteoconductive, and anti-infective efficacy of HACaS+G for the treatment of infected non-unions. In biomechanical testing, bone consolidation could not be observed under infected and non-infected conditions. Only a prophylactic effect against infections, but no eradication, could be verified in the microbiological analysis. Using µ-CT scans and histology, osteoinduction was detected in both the infected and non-infected bone, whereas osteoconduction occurred only in the non-infected setting. Our data showed that HACaS+G is osteoinductive, but does not have added benefits in infected non-unions in terms of osteoconduction and mechanical bone stability, especially in those with segmental bone defects.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
- Correspondence: (H.F.); (L.H.)
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Catharina Rothhaas
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Nadine Titze
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Thorsten Guehring
- Trauma Centre, Hospital Paulinenhilfe Stuttgart at Tübingen University Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
| | - Lars Helbig
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
- Correspondence: (H.F.); (L.H.)
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18
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Liu X, Sun S, Wang N, Kang R, Xie L, Liu X. Therapeutic application of hydrogels for bone-related diseases. Front Bioeng Biotechnol 2022; 10:998988. [PMID: 36172014 PMCID: PMC9510597 DOI: 10.3389/fbioe.2022.998988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/29/2022] [Indexed: 01/15/2023] Open
Abstract
Bone-related diseases caused by trauma, infection, and aging affect people’s health and quality of life. The prevalence of bone-related diseases has been increasing yearly in recent years. Mild bone diseases can still be treated with conservative drugs and can be cured confidently. However, serious bone injuries caused by large-scale trauma, fractures, bone tumors, and other diseases are challenging to heal on their own. Open surgery must be used for intervention. The treatment method also faces the problems of a long cycle, high cost, and serious side effects. Studies have found that hydrogels have attracted much attention due to their good biocompatibility and biodegradability and show great potential in treating bone-related diseases. This paper mainly introduces the properties and preparation methods of hydrogels, reviews the application of hydrogels in bone-related diseases (including bone defects, bone fracture, cartilage injuries, and osteosarcoma) in recent years. We also put forward suggestions according to the current development status, pointing out a new direction for developing high-performance hydrogels more suitable for bone-related diseases.
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Affiliation(s)
- Xiyu Liu
- Third School of Clinical Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Shuoshuo Sun
- Third School of Clinical Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Nan Wang
- Third School of Clinical Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Ran Kang
- Third School of Clinical Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Department of Orthopedics, Nanjing Lishui Hospital of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Ran Kang, ; Lin Xie, ; Xin Liu,
| | - Lin Xie
- Third School of Clinical Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Ran Kang, ; Lin Xie, ; Xin Liu,
| | - Xin Liu
- Third School of Clinical Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Department of Orthopedics, Nanjing Lishui Hospital of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Ran Kang, ; Lin Xie, ; Xin Liu,
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19
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Gharacheh H, Guvendiren M. Cell-Laden Composite Hydrogel Bioinks with Human Bone Allograft Particles to Enhance Stem Cell Osteogenesis. Polymers (Basel) 2022; 14:polym14183788. [PMID: 36145933 PMCID: PMC9503810 DOI: 10.3390/polym14183788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
There is a growing demand for bone graft substitutes that mimic the extracellular matrix properties of the native bone tissue to enhance stem cell osteogenesis. Composite hydrogels containing human bone allograft particles are particularly interesting due to inherent bioactivity of the allograft tissue. Here, we report a novel photocurable composite hydrogel bioink for bone tissue engineering. Our composite bioink is formulated by incorporating human allograft bone particles in a methacrylated alginate formulation to enhance adult human mesenchymal stem cell (hMSC) osteogenesis. Detailed rheology and printability studies confirm suitability of our composite bioinks for extrusion-based 3D bioprinting technology. In vitro studies reveal high cell viability (~90%) for hMSCs up to 28 days of culture within 3D bioprinted composite scaffolds. When cultured within bioprinted composite scaffolds, hMSCs show significantly enhanced osteogenic differentiation as compared to neat scaffolds based on alkaline phosphatase activity, calcium deposition, and osteocalcin expression.
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Affiliation(s)
- Hadis Gharacheh
- Otto H. York Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - Murat Guvendiren
- Otto H. York Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
- Correspondence:
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20
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da Costa Marques R, Simon J, d’Arros C, Landfester K, Jurk K, Mailänder V. Proteomics reveals differential adsorption of angiogenic platelet lysate proteins on calcium phosphate bone substitute materials. Regen Biomater 2022; 9:rbac044. [PMID: 35936551 PMCID: PMC9348553 DOI: 10.1093/rb/rbac044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Protein adsorption on biomaterials for bone substitution, such as calcium phosphates (CaP), evokes biological responses and shapes the interactions of biomaterials with the surrounding biological environment. Proteins adsorb when CaP materials are combined with growth factor-rich hemoderivatives prior to implantation to achieve enhanced angiogenesis and stimulate new bone formation. However, the identification of the adsorbed proteins and their angiogenic effect on bone homeostasis remain incompletely investigated. In this study, we analyzed the adsorbed complex protein composition on CaP surfaces when using the hemoderivatives plasma, platelet lysate in plasma (PL), and washed platelet lysate proteins (wPL). We detected highly abundant, non-regenerative proteins and anti-angiogenic proteins adsorbed on CaP surfaces after incubation with PL and wPL by liquid chromatography and mass spectrometry (LC–MS) proteomics. Additionally, we measured a decreased amount of adsorbed pro-angiogenic growth factors. Tube formation assays with human umbilical endothelial cells demonstrated that the CaP surfaces only stimulate an angiogenic response when kept in the hemoderivative medium but not after washing with PBS. Our results highlight the necessity to correlate biomaterial surfaces with complex adsorbed protein compositions to tailor the biomaterial surface toward an enrichment of pro-angiogenic factors.
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Affiliation(s)
- Richard da Costa Marques
- University Medical Center of the Johannes Gutenberg-University Mainz Dermatology Clinic, , Langenbeckstr. 1, Mainz, 55131, Germany
- Max Planck Institute for Polymer Research , Ackermannweg 10, Mainz, 55128, Germany
| | - Johanna Simon
- University Medical Center of the Johannes Gutenberg-University Mainz Dermatology Clinic, , Langenbeckstr. 1, Mainz, 55131, Germany
- Max Planck Institute for Polymer Research , Ackermannweg 10, Mainz, 55128, Germany
| | - Cyril d’Arros
- INSERM, UMR 1229, Regenerative Medicine and Skeleton, ONIRIS, Université de Nantes , Nantes, 44042, France
- Biomatlante—Advanced Medical Solutions Group Plc , Vigneux-de-Bretagne, 44360, France
| | - Katharina Landfester
- Max Planck Institute for Polymer Research , Ackermannweg 10, Mainz, 55128, Germany
| | - Kerstin Jurk
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz , Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Volker Mailänder
- University Medical Center of the Johannes Gutenberg-University Mainz Dermatology Clinic, , Langenbeckstr. 1, Mainz, 55131, Germany
- Max Planck Institute for Polymer Research , Ackermannweg 10, Mainz, 55128, Germany
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21
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Treatment alternatives and clinical outcomes of bone filling after benign tumour curettage. A systematic review. Orthop Traumatol Surg Res 2022; 108:102966. [PMID: 34033919 DOI: 10.1016/j.otsr.2021.102966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone grafts, bone cement, allografts, xenografts, or synthetic bone substitutes. Recently, some authors have suggested that these defects do not require filling for consolidation but the respective rate of complications of each method is not well defined. Therefore, we did a systematic review aiming to answer: (1) Not filling bone cavities after benign bone tumour curettage may increase the rate of fractures? (2) Can the volume of the bone defect in itself be a specific or reliable predictor of fracture? (3) Does the mean functional outcome, recurrence, non-weight bearing time, other postoperative complications or bone consolidation time vary between the methods of filling? PATIENTS AND METHODS The PubMed (2407 articles) and Latin American and Caribbean Health Sciences Literature (LILACS) (50 articles) databases were reviewed, without restriction considering publication date. After exclusion criteria, 62 articles were selected for data collection. Filling or not filling (UN), methods of filling, fracture rate, bone defect size, mean functional outcome, recurrence, non-weight bearing time, other postoperative complications, consolidation time were the data of interest. RESULTS The number of patients was 2555 distributed among the different filling methods. Unfilled cavities were associated with higher fracture rate [20/302 (6.62%)] versus 4/189 (2.12%) for allografts, 14/343 (4.08%) for cement filling, 4/247 for autograft (1.62%), and 12/580 (2.07%) for bone substitute. The volume of the bone defect alone is not a specific or reliable predictor of fracture. All filling methods were similar regarding the mean functional outcome, recurrence rate and consolidation time. The bone cement allowed early weight bearing time (mean of weeks): UN: 9.67; autologous bone grafts: 9.8; bone cement: 0.5; allografts: 9.0; synthetic bone substitutes: 9.96. CONCLUSION Not filling the bone cavity after benign bone tumour curettage is an alternative, but can increase fracture rate, even in small volume bone defects. The use of prophylactic fixation drastically reduces the fracture rate. Filling with cement reduces weight bearing time. There are little differences between the methods used to fill, even compared to not filling the cavity. LEVEL OF EVIDENCE III; systematic review.
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22
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Kaiser F, Schröter L, Stein S, Krüger B, Weichhold J, Stahlhut P, Ignatius A, Gbureck U. Accelerated bone regeneration through rational design of magnesium phosphate cements. Acta Biomater 2022; 145:358-371. [PMID: 35443213 DOI: 10.1016/j.actbio.2022.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 12/17/2022]
Abstract
Results of several studies during past years suggested that magnesium phosphate cements (MPCs) not only show excellent biocompatibility and osteoconductivity, but they also provide improved regeneration capacity due to higher solubility compared to calcium phosphates. These findings also highlighted that chemical similarity of bone substitutes to the natural bone tissue is not a determinant factor in the success of regenerative strategies. The aim of this study was to further improve the degradation speed of MPCs for a fast bone ingrowth within a few months. We confirmed our hypothesis, that decreasing the powder-liquid ratio (PLR) of cement results in an increased content of highly soluble phases such as struvite (MgNH4PO4⋅6H2O) as well as K-struvite (MgKPO4⋅6H2O). Promising compositions with a low PLR of 1 g ml-1 were implanted in partially-loaded tibia defects in sheep. Both cements were partially degraded and replaced by bone tissue after 4 months. The degradation speed of the K-struvite cement was significantly higher compared to the struvite cement, initially resulting in the formation of a cell-rich resorption zone at the surface of some implants, as determined by histology. Overall, both MPCs investigated in this study seem to be promising as an alternative to the clinically well-established, but slowly degrading calcium phosphate cements, depending on defect size and desired degradation rate. Whereas the K-struvite cement might require further modification towards a slower resorption and reduced inflammatory response in vivo, the struvite cement appears promising for the treatment of bone defects due to its continuous degradation with simultaneous new bone formation. STATEMENT OF SIGNIFICANCE: Cold setting bone cements are used for the treatment of bone defects that exceed a critical size and cannot heal on their own. They are applied pasty into the bone defect and harden afterwards so that the shape adapts to the individual defect. Magnesium phosphates such as magnesium ammonium phosphate hexahydrate (struvite) belong to a new class of these cold setting bone cements. They degrade much faster than the clinically established calcium phosphates. In this study, a magnesium phosphate that has hardly been investigated so far was implanted into partially-loaded defects in sheeps: Potassium magnesium phosphate hexahydrate. This showed even faster resorption compared to the struvite cement: after 4 months, 63% of the cement was already degraded.
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Affiliation(s)
- Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Lena Schröter
- Institute for Orthopaedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081 Ulm, Germany
| | - Svenja Stein
- Institute for Orthopaedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081 Ulm, Germany
| | - Benjamin Krüger
- Institute for Orthopaedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081 Ulm, Germany
| | - Jan Weichhold
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Philipp Stahlhut
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Anita Ignatius
- Institute for Orthopaedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081 Ulm, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany.
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Ansari MAA, Golebiowska AA, Dash M, Kumar P, Jain PK, Nukavarapu SP, Ramakrishna S, Nanda HS. Engineering biomaterials to 3D-print scaffolds for bone regeneration: practical and theoretical consideration. Biomater Sci 2022; 10:2789-2816. [PMID: 35510605 DOI: 10.1039/d2bm00035k] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
There are more than 2 million bone grafting procedures performed annually in the US alone. Despite significant efforts, the repair of large segmental bone defects is a substantial clinical challenge which requires bone substitute materials or a bone graft. The available biomaterials lack the adequate mechanical strength to withstand the static and dynamic loads while maintaining sufficient porosity to facilitate cell in-growth and vascularization during bone tissue regeneration. A wide range of advanced biomaterials are being currently designed to mimic the physical as well as the chemical composition of a bone by forming polymer blends, polymer-ceramic and polymer-degradable metal composites. Transforming these novel biomaterials into porous and load-bearing structures via three-dimensional printing (3DP) has emerged as a popular manufacturing technique to develop engineered bone grafts. 3DP has been adopted as a versatile tool to design and develop bone grafts that satisfy porosity and mechanical requirements while having the ability to form grafts of varied shapes and sizes to meet the physiological requirements. In addition to providing surfaces for cell attachment and eventual bone formation, these bone grafts also have to provide physical support during the repair process. Hence, the mechanical competence of the 3D-printed scaffold plays a key role in the success of the implant. In this review, we present various recent strategies that have been utilized to design and develop robust biomaterials that can be deployed for 3D-printing bone substitutes. The article also reviews some of the practical, theoretical and biological considerations adopted in the 3D-structure design and development for bone tissue engineering.
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Affiliation(s)
- Mohammad Aftab Alam Ansari
- Biomedical Engineering and Technology Lab, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
- FFF Laboratory, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
- International Centre for Sustainable and Net Zero Technologies, PDPM-Indian Institute of Information Technology Design and Manufacturing (IIITDM) Jabalpur, Dumna Airport Road, Jabalpur-482005, MP, India
| | - Aleksandra A Golebiowska
- Biomedical Engineering, Materials Science & Engineering, and Orthopaedic Surgery, University of Connecticut, 260 Glenbrook Road, Unit 3247 Storrs, CT, 06269, USA
| | - Madhusmita Dash
- School of Minerals, Metallurgical and Materials Engineering, Indian Institute of Technology Bhubaneswar, Arugul, Khurdha 752050, Odisha, India
- International Centre for Sustainable and Net Zero Technologies, PDPM-Indian Institute of Information Technology Design and Manufacturing (IIITDM) Jabalpur, Dumna Airport Road, Jabalpur-482005, MP, India
| | - Prasoon Kumar
- Biodesign and Medical device laboratory, Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, 769008, Odisha, India.
| | - Prashant Kumar Jain
- FFF Laboratory, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
| | - Syam P Nukavarapu
- Biomedical Engineering, Materials Science & Engineering, and Orthopaedic Surgery, University of Connecticut, 260 Glenbrook Road, Unit 3247 Storrs, CT, 06269, USA
| | - Seeram Ramakrishna
- Centre for Nanofibers and Nanotechnology, Department of Mechanical Engineering, National University of Singapore, Engineering Drive 3, Singapore 117587, Singapore
| | - Himansu Sekhar Nanda
- Biomedical Engineering and Technology Lab, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
- International Centre for Sustainable and Net Zero Technologies, PDPM-Indian Institute of Information Technology Design and Manufacturing (IIITDM) Jabalpur, Dumna Airport Road, Jabalpur-482005, MP, India
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24
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Radiological and Clinical Outcomes after Anterior Cervical Discectomy and Fusion (ACDF) with an Innovative 3D Printed Cellular Titanium Cage Filled with Vertebral Bone Marrow. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6339910. [PMID: 35528156 PMCID: PMC9071886 DOI: 10.1155/2022/6339910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objectives To assess the clinical and radiological outcomes after ACDF with 3D printed cellular titanium cages filled with bone marrow and to compare the clinical and radiological results with the current scientific literature. Methods ACDF was performed monosegmentally under standardized conditions. X-rays were analyzed to determine the range of motion, fusion rates, and subsidence preoperatively and 3 and 12 months postoperatively. Clinical outcome measurements included neck disability index (NDI), visual analogue scale (VAS) for brachialgia and cervicalgia, and patient satisfaction. Results 18 patients were included in the study. The mean RoM decreased from 7.7° ± 2.6 preoperatively to 1.7° ± 1.1° after 3 months and 1.8° ± 1.2° 12 months after surgery. The fusion rates were at 94.4% after 3 and 12 months. The mean subsidence was 0.9 mm ± 0.5 mm 3 months postoperatively and 1.1 mm ± 0.5 mm 12 months after surgery. The mean NDI improved significantly from preoperatively to 12 months postoperatively (34.6 ± 6.2 and 3.4 ± 4.1, respectively). The VAS-neck also showed a large improvement from 5.8 ± 2.2 before and 1.3 ± 1.4 12 months after surgery, as did the VAS-arm (6.4 ± 1.5 and 0.9 ± 1.6, respectively). Patient satisfaction was high throughout the follow-up period. Conclusion ACDF with a 3D printed titanium cage resulted in fast fusion without pathological subsidence. In comparison to other cage materials such as PEEK, the 3D printed titanium cage was noninferior in regard to its fusion rate and clinical results.
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25
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Freischmidt H, Armbruster J, Rothhaas C, Titze N, Guehring T, Nurjadi D, Sonntag R, Schmidmaier G, Grützner PA, Helbig L. Treatment of Infection-Related Non-Unions with Bioactive Glass-A Promising Approach or Just Another Method of Dead Space Management? MATERIALS 2022; 15:ma15051697. [PMID: 35268930 PMCID: PMC8911496 DOI: 10.3390/ma15051697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 12/17/2022]
Abstract
The treatment of infected and non-infected non-unions remains a major challenge in trauma surgery. Due to the limited availability of autologous bone grafts and the need for local anti-infective treatment, bone substitutes have been the focus of tissue engineering for years. In this context, bioactive glasses are promising, especially regarding their anti-infective potential, which could reduce the need for local and systemic treatment with conventional antibiotics. The aim of this study was to investigate the osteoinductive and osteoconductive effects, as well as the anti-infectious potential, of S53P4 using a standardized non-union model, which had not been investigated previously. Using an already established sequential animal model in infected and non-infected rat femora, we were able to investigate bioactive glass S53P4 under realistic non-union conditions regarding its osteoinductive, osteoconductive and anti-infective potential with the use of µCT scans, biomechanical testing and histological, as well as microbiological, analysis. Although S53P4 did not lead to a stable union in the non-infected or the infected setting, µCT analysis revealed an osteoinductive effect of S53P4 under non-infected conditions, which was diminished under infected conditions. The osteoconductive effect of S53P4 remained almost negligible in histological analysis, even 8 weeks after treatment. Additionally, the expected anti-infective effect could not be demonstrated. Our data suggested that S53P4 should not be used in infected non-unions, especially in those with large bone defects.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Catharina Rothhaas
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Nadine Titze
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Thorsten Guehring
- Trauma Centre, Hospital Paulinenhilfe Stuttgart at Tübingen University Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany;
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany;
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;
| | - Gerhard Schmidmaier
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany; (H.F.); (J.A.); (C.R.); (N.T.); (P.A.G.)
| | - Lars Helbig
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany;
- Correspondence:
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26
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Maluta T, Lavagnolo U, Segalla L, Elena N, Bernardi P, Degl'Innocenti D, Sbarbati A, Magnan B. Evaluation of biocompatibility, osteointegration and biomechanical properties of the new Calcemex® cement: An <em>in vivo</em> study. Eur J Histochem 2022; 66. [PMID: 35083910 PMCID: PMC8819458 DOI: 10.4081/ejh.2022.3313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022] Open
Abstract
The mixture of polymethylmethacrylate (PMMA) and β-tricalciumphospate (β-TCP) is the most widely used bone graft. Common features of bone cement are the biocompatibility, bioactivity, mechanical stability and ability to fuse with the host's bone tissue. However, there are still few studies that have evaluated these characteristics in vivo. Our study aims to acquire these parameters, using an animal model with functional characteristics similar to those of humans. The analyzed cement is Calcemex®, evaluated both in compact and fluid formulation. The chosen animal models were 5 pigs, treated with femoral and tibial implants of Calcemex® samples. After one year, the pigs were sacrificed and the specimens explanted for morphological, histological, ultrastructural and mechanical evaluations. For both formulations, the investigation highlighted the absence of foreign body reactions in the host, the histological integration with the surrounding tissues and the preservation of mechanical compression resistance.
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Affiliation(s)
- Tommaso Maluta
- Department of Surgery, Orthopaedic and Traumatology Clinic, University of Verona.
| | - Umberto Lavagnolo
- Department of Surgery, Orthopaedic and Traumatology Clinic; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Lydia Segalla
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Nicholas Elena
- Department of Surgery, Orthopaedic and Traumatology Clinic, University of Verona.
| | - Paolo Bernardi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | | | - Andrea Sbarbati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Bruno Magnan
- Department of Surgery, Orthopaedic and Traumatology Clinic, University of Verona.
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27
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Uddin A, Bramall J, Santos D. Phalangeal autologous bone graft for flail digit subluxation: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221103349. [PMID: 35720250 PMCID: PMC9198418 DOI: 10.1177/2050313x221103349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
A 70-year-old patient was referred for a surgical opinion with a flail digit. Flail digit occurs as a result of over resection to the head of the proximal phalanx beyond the surgical neck and proximally into the shaft. The patient was complaining of a symptomatic right fourth digit (pain 7/10 on a Visual Analogue Scale) that had previously undergone two failed hammer toe surgeries resulting in symptomatic plantar hyperkeratosis with no history of ulceration or infection. The patient was surgically managed with autologous bone graft harvested from an adjacent digit biphalangic phalanx. Six months postoperative, the patient presented asymptomatic. Anatomical alignment, digital stabilisation and function were achieved. Full autologous graft consolidation was confirmed radiographically. Favourable patient-reported outcomes using the Manchester–Oxford Foot Questionnaire showed improvement in all domains. Currently, there is no published case study or description utilising our surgical technique to treat flail digit deformity.
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Affiliation(s)
- Akram Uddin
- Essex Partnership University NHS Foundation Trust & Northamptonshire Healthcare NHS Foundation Trust, UK
| | - John Bramall
- Essex Partnership University NHS Foundation Trust, UK
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
- School of Health, University of Gibraltar, Gibraltar, UK
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28
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Majumdar S, Gupta S, Krishnamurthy S. Multifarious applications of bioactive glasses in soft tissue engineering. Biomater Sci 2021; 9:8111-8147. [PMID: 34766608 DOI: 10.1039/d1bm01104a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tissue engineering (TE), a new paradigm in regenerative medicine, repairs and restores the diseased or damaged tissues and eliminates drawbacks associated with autografts and allografts. In this context, many biomaterials have been developed for regenerating tissues and are considered revolutionary in TE due to their flexibility, biocompatibility, and biodegradability. One such well-documented biomaterial is bioactive glasses (BGs), known for their osteoconductive and osteogenic potential and their abundant orthopedic and dental clinical applications. However, in the last few decades, the soft tissue regenerative potential of BGs has demonstrated great promise. Therefore, this review comprehensively covers the biological application of BGs in the repair and regeneration of tissues outside the skeleton system. BGs promote neovascularization, which is crucial to encourage host tissue integration with the implanted construct, making them suitable biomaterial scaffolds for TE. Moreover, they heal acute and chronic wounds and also have been reported to restore the injured superficial intestinal mucosa, aiding in gastroduodenal regeneration. In addition, BGs promote regeneration of the tissues with minimal renewal capacity like the heart and lungs. Besides, the peripheral nerve and musculoskeletal reparative properties of BGs are also reported. These results show promising soft tissue regenerative potential of BGs under preclinical settings without posing significant adverse effects. Albeit, there is limited bench-to-bedside clinical translation of elucidative research on BGs as they require rigorous pharmacological evaluations using standardized animal models for assessing biomolecular downstream pathways.
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Affiliation(s)
- Shreyasi Majumdar
- Neurotherapeutics Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi-221005, India.
| | - Smriti Gupta
- Neurotherapeutics Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi-221005, India.
| | - Sairam Krishnamurthy
- Neurotherapeutics Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi-221005, India.
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Influence of Culture Period on Osteoblast Differentiation of Tissue-Engineered Bone Constructed by Apatite-Fiber Scaffolds Using Radial-Flow Bioreactor. Int J Mol Sci 2021; 22:ijms222313080. [PMID: 34884885 PMCID: PMC8657963 DOI: 10.3390/ijms222313080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 01/17/2023] Open
Abstract
With the limitation of autografts, the development of alternative treatments for bone diseases to alleviate autograft-related complications is highly demanded. In this study, a tissue-engineered bone was formed by culturing rat bone marrow cells (RBMCs) onto porous apatite-fiber scaffolds (AFSs) with three-dimensional (3D) interconnected pores using a radial-flow bioreactor (RFB). Using the optimized flow rate, the effect of different culturing periods on the development of tissue-engineered bone was investigated. The 3D cell culture using RFB was performed for 0, 1 or 2 weeks in a standard medium followed by 0, 1 or 2 weeks in a differentiation medium. Osteoblast differentiation in the tissue-engineered bone was examined by alkaline phosphatase (ALP) and osteocalcin (OC) assays. Furthermore, the tissue-engineered bone was histologically examined by hematoxylin and eosin and alizarin red S stains. We found that the ALP activity and OC content of calcified cells tended to increase with the culture period, and the differentiation of tissue-engineered bone could be controlled by varying the culture period. In addition, the employment of RFB and AFSs provided a favorable 3D environment for cell growth and differentiation. Overall, these results provide valuable insights into the design of tissue-engineered bone for clinical applications.
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Kim HI, Raja N, Choi Y, Kim J, Sung A, Choi YJ, Yun HS, Park H. Selective Detection of an Infection Biomarker by an Osteo-Friend Scaffold: Development of a Multifunctional Artificial Bone Substitute. BIOSENSORS 2021; 11:473. [PMID: 34940230 PMCID: PMC8699388 DOI: 10.3390/bios11120473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Developments in three-dimensional (3D) printing technologies have led to many potential applications in various biomedical fields, especially artificial bone substitutes (ABSs). However, due to the characteristics of artificial materials, biocompatibility and infection remain issues. Here, multifunctional ABSs have been designed to overcome these issues by the inclusion of a biochemical modality that allows simultaneous detection of an infection biomarker by osteo-friend 3D scaffolds. The developed multifunctional scaffolds consist of calcium-deficient hydroxyapatite (CDHA), which has a similar geometric structure and chemical composition to human bone, and gold nanoparticles (Au NPs), which assists osteogenesis and modulates the fluorescence of labels in their microenvironment. The Au NPs were subsequently conjugated with fluorescent dye-labeled probe DNA, which allowed selective interaction with a specific target biomarker, and the fluorescent signal of the dye was temporally quenched by the Au NP-derived Förster resonance energy transfer (FRET). When the probe DNA unfolded to bind to the target biomarker, the fluorescence signal was recovered due to the increased distance between the dye and Au NPs. To demonstrate this sensing mechanism, a microbial oligonucleotide was selected as a target biomarker. Consequently, the multifunctional scaffold simultaneously facilitated osteogenic proliferation and the detection of the infection biomarker.
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Affiliation(s)
- Hye-In Kim
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
| | - Naren Raja
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
| | - Youngjun Choi
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
| | - Jueun Kim
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
- Department of Advanced Materials Engineering, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Korea
| | - Aram Sung
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
| | - Yeong-Jin Choi
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
| | - Hui-suk Yun
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
- Department of Advanced Materials Engineering, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Korea
| | - Honghyun Park
- Department of Advanced Biomaterials Research, Ceramics Materials Division, Korea Institute of Materials Science (KIMS), 797 Changwon-daero, Seongsan-gu, Changwon 51508, Korea; (H.-I.K.); (N.R.); (Y.C.); (J.K.); (A.S.); (Y.-J.C.); (H.-s.Y.)
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Tuleubayev B, Rudenko A. Investigation of Antibiotic Release from Bone Allograft in an Experiment on Rabbits. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The treatment of chronic osteomyelitis, despite the use of new methods, is still an urgent problem. Local use of antibacterial drugs in combination with systemic antibiotic therapy has become popular in recent decades. Autologous bone grafts are considered ideal for bone defects filling. Different methods of allograft preparation may have differences in the rate and duration of antibiotic release. Moreover, it can affect the effectiveness of microbial agent eradication. The study analyzed the differences in the release of gentamicin from different types of allografts in dynamics and methods of preparation: «PerOssal» medium, whole bone allograft soaked in antibiotic, whole bone allograft, welded with an antibiotic, and perforated bone allograft soaked in an antibiotic solution.
AIM: The objective of the study was to study the stability of antibiotic release and to determine the effectiveness of local transport systems. Evaluation of the difference in gentamicin release from different types of allografts in dynamics and methods of preparation had been realized: “PerOssal” medium, whole bone allograft soaked in antibiotic, whole bone allograft welded with an antibiotic, and perforated bone allograft, soaked in antibiotic solution.
MATERIALS AND METHODS: The research was conducted between September 2020 and March 2021. The experiments were performed on 120 laboratory rabbits (weight – 3000–3500 g, age – 6–8 months), which were divided into four groups (30 animals in each group). Group 1 consisted of animals treated with “PerOssal.” The whole bone allograft soaked in an antibiotic was used in the treatment of animals of Group 2. The whole bone allograft, welded with an antibiotic, was used in the treatment of animals of Group 3. Perforated bone allograft soaked in an antibiotic was used in Group 4. Osteomyelitis of the proximal femur was formed in experimental animals.
RESULTS AND DISCUSSION: Statistically insignificant decrease in the concentration of gentamicin was observed by the 7th day in all experimental groups. In rabbits whose bone defect was filled with a whole bone allograft welded with antibiotic and perforated bone allograft impregnated with an antibiotic (Groups 3 and 4), the most stable concentration of gentamicin was noted throughout the study period. Statistically significant differences were revealed between the experimental groups in relation to the dynamics of changes in the concentration of gentamicin in blood plasma. It was found that the group using the biodegradable material “PerOssal” on the 1st day showed a high concentration of the antibiotic in the blood plasma. However, by the 2nd day, a lower concentration of the antibiotic was recorded compared to all comparison groups of the bone allograft.
CONCLUSIONS: The results of the analysis of the dynamics of gentamicin concentration may indicate significant differences between the methods of graft preparation, especially in the relationship with antibiotic release into the blood plasma. The most stable antibiotic concentration was registered in the groups of animals that underwent the filling of bone defect using a whole bone allograft welded with an antibiotic and a perforated bone allograft impregnated with antibiotic. A significant decrease of gentamicin concentration in the femur homogenate by the 7th day after transplantation was observed when using a whole bone allograft impregnated with an antibiotic. At the same time, a stable concentration of the antibiotic in the blood plasma was registered. The highest initial antibiotic concentration in the homogenate with a gradual decrease over 7 days was observed when using the antibiotic-impregnated biodegradable material “PerOssal.”
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de Melo Pereira D, Davison N, Habibović P. Human osteoclast formation and resorptive function on biomineralized collagen. Bioact Mater 2021; 8:241-252. [PMID: 34541399 PMCID: PMC8424427 DOI: 10.1016/j.bioactmat.2021.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022] Open
Abstract
Biomineralized collagen composite materials pose an intriguing alternative to current synthetic bone graft substitutes by offering a biomimetic composition that closely resembles native bone. We hypothesize that this composite can undergo cellular resorption and remodeling similar to natural bone. We investigate the formation and activity of human osteoclasts cultured on biomineralized collagen and pure collagen membranes in comparison to cortical bone slices. Human monocytes/macrophages from peripheral blood differentiate into multinucleated, tartrate-resistant alkaline phosphatase (TRAP)-positive osteoclast-like cells on all substrates. These cells form clear actin rings on cortical bone, but not on biomineralized collagen or pure collagen membranes. Osteoclasts form resorption pits in cortical bone, resulting in higher calcium ion concentration in cell culture medium; however, osteoclast resorption of biomineralized collagen and collagen membranes does not measurably occur. Activity of osteoclast enzymes – TRAP, carbonic anhydrase II (CA-II), and cathepsin-K (CTS-K) – is similar on all substrates, despite phenotypic differences in actin ring formation and resorption. The mesh-like structure, relatively low stiffness, and lack of RGD-containing binding domains are likely the factors responsible for preventing formation of stable actin rings on and resorption of (biomineralized) collagen membranes. This insight helps to guide further research toward the optimized design of biomineralized collagen composites as a more biomimetic bone-graft substitute. Human osteoclasts differentiated on biomineralized collagen, but no resorption occured. Porous surface of fibrillary collagen and lack of RGD ligands to the vitronectin receptor likely prevented osteoclast resorption. Quantification of resorption on uneven surfaces in comparison with bone was possible with 3D laser microscopy.
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Affiliation(s)
- Daniel de Melo Pereira
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Noel Davison
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Pamela Habibović
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER, Maastricht, The Netherlands
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Systemic Administration of PTH Supports Vascularization in Segmental Bone Defects Filled with Ceramic-Based Bone Graft Substitute. Cells 2021; 10:cells10082058. [PMID: 34440827 PMCID: PMC8392660 DOI: 10.3390/cells10082058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 12/19/2022] Open
Abstract
Non-unions continue to present a challenge to trauma surgeons, as current treatment options are limited, duration of treatment is long, and the outcome often unsatisfactory. Additionally, standard treatment with autologous bone grafts is associated with comorbidity at the donor site. Therefore, alternatives to autologous bone grafts and further therapeutic strategies to improve on the outcome and reduce cost for care providers are desirable. In this study in Sprague–Dawley rats we employed a recently established sequential defect model, which provides a platform to test new potential therapeutic strategies on non-unions while gaining mechanistic insight into their actions. The effects of a combinatorial treatment of a bone graft substitute (HACaS+G) implantation and systemic PTH administration was assessed by µ-CT, histological analysis, and bio-mechanical testing and compared to monotreatment and controls. Although neither PTH alone nor the combination of a bone graft substitute and PTH led to the formation of a stable union, our data demonstrate a clear osteoinductive and osteoconductive effect of the bone graft substitute. Additionally, PTH administration was shown to induce vascularization, both as a single adjuvant treatment and in combination with the bone graft substitute. Thus, systemic PTH administration is a potential synergistic co-treatment to bone graft substitutes.
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Vascularization Strategies in Bone Tissue Engineering. Cells 2021; 10:cells10071749. [PMID: 34359919 PMCID: PMC8306064 DOI: 10.3390/cells10071749] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
Bone is a highly vascularized tissue, and its development, maturation, remodeling, and regeneration are dependent on a tight regulation of blood vessel supply. This condition also has to be taken into consideration in the context of the development of artificial tissue substitutes. In classic tissue engineering, bone-forming cells such as primary osteoblasts or mesenchymal stem cells are introduced into suitable scaffolds and implanted in order to treat critical-size bone defects. However, such tissue substitutes are initially avascular. Because of the occurrence of hypoxic conditions, especially in larger tissue substitutes, this leads to the death of the implanted cells. Therefore, it is necessary to devise vascularization strategies aiming at fast and efficient vascularization of implanted artificial tissues. In this review article, we present and discuss the current vascularization strategies in bone tissue engineering. These are based on the use of angiogenic growth factors, the co-implantation of blood vessel forming cells, the ex vivo microfabrication of blood vessels by means of bioprinting, and surgical methods for creating surgically transferable composite tissues.
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Huchital MJ, Saleh A, Patel R, Subik M. Cancelloplasty for Treatment of Osteomyelitis of the Calcaneus: A Novel Technique and Case Report. Foot Ankle Spec 2021; 14:255-265. [PMID: 33272060 DOI: 10.1177/1938640020975885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Calcaneal osteomyelitis has the potential to cause limb- and life-threatening complications. The anatomic and biomechanical attributes of the heel make limb salvage in the setting of bone infection complex. Current treatment options include surgical resection of part or all of the calcaneus, lower extremity amputation, or prolonged intravenous antibiotic usage. Each modality has its own inherent disadvantages. We present a novel surgical technique using antibiotic-impregnated calcium phosphate as an alternative treatment option coupled with ultrasonic bone dissection as a method for enhancing delivery of antibiotics, while mitigating tissue damage and maintaining osseous integrity. The details of the surgical technique are discussed along with a single case example.
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Affiliation(s)
- Michael J Huchital
- North Jersey Reconstructive Foot and Ankle Fellowship, Lyndhurst, New Jersey
| | - Ali Saleh
- Department of Podiatry, Saint Mary's General Hospital, Passaic, New Jersey
| | - Rajan Patel
- North Jersey Reconstructive Foot and Ankle Fellowship, Lyndhurst, New Jersey
| | - Michael Subik
- North Jersey Reconstructive Foot and Ankle Fellowship, Lyndhurst, New Jersey.,Department of Podiatry, Saint Mary's General Hospital, Passaic, New Jersey
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Aveic S, Janßen S, Nasehi R, Seidelmann M, Vogt M, Pantile M, Rütten S, Fischer H. A 3D printed in vitro bone model for the assessment of molecular and cellular cues in metastatic neuroblastoma. Biomater Sci 2021; 9:1716-1727. [PMID: 33428699 DOI: 10.1039/d0bm00921k] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Metastasis is a complex and multifactorial process highly dependent on the interaction between disseminated tumor cells and the pre-metastatic niche. The metastatic sites detected in the bone of patients affected by neuroblastoma (NB), a malignancy of the developing sympathetic nervous system, are particularly aggressive. To improve our current knowledge of metastatic tumor cell biology and improve treatment success, appropriate in vitro and in vivo models that more closely resemble the native metastatic niche are needed. In this study, the impact of the geometry of synthetic β-tricalcium-phosphate (β-TCP) structures on the interaction of NB tumor cells with the stromal component has been examined. The tumor microenvironment is dynamically shaped by the stroma, which sustains the growth of NB cells inside the metastatic niche. The 3D growth conditions are a determining factor for the cell proliferation rate in β-TCP. With respect to planar counterparts, channeled 3D β-TCP structures stimulate more interleukin-6 and Fibronectin production and define Connexin 43 distribution inside the cells. Together, these results highlight how the biomechanical properties of the 3D microenvironment enable tumor cells to form spheroid-shaped arrangements. This, in turn, facilitates their pro-migratory and pro-invasive patterns and mimics the in vivo situation by translating realistic mechanobiological cues to the metastatic NB.
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Affiliation(s)
- Sanja Aveic
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, 52074 Aachen, Germany. and Neuroblastoma Laboratory, Istituto di Ricerca Pediatrica Fondazione Città della Speranza, 35127, Padova, Italy
| | - Simon Janßen
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Ramin Nasehi
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Max Seidelmann
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Michael Vogt
- Interdisciplinary Center for Clinical Research, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Marcella Pantile
- Neuroblastoma Laboratory, Istituto di Ricerca Pediatrica Fondazione Città della Speranza, 35127, Padova, Italy
| | - Stephan Rütten
- Electron Microscopy Facility, Institute of Pathology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Horst Fischer
- Department of Dental Materials and Biomaterials Research, RWTH Aachen University Hospital, 52074 Aachen, Germany.
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Large-Pore Platelet-Rich Fibrin with a Mg Ring to Allow MC3T3-E1 Preosteoblast Migration and to Improve Osteogenic Ability for Bone Defect Repair. Int J Mol Sci 2021; 22:ijms22084022. [PMID: 33919677 PMCID: PMC8070656 DOI: 10.3390/ijms22084022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
Platelet-rich fibrin (PRF) is a natural fibrin meshwork material with multiple functions that are suitable for tissue engineering applications. PRF provides a suitable scaffold for critical-size bone defect treatment due to its platelet cytokines and rich growth factors. However, the structure of PRF not only promotes cell attachment but also, due to its density, provides a pool for cell migration into the PRF to facilitate regeneration. In our study, we used repeated freeze drying to enlarge the pores of PRF to engineer large-pore PRF (LPPRF), a type of PRF that has expanded pores for cell migration. Moreover, a biodegradable Mg ring was used to provide stability to bone defects and the release of Mg ions during degradation may enhance osteoconduction and osteoinduction. Our results revealed that cell migration was more extensive when LPPRF was used rather than when PRF was used and that LPPRF retained the growth factors present in PRF. Moreover, the Mg ions released from the Mg ring during degradation significantly enhanced the calcium deposition of MC3T3-E1 preosteoblasts. In the present study, a bone substitute comprising LPPRF combined with a Mg ring was demonstrated to have much potential for critical-size bone defect repair.
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Bullock G, Atkinson J, Gentile P, Hatton P, Miller C. Osteogenic Peptides and Attachment Methods Determine Tissue Regeneration in Modified Bone Graft Substitutes. J Funct Biomater 2021; 12:22. [PMID: 33807267 PMCID: PMC8103284 DOI: 10.3390/jfb12020022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023] Open
Abstract
The inclusion of biofunctional molecules with synthetic bone graft substitutes has the potential to enhance tissue regeneration during treatment of traumatic bone injuries. The clinical use of growth factors has though been associated with complications, some serious. The use of smaller, active peptides has the potential to overcome these problems and provide a cost-effective, safe route for the manufacture of enhanced bone graft substitutes. This review considers the design of peptide-enhanced bone graft substitutes, and how peptide selection and attachment method determine clinical efficacy. It was determined that covalent attachment may reduce the known risks associated with growth factor-loaded bone graft substitutes, providing a predictable tissue response and greater clinical efficacy. Peptide choice was found to be critical, but even within recognised families of biologically active peptides, the configurations that appeared to most closely mimic the biological molecules involved in natural bone healing processes were most potent. It was concluded that rational, evidence-based design of peptide-enhanced bone graft substitutes offers a pathway to clinical maturity in this highly promising field.
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Affiliation(s)
- George Bullock
- School of Clinical Dentistry, The University of Sheffield, Sheffield S10 2TA, UK; (G.B.); (J.A.); (C.M.)
| | - Joss Atkinson
- School of Clinical Dentistry, The University of Sheffield, Sheffield S10 2TA, UK; (G.B.); (J.A.); (C.M.)
| | - Piergiorgio Gentile
- School of Engineering, Newcastle University, Stephenson Building, Newcastle upon Tyne NE1 7RU, UK;
| | - Paul Hatton
- School of Clinical Dentistry, The University of Sheffield, Sheffield S10 2TA, UK; (G.B.); (J.A.); (C.M.)
| | - Cheryl Miller
- School of Clinical Dentistry, The University of Sheffield, Sheffield S10 2TA, UK; (G.B.); (J.A.); (C.M.)
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de Melo Pereira D, Schumacher M, Habibovic P. Cobalt-containing calcium phosphate induces resorption of biomineralized collagen by human osteoclasts. Biomater Res 2021; 25:6. [PMID: 33743840 PMCID: PMC7981861 DOI: 10.1186/s40824-021-00209-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Biomineralized collagen, consisting of fibrillar type-I collagen with embedded hydroxyapatite mineral, is a bone-mimicking material with potential application as a bone graft substitute. Despite the chemical and structural similarity with bone extracellular matrix, no evidence exists so far that biomineralized collagen can be resorbed by osteoclasts. The aim of the current study was to induce resorption of biomineralized collagen by osteoclasts by a two-fold modification: increasing the calcium phosphate content and introducing cobalt ions (Co2+), which have been previously shown to stimulate resorptive activity of osteoclasts. METHODS To this end, we produced biomineralized collagen membranes and coated them with a cobalt-containing calcium phosphate (CoCaP). Human osteoclasts, derived from CD14+ monocytes from peripheral blood, were differentiated directly on the membranes. Upon fluorescent staining of nuclei, F-actin and tartrate-resistant alkaline phosphatase, the cells were analyzed by laser confocal microscopy. Their resorption capacity was assessed by scanning electron microscopy (SEM), as well as indirectly quantified by measuring the release of calcium ions into cell culture medium. RESULTS The CoCaP coating increased the mineral content of the membranes by 4 wt.% and their elastic modulus from 1 to 10 MPa. The coated membranes showed a sustained Co2+ release in water of about 7 nM per 2 days. In contrast to uncoated membranes, on CoCaP-coated biomineralized collagen membranes, osteoclasts sporadically formed actin rings, and induced formation of resorption lacunae, as observed by SEM and confirmed by increase in Ca2+ concentration in cell culture medium. The effect of the CoCaP layer on osteoclast function is thought to be mainly caused by the increase of membrane stiffness, although the effect of Co2+, which was released in very low amounts, cannot be fully excluded. CONCLUSIONS This work shows the potential of this relatively simple approach to induce osteoclast resorption of biomineralized collagen, although the extent of osteoclast resorption was limited, and the method needs further optimization. Moreover, the coating method is suitable for incorporating bioactive ions of interest into biomineralized collagen, which is typically not possible using the common biomineralization methods, such as polymer-induced liquid precursor method.
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Affiliation(s)
- Daniel de Melo Pereira
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
| | - Matthias Schumacher
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
| | - Pamela Habibovic
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands.
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Svorai Band S, Pantanowitz M, Funk S, Waddington G, Steinberg N. Factors associated with musculoskeletal injuries in an infantry commanders course. PHYSICIAN SPORTSMED 2021; 49:81-91. [PMID: 32511050 DOI: 10.1080/00913847.2020.1780098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the prevalence of injuries among young combat soldiers as assessed and reported by the military physicians, and to investigate whether parameters such as anthropometric measures, postural balance, proprioceptive ability, and chronic ankle instability are related to injuries during and following an infantry commanders course. METHODS In this cross-sectional study, 165 soldiers were tested for anthropometric measurements, proprioceptive ability, and dynamic postural balance (DPB), as well as for their responses to an ankle stability questionnaire (CAIT), on three occasions: pre-course, middle-course, and end-course testing. All musculoskeletal injuries were assessed and recorded in the digital medical file of each participant by specialist military physicians before and during/following the course. RESULTS Ninety-eight soldiers (59.4%) were injured before the course. Forty soldiers (24.2%) incurred an injury during/following the course (with 33 out of the 40 [82.5%] soldiers that were injured during/following the course having also been injured before the course). Sixty soldiers had no injury before/during/following the course. A survival curve showed that half of the soldiers who were injured during/following the course (20 soldiers) were recorded as injured in the first half of the course (during the first 46 days of the 92-day course). Logistic regression showed that the pre-course parameters that were significant among injured soldiers compared with the non-injured soldiers were: low CAIT results (OR = 2.736, 95% CI = 1.178-6.354), high BMI (OR = 1.234, 95% CI = 1.082-1.406) and reduced proprioceptive ability (OR =.858, 95% CI =.797-.924). CONCLUSION With a high prevalence of soldiers injured during and following a commanders course, a somatosensory intervention program should be generalized into the practical daily preparation and training routines of the soldiers for improving somatosensory abilities, optimizing military physical readiness, and for preventing future musculoskeletal injuries.
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Affiliation(s)
| | - Michal Pantanowitz
- Wingate College of Physical Education and Sports Sciences, Wingate Institute , Netanya, Israel
| | - Shany Funk
- Combat Fitness Department, Doctrine and Research Branch, Israel Defense Forces , Israel
| | | | - Nili Steinberg
- Wingate College of Physical Education and Sports Sciences, Wingate Institute , Netanya, Israel
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Nanomedicines accessible in the market for clinical interventions. J Control Release 2021; 330:372-397. [DOI: 10.1016/j.jconrel.2020.12.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
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Ou M, Huang X. Influence of bone formation by composite scaffolds with different proportions of hydroxyapatite and collagen. Dent Mater 2021; 37:e231-e244. [PMID: 33509634 DOI: 10.1016/j.dental.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/14/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
Composite scaffolds with different proportions of hydroxyapatite (HA) and collagen (COL) produced different bone induction results. OBJECTIVE To examine the composite scaffolds with optimal proportion of HA and COL to achieve earlier bone induction and maximum bone formation. METHODS Composite scaffolds with the HA/COL weight ratio of 7:3, 3:7, 5:5 and 9:1 were prepared, as HA powder was added to collagen solution at 130℃ for 48 h. Then, the composites with different proportions of HA/COL were implanted into the extraction socket of right upper central incisor of C57BL/6 J mice. The bone formation of the extraction socket was observed by Hematoxylin-eosin (HE) and Masson-trichrome (Masson) staining at 1 and 2 weeks after operation. Five weeks later, the bone formation of extraction socket was observed by micro computed tomography (micro-CT). After MC3T3-E1 cells were co-cultured with materials of different proportions for 3 days, the number of cells attached on the surface of the materials and entering the materials were counted, and the expression of osteogenic related genes (Runx2, Ocn. Osx and Alp) was detected by reverse transcription polymerase chain reaction (RT-PCR). The composite scaffolds with different proportion of HA/COL with and without mouse bone marrow mesenchymal stem cells (BMMSCs) were implanted into the back of adult mice and cultured subcutaneously for 30 days, and observed histologically by HE and Masson staining. RESULTS After one week implantation with the composite HA/COL scaffolds with the weight ratio of 7:3, 3:7, 5:5 and 9:1, there was no new bone formation in the extraction socket in mouse. However, two weeks later, new bone was firstly observed in the tooth socket with the composite HA/COL scaffolds of 7:3. 5 weeks later, micro-CT scanning showed that the total amount of newly formed bone, trabecular width and bone mineral density of the HA/COL scaffolds of 7:3 were higher than the other HA/COL scaffolds (P < 0.05). After MC3T3-E1 cells were co-cultured with different composite HA/COL scaffolds for 3 days. The number of cells on the surface and inside of the HA/COL scaffolds of 7:3 was more than the other materials, and the difference was statistically significant (P < 0.05). The expression levels of Ocn and Osx of MC3T3-E1 cells were also the highest in the HA/COL scaffolds of 7:3 (P < 0.01). Bone formation was observed in the composite HA/COL scaffold of 7:3 with BMMSCs subcutaneously in mouse for 30 days, while only osteoid formation was observed in the same scaffold without BMMSCs. but bone formation was not detected in the other proportions of the HA/COL scaffolds. SIGNIFICANCE Compared with other proportions of HA/COL, the composite HA/COL scaffolds of 7:3 has stronger ability to promote bone formation, recruit osteoblasts to attach and enter into the scaffolds, and promote the osteogenesis of BMMSCs.
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Affiliation(s)
- Mingming Ou
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Huang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Steinhausen E, Lefering R, Glombitza M, Brinkmann N, Vogel C, Mester B, Dudda M. Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience. J Bone Jt Infect 2021; 6:73-83. [PMID: 34084694 PMCID: PMC8132459 DOI: 10.5194/jbji-6-73-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction:
The goals of osteomyelitis therapy are successful control of infection and
reconstruction of the bone. The gold standard for filling defects is the
autologous bone graft. Bioactive glass S53P4 is an inorganic bone
substitute. We compared the outcome of using bioactive glass (BAG) versus
autologous bone graft (AB) in patients with infected non-union.
Methods:
Patients with chronic osteomyelitis and infected non-union who received
either bioactive glass or autologous bone grafts between 2013 and 2017 were
analyzed retrospectively. The primary endpoint was successful control of
infection during follow-up. Secondary endpoints were bone healing,
functional outcome, and occurrence of complications.
Results:
Eighty-three patients were analyzed (BAG n=51, AB n=32). Twenty-one
patients experienced reinfection (BAG n=15, 29 %; AB n=6, 19 %).
Seventy-eight patients achieved full weight bearing (BAG n=47, 92 %; AB
n=31, 97 %). Sixty-four patients had complete bone healing at the end of
the follow-up period (BAG n=39, 77 %; AB n=25, 78 %). There were no
significant differences between the groups with respect to the primary or
secondary endpoints. Patients with multidrug-resistant pathogens had a
significantly higher rate of incomplete bone healing (p=0.033) and a 3-fold
higher risk of complications in both groups.
Conclusions:
Bioactive glass appears to be a suitable bone substitute not only for
successful control of infection and defect filling but also for bone healing
in cases of infected non-union. In our study, bioactive glass was neither
superior nor inferior to autologous bone graft with regard to the primary
and secondary endpoints. Further studies with larger numbers of patients are
required.
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Affiliation(s)
- Eva Steinhausen
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Martin Glombitza
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Nikolaus Brinkmann
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Carsten Vogel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian Mester
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marcel Dudda
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Sánchez Lázaro JA, Fernández Hernández Ó, Madera González F. Arthroscopic Contribution of Synthetic Graft in Tibiotalocalcaneal Arthroscopic Fusions. Cureus 2020; 12:e12334. [PMID: 33403192 PMCID: PMC7773308 DOI: 10.7759/cureus.12334] [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] [Indexed: 11/05/2022] Open
Abstract
Nonunion is a frequent complication of tibiotalocalcaneal arthrodesis. The risk of nonunion increases significantly for those patients with systemic comorbidities and smokers. The purpose of this article is to show the proper way to supplement our arthroscopic fusion surgeries with biomaterial (peptide-15) graft. We have achieved an increase in consolidation rates in complex patient cases. We can conclude that this is a simple and reproducible technique.
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Affiliation(s)
- Jaime A Sánchez Lázaro
- Orthopedics and Traumatology, Complejo Asistencial Universitario de León, León, ESP.,Orthopedics and Traumatology, Integrated Biomedical Engineering & Health Sciences, León, ESP.,Surgery, Universidad de Salamanca, León, ESP
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Manipulating Air-Gap Electrospinning to Create Aligned Polymer Nanofiber-Wrapped Glass Microfibers for Cortical Bone Tissue Engineering. Bioengineering (Basel) 2020; 7:bioengineering7040165. [PMID: 33419239 PMCID: PMC7766430 DOI: 10.3390/bioengineering7040165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
Osteons are the repeating unit throughout cortical bone, consisting of canals filled with blood and nerve vessels surrounded by concentric lamella of hydroxyapatite-containing collagen fibers, providing mechanical strength. Creating a biodegradable scaffold that mimics the osteon structure is crucial for optimizing cellular infiltration and ultimately the replacement of the scaffold with native cortical bone. In this study, a modified air-gap electrospinning setup was exploited to continuously wrap highly aligned polycaprolactone polymer nanofibers around individual 1393 bioactive glass microfibers, resulting in a synthetic structure similar to osteons. By varying the parameters of the device, scaffolds with polymer fibers wrapped at angles between 5-20° to the glass fiber were chosen. The scaffold indicated increased cell migration by demonstrating unidirectional cell orientation along the fibers, similar to recent work regarding aligned nerve and muscle regeneration. The wrapping decreased the porosity from 90% to 80%, which was sufficient for glass conversion through ion exchange validated by inductively coupled plasma. Scaffold degradation was not cytotoxic. Encapsulating the glass with polymer nanofibers caused viscoelastic deformation during three-point bending, preventing typical brittle glass fracture, while maintaining cell migration. This scaffold design structurally mimics the osteon, with the intent to replace its material compositions for better regeneration.
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Simpson CR, Kelly HM, Murphy CM. Synergistic use of biomaterials and licensed therapeutics to manipulate bone remodelling and promote non-union fracture repair. Adv Drug Deliv Rev 2020; 160:212-233. [PMID: 33122088 DOI: 10.1016/j.addr.2020.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022]
Abstract
Disrupted bone metabolism can lead to delayed fracture healing or non-union, often requiring intervention to correct. Although the current clinical gold standard bone graft implants and commercial bone graft substitutes are effective, they possess inherent drawbacks and are limited in their therapeutic capacity for delayed union and non-union repair. Research into advanced biomaterials and therapeutic biomolecules has shown great potential for driving bone regeneration, although few have achieved commercial success or clinical translation. There are a number of therapeutics, which influence bone remodelling, currently licensed for clinical use. Providing an alternative local delivery context for these therapies, can enhance their efficacy and is an emerging trend in bone regenerative therapeutic strategies. This review aims to provide an overview of how biomaterial design has advanced from currently available commercial bone graft substitutes to accommodate previously licensed therapeutics that target local bone restoration and healing in a synergistic manner, and the challenges faced in progressing this research towards clinical reality.
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Affiliation(s)
- Christopher R Simpson
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Helena M Kelly
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Ciara M Murphy
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland.
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de Melo Pereira D, Eischen-Loges M, Birgani ZT, Habibovic P. Proliferation and Osteogenic Differentiation of hMSCs on Biomineralized Collagen. Front Bioeng Biotechnol 2020; 8:554565. [PMID: 33195119 PMCID: PMC7644787 DOI: 10.3389/fbioe.2020.554565] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/05/2020] [Indexed: 01/12/2023] Open
Abstract
Biomineralized collagen with intrafibrillar calcium phosphate mineral provides an excellent mimic of the composition and structure of the extracellular matrix of bone, from nano- to micro-scale. Scaffolds prepared from this material have the potential to become the next-generation of synthetic bone graft substitutes, as their unique properties make them closer to the native tissue than synthetic alternatives currently available to clinicians. To understand the interaction between biomineralized collagen and cells that are relevant in the context of bone regeneration, we studied the growth and osteogenic differentiation of bone marrow derived human mesenchymal stromal cells (hMSCs) cultured on biomineralized collagen membranes, and compared it to the cell behavior on collagen membranes without mineral. Cells proliferated normally on both biomimetic membranes, and were more triggered to differentiate toward the osteogenic lineage by the biomineralized collagen. This was shown by the elevated mRNA levels of RUNX2, SPP1, ENPP1, and OCN after 3 days of culture, and COL1A1 after 14 days of culture on mineralized collagen. The mRNA levels of the tested markers of osteogenesis were lower on collagen membranes without mineral, with the exception of OCN, which was more highly expressed on collagen than on biomineralized collagen membranes. Expression by hMSCs of OPG, a gene involved in inhibition of osteoclastogenesis, was higher on biomineralized collagen at day 3, while M-CSF, involved in osteoblast-osteoclast communication, was upregulated on both membranes at day 3 and 14 of culture. Alkaline phosphatase activity of hMSCs was high on both biomimetic membranes when compared with cells cultured on tissue culture plastic. Cell-induced mineralization was observed on collagen membranes, while the high mineral content of the biomineralized membranes prohibited a reliable analysis of cell-induced mineralization on these membranes. In conclusion, we have identified that both collagen and biomineralized collagen support proliferation, osteogenic differentiation and mineralization of hMSCs, with biomineralized membranes having a more pronounced positive effect. These findings support the existing evidence that biomineralized collagen is a promising material in the field of bone regeneration.
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Affiliation(s)
| | | | | | - Pamela Habibovic
- Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
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Increasing Fusion Rate Between 1 and 2 Years After Instrumented Posterolateral Spinal Fusion and the Role of Bone Grafting. Spine (Phila Pa 1976) 2020; 45:1403-1410. [PMID: 32459724 PMCID: PMC7515483 DOI: 10.1097/brs.0000000000003558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Two-year clinical and radiographic follow-up of a double-blind, multicenter, randomized, intra-patient controlled, non-inferiority trial comparing a bone graft substitute (AttraX Putty) with autograft in instrumented posterolateral fusion (PLF) surgery. OBJECTIVES The aim of this study was to compare PLF rates between 1 and 2 years of follow-up and between graft types, and to explore the role of bone grafting based on the location of the PLF mass. SUMMARY OF BACKGROUND DATA There are indications that bony fusion proceeds over time, but it is unknown to what extent this can be related to bone grafting. METHODS A total of 100 adult patients underwent a primary, single- or multilevel, thoracolumbar PLF. After instrumentation and preparation for grafting, the randomized allocation side of AttraX Putty was disclosed. The contralateral posterolateral gutters were grafted with autograft. At 1-year follow-up, and in case of no fusion at 2 years, the fusion status of both sides of each segment was blindly assessed on CT scans. Intertransverse and facet fusion were scored separately. Difference in fusion rates after 1 and 2 years and between grafts were analyzed with a Generalized Estimating Equations (GEE) model (P < 0.05). RESULTS The 2-year PLF rate (66 patients) was 70% at the AttraX Putty and 68% at the autograft side, compared to 55% and 52% after 1 year (87 patients). GEE analysis demonstrated a significant increase for both conditions (odds ratio 2.0, 95% confidence interval 1.5-2.7, P < 0.001), but no difference between the grafts (P = 0.595). Ongoing bone formation was only observed between the facet joints. CONCLUSION This intra-patient controlled trial demonstrated a significant increase in PLF rate between 1 and 2 years after instrumented thoracolumbar fusion, but no difference between AttraX Putty and autograft. Based on the location of the PLF mass, this increase is most likely the result of immobilization instead of grafting. LEVEL OF EVIDENCE 1.
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Kim KT, Kim KG, Choi UY, Lim SH, Kim YJ, Sohn S, Sheen SH, Heo CY, Han I. Safety and Tolerability of Stromal Vascular Fraction Combined with β-Tricalcium Phosphate in Posterior Lumbar Interbody Fusion: Phase I Clinical Trial. Cells 2020; 9:cells9102250. [PMID: 33049918 PMCID: PMC7600447 DOI: 10.3390/cells9102250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
The rates of pseudarthrosis remain high despite recent advances in bone graft substitutes for spinal fusion surgery. The aim of this single center, non-randomized, open-label clinical trial was to determine the feasibility of combined use of stromal vascular fraction (SVF) and β-tricalcium phosphate (β-TCP) for patients who require posterior lumbar interbody fusion (PLIF) and pedicle screw fixation. Two polyetheretherketone (PEEK) cages were inserted into the intervertebral space following complete removal of the intervertebral disc. The PEEK cage (SVF group) on the right side of the patient was filled with β-TCP in combination with SVF, and the cage on the left side (control group) was filled with β-TCP alone. Fusion rate and cage subsidence were assessed by lumbar spine X-ray and CT at 6 and 12 months postoperatively. At the 6-month follow-up, 54.5% of the SVF group (right-sided cages) and 18.2% of the control group (left-sided cages) had radiologic evidence of bone fusion (p = 0.151). The 12-month fusion rate of the right-sided cages was 100%, while that of the left-sided cages was 91.6% (p = 0.755). Cage subsidence was not observed. Perioperative combined use of SVF with β-TCP is feasible and safe in patients who require spinal fusion surgery, and it has the potential to increase the early bone fusion rate following spinal fusion surgery.
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Affiliation(s)
- Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu 41566, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, College of Medicine, Gachon University, Seongnam-si 13120, Korea; (K.G.K.); (S.H.L.); (Y.J.K.)
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Seongnam-si 13120, Korea
| | - Un Yong Choi
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Korea; (U.Y.C.); (S.S.); (S.H.S.)
| | - Sang Heon Lim
- Department of Biomedical Engineering, College of Medicine, Gachon University, Seongnam-si 13120, Korea; (K.G.K.); (S.H.L.); (Y.J.K.)
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Seongnam-si 13120, Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, College of Medicine, Gachon University, Seongnam-si 13120, Korea; (K.G.K.); (S.H.L.); (Y.J.K.)
| | - Seil Sohn
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Korea; (U.Y.C.); (S.S.); (S.H.S.)
| | - Seung Hun Sheen
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Korea; (U.Y.C.); (S.S.); (S.H.S.)
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea;
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Korea; (U.Y.C.); (S.S.); (S.H.S.)
- Correspondence:
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Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155624. [PMID: 32759871 PMCID: PMC7432051 DOI: 10.3390/ijerph17155624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 01/13/2023]
Abstract
Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.
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