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Wagener N, Pumberger M, Hardt S. Impact of fixation method on femoral bone loss: a retrospective evaluation of stem loosening in first-time revision total hip arthroplasty among two hundred and fifty five patients. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06230-4. [PMID: 38822836 DOI: 10.1007/s00264-024-06230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE Implant loosening represent the most common indication for stem revision in hip revision arthroplasty. This study compares femoral bone loss and the risk of initial revisions between cemented and uncemented loosened primary stems, investigating the impact of fixation method at primary implantation on femoral bone defects. METHODS This retrospective study reviewed 255 patients who underwent their first revision for stem loosening from 2010 to 2022, receiving either cemented or uncemented stem implants. Femoral bone loss was preoperatively measured using the Paprosky classification through radiographic evaluations. Kaplan-Meier analysis estimated the survival probability of the original stem, and the hazard ratio assessed the relative risk of revision for uncemented versus cemented stems in the first postoperative year and the following two to ten years. RESULTS Cemented stems showed a higher prevalence of significant bone loss (type 3b and 4 defects: 32.39% vs. 2.72%, p < .001) compared to uncemented stems, which more commonly had type 1 and 2 defects (82.07% vs. 47.89%, p < .001). In our analysis of revision cases, primary uncemented stems demonstrated a 20% lower incidence of stem loosening in the first year post-implantation compared to cemented stems (HR 0.8; 95%-CI 0.3-2.0). However, the incidence in uncemented stems increased by 20% during the subsequent years two to ten (HR 1.2; 95%-CI 0.7-1.8). Septic loosening was more common in cemented stems (28.17% vs. 10.87% in uncemented stems, p = .001). Kaplan-Meier analysis indicated a modestly longer revision-free period for cemented stems within the first ten years post-implantation (p < .022). CONCLUSION During first-time revision, cemented stems show significantly larger femoral bone defects than uncemented stems. Septic stem loosening occurred 17.30% more in cemented stems.
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Affiliation(s)
- Nele Wagener
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Fiedler B, Bieganowski T, Singh V, Marwin S, Rozell JC, Schwarzkopf R. Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty. J Knee Surg 2024; 37:297-302. [PMID: 37142239 DOI: 10.1055/a-2086-4820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Intramedullary stems are often required in patients undergoing revision total knee arthroplasty (rTKA) to achieve stable fixation. Significant bone loss may require the addition of a metal cone to maximize fixation and osteointegration. The purpose of this study was to investigate clinical outcomes in rTKA using different fixation techniques. We conducted a single-institution retrospective review of all patients who received a tibial and femoral stem during rTKA between August 2011 and July 2021. Patients were separated into three cohorts based on fixation construct: press-fit stem with an offset coupler (OS), fully cemented straight (CS) stem, and press-fit straight (PFS) stem. A subanalysis of patients who received tibial cone augmentation was also conducted. A total of 358 patients who underwent rTKA were included in this study, of which 102 (28.5%) had a minimum 2-year follow-up and 25 (7.0%) had a minimum 5-year follow-up. In the primary analysis, 194 patients were included in the OS cohort, 72 in the CS cohort, and 92 in the PFS cohort. When stem type alone was considered, there was no significant difference in rerevision rate (p = 0.431) between cohorts. Subanalysis of patients who received augmentation with a tibial cone demonstrated that OS implants led to significantly higher rates of rerevision compared with the other two stem types (OS: 18.2% vs. CS: 2.1% vs. PFS: 11.1%; p = 0.037). The findings of the present analysis demonstrate that CS and cones in rTKA may provide more reliable long-term outcomes compared with press-fit stems with OS. LEVEL III EVIDENCE: Retrospective Cohort Study.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Scott Marwin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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3
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Wilson BJ, Owston HE, Iqbal N, Giannoudis PV, McGonagle D, Pandit H, Philipose Pampadykandathil L, Jones E, Ganguly P. In Vitro Osteogenesis Study of Shell Nacre Cement with Older and Young Donor Bone Marrow Mesenchymal Stem/Stromal Cells. Bioengineering (Basel) 2024; 11:143. [PMID: 38391629 PMCID: PMC10886325 DOI: 10.3390/bioengineering11020143] [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: 11/18/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Bone void-filling cements are one of the preferred materials for managing irregular bone voids, particularly in the geriatric population who undergo many orthopedic surgeries. However, bone marrow mesenchymal stem/stromal cells (BM-MSCs) of older-age donors often exhibit reduced osteogenic capacity. Hence, it is crucial to evaluate candidate bone substitute materials with BM-MSCs from the geriatric population to determine the true osteogenic potential, thus simulating the clinical situation. With this concept, we investigated the osteogenic potential of shell nacre cement (SNC), a bone void-filling cement based on shell nacre powder and ladder-structured siloxane methacrylate, using older donor BM-MSCs (age > 55 years) and young donor BM-MSCs (age < 30 years). Direct and indirect cytotoxicity studies conducted with human BM-MSCs confirmed the non-cytotoxic nature of SNC. The standard colony-forming unit-fibroblast (CFU-F) assay and population doubling (PD) time assays revealed a significant reduction in the proliferation potential (p < 0.0001, p < 0.05) in older donor BM-MSCs compared to young donor BM-MSCs. Correspondingly, older donor BM-MSCs contained higher proportions of senescent, β-galactosidase (SA-β gal)-positive cells (nearly 2-fold, p < 0.001). In contrast, the proliferation capacity of older donor BM-MSCs, measured as the area density of CellTrackerTM green positive cells, was similar to that of young donor BM-MSCs following a 7-day culture on SNC. Furthermore, after 14 days of osteoinduction on SNC, scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS) showed that the amount of calcium and phosphorus deposited by young and older donor BM-MSCs on SNC was comparable. A similar trend was observed in the expression of the osteogenesis-related genes BMP2, RUNX2, ALP, COL1A1, OMD and SPARC. Overall, the results of this study indicated that SNC would be a promising candidate for managing bone voids in all age groups.
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Affiliation(s)
- Bridget Jeyatha Wilson
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Heather Elizabeth Owston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
| | - Neelam Iqbal
- School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Peter V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
- Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Lizymol Philipose Pampadykandathil
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
| | - Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
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Humez M, Domann E, Thormann KM, Fölsch C, Strathausen R, Vogt S, Alt V, Kühn KD. Daptomycin-Impregnated PMMA Cement against Vancomycin-Resistant Germs: Dosage, Handling, Elution, Mechanical Stability, and Effectiveness. Antibiotics (Basel) 2023; 12:1567. [PMID: 37998769 PMCID: PMC10668807 DOI: 10.3390/antibiotics12111567] [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: 10/09/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The number of periprosthetic joint infections caused by vancomycin-resistant pathogens is increasing. Currently, no PMMA cement is commercially available to cover VRE. Daptomycin shows promising results in treating infection, offering a good safety profile and a reduced risk of developing resistance. The purpose of this in vitro study was to investigate the mechanical stability, handling properties, elution behavior, and antimicrobial effectiveness of PMMA cement loaded with three different daptomycin concentrations in comparison to commercially available antibiotic-loaded bone cement (ALBC). METHODS Mechanical properties and handling characteristics (ISO 5833, DIN 53435), HPLC elution, antimicrobial effectiveness with proliferation assay (DIN 17025), and inhibition zone testing were investigated. RESULTS All tested daptomycin concentrations met the ISO and DIN standards for mechanical strength. Loading of 40 g of PMMA cement with 0.5 g of daptomycin did not show any antimicrobial effectiveness, in contrast to 1.0 g and 1.5 g. PMMA cement with 1.5 g of daptomycin was the best in terms of elution and effectiveness, and it showed good ISO mechanical strength; ISO doughing was sticky for a little longer and setting was faster compared to the vancomycin-containing reference cement. CONCLUSION PMMA cement containing 0.5 g of gentamicin and 1.5 g of daptomycin could be a good alternative to the already established COPAL® (Wehrheim, Germany) G+V for the treatment of PJIs caused by VRE.
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Affiliation(s)
- Martina Humez
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstrasse 81, 35392 Giessen, Germany; (E.D.); (K.M.T.)
- Heraeus Medical GmbH, Philipp-Reis-Str. 8-13, 61273 Wehrheim, Germany; (R.S.); (S.V.)
| | - Eugen Domann
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstrasse 81, 35392 Giessen, Germany; (E.D.); (K.M.T.)
| | - Kai M. Thormann
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstrasse 81, 35392 Giessen, Germany; (E.D.); (K.M.T.)
- Institute of Microbiology and Molecular Biology, Justus-Liebig-Universität Giessen, Heinrich-Buff-Ring 26, 35392 Giessen, Germany
| | - Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Rainer Strathausen
- Heraeus Medical GmbH, Philipp-Reis-Str. 8-13, 61273 Wehrheim, Germany; (R.S.); (S.V.)
| | - Sebastian Vogt
- Heraeus Medical GmbH, Philipp-Reis-Str. 8-13, 61273 Wehrheim, Germany; (R.S.); (S.V.)
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre, Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany;
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Balgazarov S, Belokobylov A, Batpen A, Ramazanov Z, Dolgov A, Rimashevskiy D, Kriklivyy A. The First Stage of Knee Revision Arthroplasty in Periprosthetic Infection with Replacement of a Large Defect Double Cementing Method: A Case Report. Int Med Case Rep J 2023; 16:513-520. [PMID: 37701537 PMCID: PMC10493111 DOI: 10.2147/imcrj.s420109] [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: 05/12/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
Aim Large bone defects in patients with chronic deep periprosthetic knee infection is a major problem. It is widely accepted that bone defects filling with polymethylmethacrylate (PMMA) cement could be used only in selected cases of small bone defects (up to 5 mm) and less than 50% of articular surface due to multiple reasons: risk of thermal bone damage, inadequate cement pressurization and bone cement shrinkage, etc. Staged cementing for preventing bone heating and over negative effects of cementing on a thick layer of bone cement has limited support in the literature. Case Presentation We present the case of 4.5 years follow up after temporary-permanent spacer implantation in a 63-year-old male with chronic deep knee PJI and tibial AORI type 3 bone defect reconstructed via double cementing method. Results Method of double (staged) cementing used for reconstruction of epiphyseal tibial bone defect in a patient with fistula form of knee PJI shows excellent clinical results at 4.5 years follow up.
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Affiliation(s)
- Serik Balgazarov
- Department of Trauma Consequences and Combustiology, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Alexey Belokobylov
- Republican Center for Endoprosthetics, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Arman Batpen
- National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Zhanatai Ramazanov
- Department of Trauma Consequences and Combustiology, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Alexey Dolgov
- Postgraduate Education Department, National Scientific Center of Traumatology and Orthopedics Named after Academician N.D. Batpenov, Astana, Republic of Kazakhstan
| | - Denis Rimashevskiy
- Peoples Friendship University of Russia, Trauma and Orthopedic Department, Moscow, Russia
| | - Alexandr Kriklivyy
- Institute of Life Sciences, Karaganda Medical University, Karaganda, Republic of Kazakhstan
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Buss LF, de Martin GS, Martinez EF, Filgueiras IADAAP, Magnabosco JL, Alves BF, de Macedo Almeida B, Kotaka T, Teixeira ML, Ferreira JRM, da Rocha DN, Canal R, Aloise AC, Holliday LS, Pelegrine AA. Conditioned Media from Human Pulp Stem Cell Cultures Improve Bone Regeneration in Rat Calvarial Critical-Size Defects. J Funct Biomater 2023; 14:396. [PMID: 37623641 PMCID: PMC10455841 DOI: 10.3390/jfb14080396] [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: 07/07/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The aim of this study was to test whether lyophilized conditioned media from human dental pulp mesenchymal stem cell cultures promote the healing of critical-size defects created in the calvaria of rats. Prior to the surgical procedure, the medium in which dental pulp stem cells were cultured was frozen and lyophilized. After general anesthesia, an 8 mm diameter bone defect was created in the calvaria of twenty-four rats. The defects were filled with the following materials: xenograft alone (G1) or xenograft associated with lyophilized conditioned medium (G2). After 14 or 42 days, the animals were euthanized, and the specimens processed for histologic and immunohistochemical analysis. Bone formation at the center of the defect was observed only in the G2 at 42 days. At both timepoints, increased staining for VEGF, a marker for angiogenesis, was observed in G2. Consistent with this, at 14 days, G2 also had a higher number of blood vessels detected by immunostaining with an anti-CD34 antibody. In conclusion, conditioned media from human dental pulp mesenchymal stem cell cultures had a positive effect on the regenerative process in rat critical-size bone defects. Both the formation of bone and enhancement of vascularization were stimulated by the conditioned media.
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Affiliation(s)
- Leonardo Fernandes Buss
- Faculdade de Odontologia São Leopoldo Mandic, Campinas 13045-755, SP, Brazil; (L.F.B.); (G.S.d.M.); (I.A.d.A.A.P.F.); (J.L.M.); (B.F.A.); (B.d.M.A.); (T.K.)
| | - Gustavo Sigrist de Martin
- Faculdade de Odontologia São Leopoldo Mandic, Campinas 13045-755, SP, Brazil; (L.F.B.); (G.S.d.M.); (I.A.d.A.A.P.F.); (J.L.M.); (B.F.A.); (B.d.M.A.); (T.K.)
| | | | | | - José Luiz Magnabosco
- Faculdade de Odontologia São Leopoldo Mandic, Campinas 13045-755, SP, Brazil; (L.F.B.); (G.S.d.M.); (I.A.d.A.A.P.F.); (J.L.M.); (B.F.A.); (B.d.M.A.); (T.K.)
| | - Bruno Frenhan Alves
- Faculdade de Odontologia São Leopoldo Mandic, Campinas 13045-755, SP, Brazil; (L.F.B.); (G.S.d.M.); (I.A.d.A.A.P.F.); (J.L.M.); (B.F.A.); (B.d.M.A.); (T.K.)
| | - Bruno de Macedo Almeida
- Faculdade de Odontologia São Leopoldo Mandic, Campinas 13045-755, SP, Brazil; (L.F.B.); (G.S.d.M.); (I.A.d.A.A.P.F.); (J.L.M.); (B.F.A.); (B.d.M.A.); (T.K.)
| | - Tatiana Kotaka
- Faculdade de Odontologia São Leopoldo Mandic, Campinas 13045-755, SP, Brazil; (L.F.B.); (G.S.d.M.); (I.A.d.A.A.P.F.); (J.L.M.); (B.F.A.); (B.d.M.A.); (T.K.)
| | | | | | | | | | - Antonio Carlos Aloise
- Division of Oral Implantology, Faculdade São Leopoldo Mandic, Campinas 13045-755, SP, Brazil;
| | | | - André Antonio Pelegrine
- Division of Oral Implantology, Faculdade São Leopoldo Mandic, Campinas 13045-755, SP, Brazil;
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Wilson BJ, Philipose Pampadykandathil L. Novel Bone Void Filling Cement Compositions Based on Shell Nacre and Siloxane Methacrylate Resin: Development and Characterization. Bioengineering (Basel) 2023; 10:752. [PMID: 37508779 PMCID: PMC10376770 DOI: 10.3390/bioengineering10070752] [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: 04/03/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Shell nacre from Pinctada species has been extensively researched for managing bone defects. However, there is a gap in the research regarding using shell nacre powder as a cement with improved biological and physicochemical properties. To address this, bone void filling cement was formulated by incorporating shell nacre powder and an organically modified ceramic resin (ormocer). The shell nacre powder was specifically processed from the shells of Pinctada fucata and analysed using thermogravimetric analysis (TGA), X-ray diffraction spectroscopy, Fourier transform infrared (FTIR), and Raman spectroscopy, confirming the presence of organic constituents and inorganic aragonite. Trace element analysis confirmed the eligibility of shell nacre powder for biomedical applications. Next, the ormocer SNLSM2 was synthesized through a modified sol-gel method. FTIR, Raman, TGA, and transmission electron microscopy studies revealed the presence of a ladder-structured siloxane backbone and methacrylate side chain. To develop chemical curable composite shell nacre cement (SNC), different amounts of shell nacre (24%, 48%, and 72%) were added to the SNLSM2 resin, and the impact on the physicochemical properties of the cement was studied. Among the compositions, SNC 72 exhibited significantly lower linear polymerization shrinkage (0.4%) and higher compressive (>100 MPa) and flexural strength (>35 MPa). SNC 72 was radiopaque, and the exotherm generated during the cement curing was minimal. Cytotoxicity studies with L929 cells revealed the non-cytotoxic nature of the cement. Overall, the findings of this study prove that the shell nacre cement is a promising candidate for managing bone voids.
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Affiliation(s)
- Bridget Jeyatha Wilson
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Lizymol Philipose Pampadykandathil
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
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8
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Khan MW, Rajput IM, Qamar J, Qureshi A. Biological Reconstruction of Posteromedial Tibial Defect with Autogenous Bone Graft in Complex Knee Arthroplasty. Indian J Orthop 2023; 57:856-862. [PMID: 37214374 PMCID: PMC10192472 DOI: 10.1007/s43465-023-00857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/22/2023] [Indexed: 05/24/2023]
Abstract
Purpose We conducted this study to examine the clinical outcomes of primary total knee arthroplasty (TKA) with autogenous bone graft for a tibial bony defect with a minimum follow-up of 12 months. Methods A total of 21 individuals underwent primary TKA with autogenous on-lay bone grafting (ABG) for restoration of posteromedial tibial deformities between January 2016 and November 2021. The patients were clinically assessed using the knee society score (KSS), varus score, and range of motion (ROM) preoperatively and postoperatively to compare using a single sample t test. Postoperative complications were also considered. Results KSS before and after surgery was reported to be statistically significant [mean difference = -55.32 (6.81); P < 0.001]. The mean KSS before surgery was 21.14 (7.03) while improved to the mean KSS after surgery of 76.45 (3.05). ROM score before and after surgery was reported to be statistically significant [mean difference = -30.45 (8.99); P < 0.001]. The mean ROM before surgery was 75.45 (6.71) while the improved mean ROM after surgery of 105.91 (5.03). Varus score before and after surgery was reported to be statistically significant [mean difference = 18.45 (3.75); P < 0.001]. Conclusion The mechanical axis and stability of the knee were effectively restored, with significant differences in preoperative and postoperative results, indicating that this technique is a reasonable and versatile option when reconstructing moderate-to-severe bone loss in TKA. Graphical Abstract
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Affiliation(s)
- Muhammad Waqas Khan
- Orthopedic Department, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Irfan Muhammad Rajput
- Orthopedic Department, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Javeria Qamar
- Dow Medical, University of Health Sciences, Karachi, Pakistan
| | - Aurangzeb Qureshi
- Orthopedic Department, Niazi Medical and Dental College, Lahore Road, Sargodha, Pakistan
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Sheng X, Li C, Wang Z, Xu Y, Sun Y, Zhang W, Liu H, Wang J. Advanced applications of strontium-containing biomaterials in bone tissue engineering. Mater Today Bio 2023; 20:100636. [PMID: 37441138 PMCID: PMC10333686 DOI: 10.1016/j.mtbio.2023.100636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 07/15/2023] Open
Abstract
Strontium (Sr) and strontium ranelate (SR) are commonly used therapeutic drugs for patients suffering from osteoporosis. Researches have showed that Sr can significantly improve the biological activity and physicochemical properties of materials in vitro and in vivo. Therefore, a large number of strontium containing biomaterials have been developed for repairing bone defects and promoting osseointegration. In this review, we provide a comprehensive overview of Sr-containing biomaterials along with the current state of their clinical use. For this purpose, the different types of biomaterials including calcium phosphate, bioactive glass, and polymers are discussed and provided future outlook on the fabrication of the next-generation multifunctional and smart biomaterials.
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Bieganowski T, Buchalter DB, Singh V, Mercuri JJ, Aggarwal VK, Rozell JC, Schwarzkopf R. Bone loss in aseptic revision total knee arthroplasty: management and outcomes. Knee Surg Relat Res 2022; 34:30. [PMID: 35725586 PMCID: PMC9208118 DOI: 10.1186/s43019-022-00158-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Although several techniques and implants have been developed to address bone loss in revision total knee arthroplasty (rTKA), management of these defects remains challenging. This review article discusses the indications and management options of bone loss following total knee arthroplasty based on preoperative workup and intraoperative findings. Main text Various imaging modalities are available that can be augmented with intraoperative examination to provide a clear classification of a bony defect. For this reason, the Anderson Orthopaedic Research Institute (AORI) classification is frequently used to guide treatment. The AORI provides a reliable system by which surgeons can classify lesions based on their size and involvement of surrounding structures. AORI type I defects are managed with cement with or without screws as well as impaction bone grafting. For AORI type IIA lesions, wedge or block augmentation is available. For large defects encompassing AORI type IIB and type III defects, bulk allografts, cones, sleeves, and megaprostheses can be used in conjunction with intramedullary stems. Conclusions Treatment of bone loss in rTKA continues to evolve as different techniques and approaches have been validated through short- and mid-term follow-up. Extensive preoperative planning with imaging, accurate intraoperative evaluation of the bone loss, and comprehensive understanding of all the implant options available for the bone loss are paramount to success.
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Manescu (Paltanea) V, Antoniac I, Antoniac A, Paltanea G, Miculescu M, Bita AI, Laptoiu S, Niculescu M, Stere A, Paun C, Cristea MB. Failure Analysis of Ultra-High Molecular Weight Polyethylene Tibial Insert in Total Knee Arthroplasty. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7102. [PMID: 36295170 PMCID: PMC9605650 DOI: 10.3390/ma15207102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Knee osteoarthritis is treated based on total knee arthroplasty (TKA) interventions. The most frequent failure cause identified in surgical practice is due to wear and oxidation processes of the prothesis' tibial insert. This component is usually manufactured from ultra-high molecular weight polyethylene (UHMWPE). To estimate the clinical complications related to a specific prosthesis design, we investigated four UHMWPE tibial inserts retrieved from patients from Clinical Hospital Colentina, Bucharest, Romania. For the initial analysis of the polyethylene degradation modes, macrophotography was chosen. A light stereomicroscope was used to estimate the structural performance and the implant surface degradation. Scanning electron microscopy confirmed the optical results and fulfilled the computation of the Hood index. The oxidation process in UHMWPE was analyzed based on Fourier-transform infrared spectroscopy (FTIR). The crystallinity degree and the oxidation index were computed in good agreement with the existing standards. Mechanical characterization was conducted based on the small punch test. The elastic modulus, initial peak load, ultimate load, and ultimate displacement were estimated. Based on the aforementioned experimental tests, a variation between 9 and 32 was found in the case of the Hood score. The oxidation index has a value of 1.33 for the reference sample and a maximum of 9.78 for a retrieved sample.
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Affiliation(s)
- Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Marian Miculescu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Ana-Iulia Bita
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Stefan Laptoiu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Marius Niculescu
- Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petrascu Street, 031593 Bucharest, Romania
- Department of Orthopedics and Trauma I, Colentina Clinical Hospital, 19-21 Soseaua Stefan cel Mare, 020125 Bucharest, Romania
| | - Alexandru Stere
- Medical Ortovit Ltd., 8 Miron Costin Street, 011098 Bucharest, Romania
| | - Costel Paun
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- National Institute for Research and Development in Microtechnologies IMT-Bucharest, 126A Erou Iancu Nicolae Street, 077190 Bucharest, Romania
| | - Mihai Bogdan Cristea
- Department of Morphological Sciences, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
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Robu A, Antoniac A, Ciocoiu R, Grosu E, Rau JV, Fosca M, Krasnyuk II, Pircalabioru GG, Manescu (Paltanea) V, Antoniac I, Gradinaru S. Effect of the Antimicrobial Agents Peppermint Essential Oil and Silver Nanoparticles on Bone Cement Properties. Biomimetics (Basel) 2022; 7:biomimetics7030137. [PMID: 36134941 PMCID: PMC9496347 DOI: 10.3390/biomimetics7030137] [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: 08/10/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
The main problems directly linked with the use of PMMA bone cements in orthopedic surgery are the improper mechanical bond between cement and bone and the absence of antimicrobial properties. Recently, more research has been devoted to new bone cement with antimicrobial properties using mainly antibiotics or other innovative materials with antimicrobial properties. In this paper, we developed modified PMMA bone cement with antimicrobial properties proposing some experimental antimicrobial agents consisting of silver nanoparticles incorporated in ceramic glass and hydroxyapatite impregnated with peppermint oil. The impact of the addition of antimicrobial agents on the structure, mechanical properties, and biocompatibility of new PMMA bone cements was quantified. It has been shown that the addition of antimicrobial agents improves the flexural strength of the traditional PMMA bone cement, while the yield strength values show a decrease, most likely because this agent acts as a discontinuity inside the material rather than as a reinforcing agent. In the case of all samples, the addition of antimicrobial agents had no significant influence on the thermal stability. The new PMMA bone cement showed good biocompatibility and the possibility of osteoblast proliferation (MTT test) along with a low level of cytotoxicity (LDH test).
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Affiliation(s)
- Alina Robu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Robert Ciocoiu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Elena Grosu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Julietta V. Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere, 100, 00133 Rome, Italy
- Institute of Pharmacy, Department of Analytical, Physical and Colloid Chemistry, I.M. Sechenov First Moscow State Medical University, Trubetskaya 8, Build. 2, 119991 Moscow, Russia
| | - Marco Fosca
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere, 100, 00133 Rome, Italy
| | - Ivan I. Krasnyuk
- Institute of Pharmacy, Department of Analytical, Physical and Colloid Chemistry, I.M. Sechenov First Moscow State Medical University, Trubetskaya 8, Build. 2, 119991 Moscow, Russia
| | - Gratiela Gradisteanu Pircalabioru
- Research Institute of the University of Bucharest, University of Bucharest, 90 Soseaua, Panduri, 050663 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei Street, District 5, 050094 Bucharest, Romania
| | - Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei Street, District 5, 050094 Bucharest, Romania
- Correspondence:
| | - Sebastian Gradinaru
- Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
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Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11164854. [PMID: 36013091 PMCID: PMC9409753 DOI: 10.3390/jcm11164854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
In the treatment of knee periprosthetic joint infection with a two-stage protocol, static spacers allow for the local delivery of high doses of antibiotics and help to preserve soft tissue tension. Articulated spacers were introduced to better preserve flexion after the reimplantation. The aim of this systematic review is to provide a comprehensive data collection of the results of these different spacers. An in-depth search on the main clinical databases was performed concerning the studies reporting data on the topic. A total of 87 studies and 4250 spacers were included. No significant differences were found both in pooling data analysis and meta-analysis of comparative studies about infection recurrences, complications, and clinical scores. Mean active knee flexion at last follow-up after total knee reimplantation was found to be significantly higher using articulated spacers (91.6° ± 7° for static spacers vs. 100.3° ± 9.9° for articulated spacers; p < 0.001). Meta-analysis also recognized this strong significant difference (p < 0.001). This review has confirmed that articulated spacers do not appear to be inferior to static spacers regarding all clinical outcomes, while they are superior in terms of active flexion. However, the low quality of the studies and the risk for selection bias with complex patients preferentially treated with static spacers need to be accounted for.
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Tzagiollari A, McCarthy HO, Levingstone TJ, Dunne NJ. Biodegradable and Biocompatible Adhesives for the Effective Stabilisation, Repair and Regeneration of Bone. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9060250. [PMID: 35735493 PMCID: PMC9219717 DOI: 10.3390/bioengineering9060250] [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: 04/12/2022] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
Bone defects and complex fractures present significant challenges for orthopaedic surgeons. Current surgical procedures involve the reconstruction and mechanical stabilisation of complex fractures using metal hardware (i.e., wires, plates and screws). However, these procedures often result in poor healing. An injectable, biocompatible, biodegradable bone adhesive that could glue bone fragments back together would present a highly attractive solution. A bone adhesive that meets the many clinical requirements for such an application has yet to be developed. While synthetic and biological polymer-based adhesives (e.g., cyanoacrylates, PMMA, fibrin, etc.) have been used effectively as bone void fillers, these materials lack biomechanical integrity and demonstrate poor injectability, which limits the clinical effectiveness and potential for minimally invasive delivery. This systematic review summarises conventional approaches and recent developments in the area of bone adhesives for orthopaedic applications. The required properties for successful bone repair adhesives, which include suitable injectability, setting characteristics, mechanical properties, biocompatibility and an ability to promote new bone formation, are highlighted. Finally, the potential to achieve repair of challenging bone voids and fractures as well as the potential of new bioinspired adhesives and the future directions relating to their clinical development are discussed.
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Affiliation(s)
- Antzela Tzagiollari
- School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland; (A.T.); (T.J.L.)
- Centre for Medical Engineering Research, Dublin City University, D09 NA55 Dublin, Ireland
| | - Helen O. McCarthy
- School of Pharmacy, Queen’s University, Belfast BT9 7BL, UK;
- School of Chemical Sciences, Dublin City University, D09 NA55 Dublin, Ireland
- Biodesign Europe, Dublin City University, D09 NA55 Dublin, Ireland
| | - Tanya J. Levingstone
- School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland; (A.T.); (T.J.L.)
- Centre for Medical Engineering Research, Dublin City University, D09 NA55 Dublin, Ireland
- Biodesign Europe, Dublin City University, D09 NA55 Dublin, Ireland
- Tissue, Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 PN40 Dublin, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, D09 NA55 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Nicholas J. Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland; (A.T.); (T.J.L.)
- Centre for Medical Engineering Research, Dublin City University, D09 NA55 Dublin, Ireland
- Biodesign Europe, Dublin City University, D09 NA55 Dublin, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, D09 NA55 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, D02 PN40 Dublin, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence: ; Tel.: +353-(0)1-7005712
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15
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[Bone defect management in revision knee arthroplasty]. DER ORTHOPADE 2021; 50:1004-1010. [PMID: 34654936 DOI: 10.1007/s00132-021-04181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 2019, 124,677 primary total knee arthroplasties and 14,462 revision TKA were performed in Germany. This corresponds to a percentage of 11.6%. According to the EPRD, the probability of further revision surgery after the first exchange operation is around 15%. REASONS The most common reason for revision surgery is still aseptic loosening with 23.9%. One possible cause could be the difficult fixation of revision total knee arthroplasty. If the bone quality is insufficient, cement-free or cemented diaphyseal anchoring of the prosthesis is often not sufficient to ensure adequate fixation. As a rule, defect management and fixation of the implant are based on the defect situation and the quality of the bone. Therefore, revision total knee arthroplasties based on the fixation principle of Jones et al. should be sufficiently fixed in at least 2 zones. TECHNIQUES There are various techniques for stable anchoring of revision implants. In addition to cemented or cementless stem anchoring, bone allografts, wedges and blocks and, in recent years, cones and sleeves have become increasingly popular. In the present work, the various options for a stable anchoring of revision implants are presented and evaluated. In addition, the clinical and radiological outcome of cones vs. sleeves in bone defect management in revision knee arthroplasty will be compared.
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Hasandoost L, Marx D, Zalzal P, Safir O, Hurtig M, Mehrvar C, Waldman SD, Papini M, Towler MR. Comparative Evaluation of Two Glass Polyalkenoate Cements: An In Vivo Pilot Study Using a Sheep Model. J Funct Biomater 2021; 12:jfb12030044. [PMID: 34449631 PMCID: PMC8395762 DOI: 10.3390/jfb12030044] [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: 04/29/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Poly(methyl methacrylate) (PMMA) is used to manage bone loss in revision total knee arthroplasty (rTKA). However, the application of PMMA has been associated with complications such as volumetric shrinkage, necrosis, wear debris, and loosening. Glass polyalkenoate cements (GPCs) have potential bone cementation applications. Unlike PMMA, GPC does not undergo volumetric shrinkage, adheres chemically to bone, and does not undergo an exothermic setting reaction. In this study, two different compositions of GPCs (GPCA and GPCB), based on the patented glass system SiO2-CaO-SrO-P2O5-Ta2O5, were investigated. Working and setting times, pH, ion release, compressive strength, and cytotoxicity of each composition were assessed, and based on the results of these tests, three sets of samples from GPCA were implanted into the distal femur and proximal tibia of three sheep (alongside PMMA as control). Clinical CT scans and micro-CT images obtained at 0, 6, and 12 weeks revealed the varied radiological responses of sheep bone to GPCA. One GPCA sample (implanted in the sheep for 12 weeks) was characterized with no bone resorption. Furthermore, a continuous bone-cement interface was observed in the CT images of this sample. The other implanted GPCA showed a thin radiolucent border at six weeks, indicating some bone resorption occurred. The third sample showed extensive bone resorption at both six and 12 weeks. Possible speculative factors that might be involved in the varied response can be: excessive Zn2+ ion release, low pH, mixing variability, and difficulty in inserting the samples into different parts of the sheep bone.
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Affiliation(s)
- Leyla Hasandoost
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, ON M5B 2K3, Canada; (L.H.); (D.M.); (S.D.W.); (M.P.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Daniella Marx
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, ON M5B 2K3, Canada; (L.H.); (D.M.); (S.D.W.); (M.P.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Paul Zalzal
- Faculty of Medicine, Department of Surgery, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Oakville Trafalgar Memorial Hospital, Oakville, ON L6J 3L7, Canada
| | - Oleg Safir
- Division of Orthopedic Surgery, Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada;
| | - Mark Hurtig
- Ontario Veterinary College, University of Guelph, 50 Stone Rd E, Guelph, ON N1G 2W1, Canada;
| | - Cina Mehrvar
- Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Stephen D. Waldman
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, ON M5B 2K3, Canada; (L.H.); (D.M.); (S.D.W.); (M.P.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Department of Chemical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Marcello Papini
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, ON M5B 2K3, Canada; (L.H.); (D.M.); (S.D.W.); (M.P.)
- Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Mark R. Towler
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, ON M5B 2K3, Canada; (L.H.); (D.M.); (S.D.W.); (M.P.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada;
- Correspondence:
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Zapata MEV, Tovar CDG, Hernandez JHM. The Role of Chitosan and Graphene Oxide in Bioactive and Antibacterial Properties of Acrylic Bone Cements. Biomolecules 2020; 10:E1616. [PMID: 33265973 PMCID: PMC7760599 DOI: 10.3390/biom10121616] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023] Open
Abstract
Acrylic bone cements (ABC) are widely used in orthopedics for joint fixation, antibiotic release, and bone defect filling, among others. However, most commercially available ABCs exhibit a lack of bioactivity and are susceptible to infection after implantation. These disadvantages generate long-term loosening of the prosthesis, high morbidity, and prolonged and expensive treatments. Due to the great importance of acrylic bone cements in orthopedics, the scientific community has advanced several efforts to develop bioactive ABCs with antibacterial activity through several strategies, including the use of biodegradable materials such as chitosan (CS) and nanostructures such as graphene oxide (GO), with promising results. This paper reviews several studies reporting advantages in bioactivity and antibacterial properties after incorporating CS and GO in bone cements. Detailed information on the possible mechanisms by which these fillers confer bioactive and antibacterial properties to cements, resulting in formulations with great potential for use in orthopedics, are also a focus in the manuscript. To the best of our knowledge, this is the first systematic review that presents the improvement in biological properties with CS and GO addition in cements that we believe will contribute to the biomedical field.
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Affiliation(s)
- Mayra Eliana Valencia Zapata
- Grupo de Materiales Compuestos, Escuela de Ingeniería de Materiales, Universidad del Valle, Calle 13 # 100-00, Cali 76001, Colombia;
| | - Carlos David Grande Tovar
- Grupo de Investigación de Fotoquímica y Fotobiología, Universidad del Atlántico, Carrera 30 Número 8-49, Puerto Colombia 081008, Colombia
| | - José Herminsul Mina Hernandez
- Grupo de Materiales Compuestos, Escuela de Ingeniería de Materiales, Universidad del Valle, Calle 13 # 100-00, Cali 76001, Colombia;
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