1
|
Gagala J. Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute. BMC Musculoskelet Disord 2021; 22:835. [PMID: 34587917 PMCID: PMC8480101 DOI: 10.1186/s12891-021-04694-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. METHODS Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. RESULTS The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. CONCLUSION Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.
Collapse
Affiliation(s)
- Jacek Gagala
- Orthopaedic and Traumatology Department, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Osteogenic differentiation of equine cord blood multipotent mesenchymal stromal cells within coralline hydroxyapatite scaffolds in vitro. Vet Comp Orthop Traumatol 2017; 24:354-62. [DOI: 10.3415/vcot-10-10-0142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 06/05/2011] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To investigate the osteogenic differentiation potential of equine umbilical cord blood-derived multipotent mesenchymal stromal cells (CB-MSC) within coralline hydro-xyapatite scaffolds cultured in osteogenic induction culture medium.Methods: Scaffolds seeded with equine CBMSC were cultured in cell expansion culture medium (control) or osteogenic induction medium (treatment). Cell viability and distribution were confirmed by the MTT cell viability assay and DAPI nuclear fluorescence staining, respectively. Osteogenic differentiation was evaluated after 10 days using reverse transcription polymerase chain reaction, alkaline phosphatase activity, and secreted osteocalcin concentration. Cell morphology and matrix deposition were assessed by scanning electron microscopy (SEM) after 14 days in culture.Results: Cells showed viability and adequate distribution within the scaffold. Successful osteogenic differentiation within the scaffolds was demonstrated by the increased expression of osteogenic markers such as Runx2, osteopontin, osteonectin, collagen IA increased levels of alkaline phosphatase activity increased osteocalcin protein secretion and bone-like matrix presence in the scaffold pores upon SEM evaluation.Clinical significance: These results demonstrate that equine CB-MSC maintain viability and exhibit osteogenic potential in coralline hydroxyapatite scaffolds when induced in vitro. Equine CB-MSC scaffold constructs deserve further investigation for their potential role as biologically active fillers to enhance bone-gap repair in the horse.
Collapse
|
4
|
Ishikawa K, Kawachi G, Tsuru K, Yoshimoto A. Fabrication of calcite blocks from gypsum blocks by compositional transformation based on dissolution-precipitation reactions in sodium carbonate solution. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 72:389-393. [PMID: 28024601 DOI: 10.1016/j.msec.2016.11.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/26/2016] [Accepted: 11/23/2016] [Indexed: 11/18/2022]
Abstract
Calcium carbonate (CaCO3) has been used as a bone substitute, and is a precursor for carbonate apatite, which is also a promising bone substitute. However, limited studies have been reported on the fabrication of artificial calcite blocks. In the present study, cylindrical calcite blocks (ϕ6×3mm) were fabricated by compositional transformation based on dissolution-precipitation reactions using different calcium sulfate blocks as a precursor. In the dissolution-precipitation reactions, both CaSO4·2H2O and CaSO4 transformed into calcite, a polymorph of CaCO3, while maintaining their macroscopic structure when immersed in 1mol/L Na2CO3 solution at 80°C for 1week. The diametral tensile strengths of the calcite blocks formed using CaSO4·2H2O and CaSO4 were 1.0±0.3 and 2.3±0.7MPa, respectively. The fabrication of calcite blocks using CaSO4·2H2O and CaSO4 proposed in this investigation may be a useful method to produce calcite blocks because of the self-setting ability and high temperature stability of gypsum precursors.
Collapse
Affiliation(s)
- Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Giichiro Kawachi
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kanji Tsuru
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ayami Yoshimoto
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
5
|
Abstract
Xenogeneic bone graft materials are an alternative to autologous bone grafting. Among such implants, coralline-derived bone grafts substitutes have a long track record as safe, biocompatible and osteoconductive graft materials. In this review, we present the available literature surrounding their use with special focus on the commercially available graft materials. Corals thanks to their chemical and structural characteristics similar to those of the human cancellous bone have shown great potential but clinical data presented to date is ambiguous with both positive and negative outcomes reported. Correct formulation and design of the graft to ensure adequate osteo-activity and resorption appear intrinsic to a successful outcome.
Collapse
Affiliation(s)
- Ippokratis Pountos
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
| |
Collapse
|
6
|
Müller WEG, Tolba E, Schröder HC, Wang X. Polyphosphate: A Morphogenetically Active Implant Material Serving as Metabolic Fuel for Bone Regeneration. Macromol Biosci 2015; 15:1182-1197. [DOI: 10.1002/mabi.201500100] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Werner E. G. Müller
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry; University Medical Center of the Johannes Gutenberg University; Duesbergweg 6; D-55128 Mainz Germany
| | - Emad Tolba
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry; University Medical Center of the Johannes Gutenberg University; Duesbergweg 6; D-55128 Mainz Germany
- Biomaterials Department; Inorganic Chemical Industries Division; National Research Center; Doki Cairo; 11884 Egypt
| | - Heinz C. Schröder
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry; University Medical Center of the Johannes Gutenberg University; Duesbergweg 6; D-55128 Mainz Germany
| | - Xiaohong Wang
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry; University Medical Center of the Johannes Gutenberg University; Duesbergweg 6; D-55128 Mainz Germany
| |
Collapse
|
7
|
Ishikawa K, Tram NXT, Tsuru K, Toita R. Fabrication of porous calcite using chopped nylon fiber and its evaluation using rats. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:94. [PMID: 25649514 DOI: 10.1007/s10856-015-5432-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 12/14/2014] [Indexed: 06/04/2023]
Abstract
Although porous calcite has attracted attention as bone substitutes, limited studies have been made so far. In the present study, porous calcite block was fabricated by introducing chopped nylon fiber as porogen. Ca(OH)2 powder containing 10 wt% chopped nylon fiber was compacted at 150 MPa, and sintered to burn out the fiber and to carbonate the Ca(OH)2 under stream of 1:2 O2-CO2. Sintering of Ca(OH)2 at 750 °C or lower temperature resulted in incomplete burning out of the fiber whereas sintering at 800 °C or higher temperature resulted in the formation of CaO due to the thermal decomposition of Ca(OH)2. However, sintering at 770 °C resulted in complete burning out of the fiber and complete carbonation of Ca(OH)2 to calcite without forming CaO. Macro- and micro-porosities of the porous calcite were approximately 23 and 16%, respectively. Diameter of the macropores was approximately 100 μm which is suitable for bone tissue penetration. Porous calcite block fabricated by this method exhibited good tissue response when implanted in the bone defect in femur of 12-weeks-old rat. Four weeks after implantation, bone bonded on the surface of calcite. Furthermore, bone tissue penetrated interior to the macropore at 8 weeks. These results demonstrated the good potential value of porous calcite as artificial bone substitutes.
Collapse
Affiliation(s)
- Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
| | | | | | | |
Collapse
|
8
|
Fu K, Xu Q, Czernuszka J, Triffitt JT, Xia Z. Characterization of a biodegradable coralline hydroxyapatite/calcium carbonate composite and its clinical implementation. Biomed Mater 2013; 8:065007. [PMID: 24288015 DOI: 10.1088/1748-6041/8/6/065007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A partially converted, biodegradable coralline hydroxyapatite/calcium carbonate (CHACC) composite comprising a coral calcium carbonate scaffold enveloped by a thin layer of hydroxyapatite was used in the present study. The CHACC was characterized using powder x-ray diffraction, scanning electron microscopy and energy dispersive x-ray spectroscopy. The ability of the CHACC to promote conductive osteogenesis was assessed in vitro using human mesenchymal stem cells (hMSCs) and in vivo using an immunodeficient mouse model. The clinical performance of CHACC as a bone substitute to fill voids caused by excision of bone tumours was also observed in 16 patients. The CHACC was found to consist of two overlapping layers both morphologically and chemically. Hydroxyapatite formed a thin layer of nanocrystals on the surface and a thick rough crystal layer of around 30 µm in thickness enveloping the rock-like core calcium carbonate exoskeletal architecture. hMSCs cultured on CHACC in osteogenic medium demonstrated significant osteogenic differentiation. After subcutaneous implantation of CHACC incorporating osteogenically differentiated hMSCs and an anti-resorptive agent, risedronate, into an immunodeficient mouse model, bone formation was observed on the surface of the implants. Clinical application of CHACC alone in 16 patients for bone augmentation after tumour removal showed that after implantation, visible callus formation was observed at one month and clinical bone healing achieved at four months. The majority of the implanted CHACC was degraded in 18-24 months. In conclusion, CHACC appears to be an excellent biodegradable bone graft material. It biointegrates with the host, is osteoconductive, biodegradable and can be an attractive alternative to autogenous grafts.
Collapse
Affiliation(s)
- Kun Fu
- Department of Orthopaedic Surgery, Affiliated Hospital, Hainan Medical College, #33 Longhua Road, Haikou, Hainan Province, People's Republic of China
| | | | | | | | | |
Collapse
|
9
|
Deirmengian GK, Zmistowski B, O'Neil JT, Hozack WJ. Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am 2011; 93:1842-52. [PMID: 22005871 DOI: 10.2106/jbjs.j.01197] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Most acetabular revisions can be managed with a hemispherical component with screw fixation. Areas of segmental bone loss that preclude acetabular component stability may be managed with structural allograft or second-generation porous metal augments. Acetabular cages have a limited application but can be a useful tool in the management of massive bone loss and pelvic discontinuity.
Collapse
Affiliation(s)
- Gregory K Deirmengian
- Rothman Institute of Orthopaedics, Thomas Jefferson University Medical School, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|
10
|
Zhang Y, Yin QS, Zhang Y, Xia H, Ai FZ, Jiao YP, Chen XQ. Determination of antibacterial properties and cytocompatibility of silver-loaded coral hydroxyapatite. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:2453-2462. [PMID: 20526656 DOI: 10.1007/s10856-010-4101-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 05/20/2010] [Indexed: 05/27/2023]
Abstract
In this study, silver-loaded coral hydroxyapatites (SLCHAs) were used as scaffolds for bone tissue engineering. The SLCHAs were prepared by surface adsorption process and ion-exchange reaction between Ca(2+) of coral hydroxyapatite (CHA) and Ag(+) of silver nitrate with different concentrations at room temperature. The properties of the composite SLCHAs were investigated by inductively coupled plasma-atomic emission spectrometry (ICP-AES), scanning electron microscropy (SEM) equipped with backscattered electron detector (BSE), and energy-dispersive X-ray spectrometer (EDS). The SEM images showed that the morphology of the SLCHAs depended on the content of Ag(+), and the silver ions were uniformly distributed on the surface of SLCHAs. The ICP-AES results demonstrated that the silver content of the SLCHAs decreased along with the decrease of the concentration of silver nitrate. The SLCHAs were found effective against Escherichia coli and Staphylococcus aureus by antibacterial test. Mouse embryonic pre-osteoblast cells (MC3T3-E1) were used to test the cytocompatibility of SLCHAs, CHA, and pure coral. Cell morphology and cell proliferation were studied with SEM, laser scanning confocal microscope (LSCM), and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay after 1, 3, and 5 days of culture. The results indicated the cell morphology and proliferation on the scaffolds of Ag(+) (13.6 microg/ml)/CHA and Ag(+) (1.7 microg/ml)/CHA were better than that on Ag(+) (170 microg/ml)/CHA. In addition, adhesion of MC3T3-E1 on the scaffolds showed that the confluent cells showed fusiform shape and arranged tightly on the scaffolds. All the results showed that the antibacterial SLCHAs would have potential clinical application as the scaffolds for bone tissue engineering.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Orthopaedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China.
| | | | | | | | | | | | | |
Collapse
|
11
|
Whitehouse MR, Blom AW. The Use of Ceramics as Bone Substitutes in Revision Hip Arthroplasty. MATERIALS 2009. [PMCID: PMC5513567 DOI: 10.3390/ma2041895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The number of grafting procedures, including those performed in primary and revision hip arthroplasty, continues to rise around the world. Demand for musculoskeletal donor tissue now outstrips supply. There is no single bone substitute that is ideal for all circumstances. Bone substitutes act as a scaffold and are usually osteoconductive. They are rarely osteoinductive; if they are, a molecular bond is formed between the graft and host bone, improving fixation and longevity. Bone graft substitutes are very rarely osteogenic. There is a growing body of clinical evidence supporting the use of bone graft substitutes in vivo for complex hip arthroplasty.
Collapse
Affiliation(s)
- Michael R. Whitehouse
- Department of Academic Orthopaedic Surgery (University of Bristol), BIRC, Lower Level AOC, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK; E-Mail: (A.W.B.)
- Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +44(0)1179595905; Fax: +44(0)1179595936
| | - Ashley W. Blom
- Department of Academic Orthopaedic Surgery (University of Bristol), BIRC, Lower Level AOC, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK; E-Mail: (A.W.B.)
- Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
| |
Collapse
|