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Ho A, Ohuchi H, Okada T, Takazawa S, Yamada S, Kato Y. Ultrasound-Guided Posteromedial Semitendinosus Tendon Harvest. Arthrosc Tech 2024; 13:103019. [PMID: 39233814 PMCID: PMC11369933 DOI: 10.1016/j.eats.2024.103019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/09/2024] [Indexed: 09/06/2024] Open
Abstract
Hamstring tendon autografts have emerged as the graft of choice by over 50% of sports surgeons worldwide performing anterior cruciate ligament reconstruction. A more recent technique in harvesting the semitendinosus tendon, the posteromedial approach, afforded multiple benefits compared with the anteromedial approach. However, for the inexperienced surgeon, the current techniques may not be as simple because of decreased tendon tension after general anesthesia induction and subcutaneous layer dissection, making it difficult to palpate the semitendinosus tendon. By utilizing ultrasound to assist us during our harvest, we can perform the procedure with increased accuracy and efficiency, which leads to a safer, more proficient, and less invasive procedure.
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Affiliation(s)
- Alexander Ho
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Takuya Okada
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Shuzo Takazawa
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Shin Yamada
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Yuki Kato
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
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2
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Xie HQ, Xie HT, Luo T, Yang BY, Gan DQ, Liao DF, Cui L, Song L, Xie MM. Design of 3D printing osteotomy block for foot based on triply periodic minimal surface. Sci Rep 2024; 14:15851. [PMID: 38982110 PMCID: PMC11233604 DOI: 10.1038/s41598-024-65318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
The ankle joint, which connects the lower limbs and the sole of the foot, is prone to sprain during walking and sports, which leads to ankle arthritis. Supratroleolar osteotomy is an ankle preserving operation for the treatment of ankle arthritis, in which the osteotomy is an important fixing and supporting part. In order to avoid stress shielding effect as much as possible, the osteotomy block is designed as a porous structure. In this study, the osteotomy block was designed based on three-period minimal surface, and the designed structure was manufactured by 3D printing. The mechanical properties of different structures were studied by mechanical test and finite element simulation. In mechanical tests, the Gyroid structure showed a progressive failure mechanism from bottom to bottom, while the Diamond structure showed a shear failure zone at 45° Angle, which was not conducive to energy absorption and was more prone to brittle fracture than the Gyroid structure. Therefore, the Gyroid structure is valuable for further research in the development of porous osteotomy.
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Affiliation(s)
- Hai-Qiong Xie
- School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, People's Republic of China
| | - Hai-Tao Xie
- XingGuo People's Hospital, Jiangxi, 341000, People's Republic of China
| | - Tao Luo
- School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, People's Republic of China
| | - Bai-Yin Yang
- School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, People's Republic of China
| | - Dao-Qi Gan
- School of Advanced Manufacturing Engineering, Chongqing University of Posts and Telecommunications, Chongqing, 400065, People's Republic of China
| | - Dong-Fa Liao
- Trauma Center, General Hospital of Western Theater Command of PLA, Rongdu Str. 270, Chengdu, 610083, People's Republic of China
| | - Lin Cui
- Trauma Center, General Hospital of Western Theater Command of PLA, Rongdu Str. 270, Chengdu, 610083, People's Republic of China
| | - Lei Song
- Department of Orthopaedics, First Affliated Hospital, Army Medical University, No. 30 Gaotanyanzheng Street, Chongqing, 400038, People's Republic of China.
| | - Mei-Ming Xie
- Trauma Center, General Hospital of Western Theater Command of PLA, Rongdu Str. 270, Chengdu, 610083, People's Republic of China.
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Li P, Yin R, Cheng J, Lin J. Bacterial Biofilm Formation on Biomaterials and Approaches to Its Treatment and Prevention. Int J Mol Sci 2023; 24:11680. [PMID: 37511440 PMCID: PMC10380251 DOI: 10.3390/ijms241411680] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Bacterial biofilms can cause widespread infection. In addition to causing urinary tract infections and pulmonary infections in patients with cystic fibrosis, biofilms can help microorganisms adhere to the surfaces of various medical devices, causing biofilm-associated infections on the surfaces of biomaterials such as venous ducts, joint prostheses, mechanical heart valves, and catheters. Biofilms provide a protective barrier for bacteria and provide resistance to antimicrobial agents, which increases the morbidity and mortality of patients. This review summarizes biofilm formation processes and resistance mechanisms, as well as the main features of clinically persistent infections caused by biofilms. Considering the various infections caused by clinical medical devices, we introduce two main methods to prevent and treat biomaterial-related biofilm infection: antibacterial coatings and the surface modification of biomaterials. Antibacterial coatings depend on the covalent immobilization of antimicrobial agents on the coating surface and drug release to prevent and combat infection, while the surface modification of biomaterials affects the adhesion behavior of cells on the surfaces of implants and the subsequent biofilm formation process by altering the physical and chemical properties of the implant material surface. The advantages of each strategy in terms of their antibacterial effect, biocompatibility, limitations, and application prospects are analyzed, providing ideas and research directions for the development of novel biofilm infection strategies related to therapeutic materials.
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Affiliation(s)
| | | | | | - Jinshui Lin
- Shaanxi Key Laboratory of Chinese Jujube, College of Life Sciences, Yan’an University, Yan’an 716000, China; (P.L.); (R.Y.); (J.C.)
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Minehara H, Maruo A, Amadei R, Contini A, Braile A, Kelly M, Jenner L, Schemitsch GW, Schemitsch EH, Miclau T. Open fractures: Current treatment perspective. OTA Int 2023; 6:e240. [PMID: 37533445 PMCID: PMC10392445 DOI: 10.1097/oi9.0000000000000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 08/04/2023]
Abstract
Severe open fractures present challenges to orthopaedic surgeons worldwide, with increased risks of significant complications. Although different global regions have different resources and systems, there continue to be many consistent approaches to open fracture care. Management of these complex injures continues to evolve in areas ranging from timing of initial operative debridement to the management of critical-sized bone defects. This review, compiled by representative members of the International Orthopaedic Trauma Association, focuses on several critical areas of open fracture management, including antibiotic administration, timing of debridement, bone loss, soft tissue management, and areas of need for future investigation.
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Affiliation(s)
- Hiroaki Minehara
- Department of Traumatology, Fukushima Medical University, Trauma and Reconstruction Center, Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Akihiro Maruo
- Department of Orthopaedic Surgery, Harima-Himeji General Medical Center, Himeji, Japan
| | - Rafael Amadei
- Orthopaedics Trauma Unit, Cuenca Alta Cañuelas Hospital, Buenos Aires, Argentina
| | - Achille Contini
- Orthopedics and Traumatology Department, ASL 1 “Ospedale del Mare” Hospital, Napoli, Italy
| | - Adriano Braile
- Orthopedics and Traumatology Department, ASL 1 “Ospedale del Mare” Hospital, Napoli, Italy
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania “Luigi Vanvitelli,” Napoli, Italy
| | | | | | | | - Emil H. Schemitsch
- Department of Surgery, University of Western Ontario, London Health Sciences Centre, London, ON, Canada; and
| | - Theodore Miclau
- Department of Orthopaedic Surgery; Orthopaedic Trauma Institute; University of California, San Francisco, CA
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Mohan S, Karunanithi P, Raman Murali M, Anwar Ayob K, Megala J, Genasan K, Kamarul T, Balaji Raghavendran HR. Potential Use of 3D CORAGRAF-Loaded PDGF-BB in PLGA Microsphere Seeded Mesenchymal Stromal Cells in Enhancing the Repair of Calvaria Critical-Size Bone Defect in Rat Model. Mar Drugs 2022; 20:md20090561. [PMID: 36135749 PMCID: PMC9506139 DOI: 10.3390/md20090561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Our previous study evidenced that the 3D CORAGRAF loaded with PLGA microsphere constitutes PDGF-BB can support cell attachment and proliferation and can induce an osteogenic commitment of mesenchymal stromal cells in the in vitro condition. However, how this construct can perform in pathophysiological conditions in terms of repairing critical bone defects is yet to be understood. A study was therefore conducted to investigate the regeneration potential of calvaria critical-size defects using CORAGRAF + PLGA with PDGF-BB + mesenchymal stromal cells (MSCs) in a rat model. A 5 mm critical bone defect was created on calvaria of 40 male Sprague-Dawley rats. CORAGRAF incorporated either with or without PDGF-BB and seeded with rat bone-marrow-derived MSCs was implanted at the defect region. The bone regeneration potential of implanted constructs was assessed using micro-CT imaging and histological staining in weeks 4 and 8. The micro-CT images indicated a significant closure of defects in the cranial bone of the rats treated with 3D CORAGRAF + PLGA with PDGF-BB + MSCs on week 4 and 8 post-implantation. This finding, further supported with the histology outcome where the rat cranial defect treated with CORAGRAF + PLGA with PDGF-BB + MSCs indicated neo-bony ingrowth with organized and mature bone-like morphology as compared with other groups. The previous in vitro results substantiated with our pre-clinical findings demonstrate that the combination of CORAGRAF + PLGA with PDGF-BB + MSCs could be an ideal construct to support bone regeneration in critical bone defects. Hence, this construct can be further investigated for its safety and efficacy in large animal models, or it can be skipped to human trial prior for commercialization.
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Affiliation(s)
- Saktiswaren Mohan
- National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Puvanan Karunanithi
- Department of Anatomy, Faculty of Medicine, Manipal University College Malaysia, Melaka 75150, Malaysia
| | - Malliga Raman Murali
- National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Khairul Anwar Ayob
- National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jayaraman Megala
- Department of Genetic Engineering, Faculty of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai 603203, Tamil Nadu, India
| | - Krishnamurithy Genasan
- National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: (K.G.); (T.K.); (H.R.B.R.)
| | - Tunku Kamarul
- National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Advanced Medical and Dental Institute (AMDI), University Sains Malaysia, Bertam, Kepala Batas 13200, Malaysia
- Correspondence: (K.G.); (T.K.); (H.R.B.R.)
| | - Hanumantha Rao Balaji Raghavendran
- National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Biomaterials Laboratory, Faculty of Clinical Research, Central Research Facility, Sri Ramachandra Institute of Higher Education and Research, Chennai 600 116, Tamil Nadu, India
- Correspondence: (K.G.); (T.K.); (H.R.B.R.)
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Choe R, Devoy E, Jabari E, Packer JD, Fisher JP. Biomechanical Aspects of Osteochondral Regeneration: Implications and Strategies for Three-Dimensional Bioprinting. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:766-788. [PMID: 34409874 PMCID: PMC9419968 DOI: 10.1089/ten.teb.2021.0101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Osteoarthritis is among the most prevalent of musculoskeletal disorders in the world that causes joint pain, deformity, and limited range of movement. The resulting osteochondral defect can significantly decrease the patient's quality of life, but current treatment options have not demonstrated the capacity to fully regenerate the entire osteochondral microenvironment. Structurally, the osteochondral unit is a composite system composed of three layers-articular cartilage, calcified cartilage, and subchondral bone. Collectively these distinct layers contribute to the distinct biomechanical properties that maintain the health and aid in load transfer during joint articulation. The purpose of this review was to examine the role of the osteochondral interface in tissue engineering. Topics of discussion include the biomechanics of the osteochondral unit and an overview of various strategies for osteochondral interface tissue engineering, with a specific focus on three-dimensional bioprinting. The goal of this review was to elucidate the importance of the osteochondral interface and overview some strategies of developing an interface layer within tissue engineered scaffolds. Impact Statement This review provides an overview of interface tissue engineering for osteochondral regeneration. It offers a detailed investigation into the biomechanics of the osteochondral unit as it relates to tissue engineering, and highlights the strategies that have been utilized to develop the osteochondral interface within tissue engineering scaffolds.
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Affiliation(s)
- Robert Choe
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
- Address correspondence to: Robert Choe, DMD, MSc, Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD 20742, USA
| | - Eoin Devoy
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
| | - Erfan Jabari
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John P. Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
- Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
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7
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Variations in common operations in athletes and non-Athletes. J Orthop 2022; 32:160-165. [PMID: 35747324 DOI: 10.1016/j.jor.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/11/2022] [Indexed: 12/27/2022] Open
Abstract
Background Achieving pre-injury activity level after an injury is the fundamental goal of any orthopedic treatment for an athlete. Unfortunately, pre-injury activity levels differ significantly in different patient categories, especially in athletes and non-athlete. Hence, an outcome suitable to a non-athlete may not be adequate for an athlete. This has led to variations in the surgical approach to the same injury in an athlete and non-athlete.There is plenty of literature published comparing the outcome in athletes and non-athletes after a particular surgery. Scattered discussion about variations in these surgeries based on functional demand was done in many publications. But there was a lack of a comprehensive narrative review summarizing variations in common operations among athletes and non-athletes. Aim This review attempted to summarize variations in common sports operations between high functional demand patients and low demand patients and discuss the variations from the author's perspective. Methods A review of all the relevant papers were conducted focusing on athletes and non-athletes. Most commonly performed sports surgeries were ACL reconstruction, Meniscal repair, PCL reconstruction, and Shoulder instability surgery. A literature search was done for each commonly performed surgery using relevant keywords in PubMed and Google Scholars. Summary of papers pertinent to athletes and non-athletes were compiled to prepare this narrative review. Results There is a lack of papers directly comparing results in athletes and non-athletes. However, many research papers discussed surgical variations in athletes (high demand) and non-athletes (low demand) patients. There are controversies in all commonly performed surgeries, and none of the papers gives a definitive guideline on the approach to athletes and non-athlete. Conclusion Rather than a common suggestion on surgical variation, an individualized approach would be appropriate to decide on variation in particular surgery in both athletes and non-athletes.
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8
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Bone Mineralization in Electrospun-Based Bone Tissue Engineering. Polymers (Basel) 2022; 14:polym14102123. [PMID: 35632005 PMCID: PMC9146582 DOI: 10.3390/polym14102123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 02/06/2023] Open
Abstract
Increasing the demand for bone substitutes in the management of bone fractures, including osteoporotic fractures, makes bone tissue engineering (BTE) an ideal strategy for solving the constant shortage of bone grafts. Electrospun-based scaffolds have gained popularity in BTE because of their unique features, such as high porosity, a large surface-area-to-volume ratio, and their structural similarity to the native bone extracellular matrix (ECM). To imitate native bone mineralization through which bone minerals are deposited onto the bone matrix, a simple but robust post-treatment using a simulated body fluid (SBF) has been employed, thereby improving the osteogenic potential of these synthetic bone grafts. This study highlights recent electrospinning technologies that are helpful in creating more bone-like scaffolds, and addresses the progress of SBF development. Biomineralized electrospun bone scaffolds are also reviewed, based on the importance of bone mineralization in bone regeneration. This review summarizes the potential of SBF treatments for conferring the biphasic features of native bone ECM architectures onto electrospun-based bone scaffolds.
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Morphological and Biological Evaluations of Human Periodontal Ligament Fibroblasts in Contact with Different Bovine Bone Grafts Treated with Low-Temperature Deproteinisation Protocol. Int J Mol Sci 2022; 23:ijms23095273. [PMID: 35563664 PMCID: PMC9101062 DOI: 10.3390/ijms23095273] [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: 04/06/2022] [Revised: 04/24/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Several types of deproteinised bovine bone mineral (DBBM) are available on the market, and each one is obtained with a thermic and chemical process that can differ, achieving different results. Currently, several protocols using low temperature are suggested to reduce the possible particle crystallisation during the production process. This study aimed to evaluate the biomorphological reaction of periodontal fibroblast cultures in contact with different DBBM particles treated with a low-temperature protocol (Thermagen®) and without exposure to sodium hydroxide (NaOH). Morphological evaluation was performed using light, confocal laser, and scanning electron microscopy, and the biological reaction in terms of proliferation was performed using an XTT proliferation assay at 24 h (T1), 72 h (T2), and 7 days (T3). The morphological analysis highlighted how the presence of the materials stimulated a change in the morphology of the cells into a polygonal shape, surface reactions with the thickening of the membrane, and expression of actin. In particular, the morphological changes were appreciable from T1, with a progressive increase in the considered morphological characteristics at T2 and T3 follow-ups. The proliferation assay showed a statistical significance between the different experimental materials and the negative control in T2 and T3 follow-ups. The post hoc analysis did not reveal any differences between the materials. In conclusion, the grafts obtained with the low-temperature extractions protocol and not exposed to NaOH solution showed positive morphological reactions with no differences in the sizes of particles.
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Freitas P, Kishida R, Hayashi K, Tsuchiya A, Shimabukuro M, Ishikawa K. Fabrication and histological evaluation of porous carbonate apatite blocks using disodium hydrogen phosphate crystals as a porogen and phosphatization accelerator. J Biomed Mater Res A 2022; 110:1278-1290. [PMID: 35194936 DOI: 10.1002/jbm.a.37374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 01/21/2023]
Abstract
The porous architecture of artificial bones plays a pivotal role in bone ingrowth. Although salt leaching methods produce predictable porous architectures, their application in the low-temperature fabrication of ceramics remains a challenge. Carbonate apatite (CO3 Ap) blocks with three ranges of pore sizes: 100-200, 200-400, and 400-600 μm, were fabricated from CaCO3 blocks with embedded Na2 HPO4 crystals as a porogen and accelerator for CaCO3 -to-CO3 Ap conversion. CaCO3 blocks were obtained from Ca(OH)2 compacts with Na2 HPO4 by CO2 flow at 100% humidity. When carbonated under 100% water humidity, the dissolution of Na2 HPO4 and the formation of hydroxyapatite were observed. Using 90% methanol and 10% water were beneficial in avoiding the Na2 HPO4 consumption and generating the metastable CaCO3 vaterite, which was rapidly converted into CO3 Ap in a Na2 HPO4 solution in 7 days. For the histological evaluation, the CO3 Ap blocks were implanted in rabbit femur defects. Four weeks after implantation, new bone was formed at the edges of the blocks. After 12 weeks, new bone was observed in the central areas of the material. Notably, CO3 Ap blocks with pore sizes of 100-200 μm were the most effective, exhibiting approximately 23% new bone area. This study sheds new light on the fabrication of tailored porous blocks and provides a useful guide for designing artificial bones.
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Affiliation(s)
- Pery Freitas
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Ryo Kishida
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Koichiro Hayashi
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Akira Tsuchiya
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Masaya Shimabukuro
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Sultana A, Zare M, Luo H, Ramakrishna S. Surface Engineering Strategies to Enhance the In Situ Performance of Medical Devices Including Atomic Scale Engineering. Int J Mol Sci 2021; 22:11788. [PMID: 34769219 PMCID: PMC8583812 DOI: 10.3390/ijms222111788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022] Open
Abstract
Decades of intense scientific research investigations clearly suggest that only a subset of a large number of metals, ceramics, polymers, composites, and nanomaterials are suitable as biomaterials for a growing number of biomedical devices and biomedical uses. However, biomaterials are prone to microbial infection due to Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Staphylococcus epidermidis (S. epidermidis), hepatitis, tuberculosis, human immunodeficiency virus (HIV), and many more. Hence, a range of surface engineering strategies are devised in order to achieve desired biocompatibility and antimicrobial performance in situ. Surface engineering strategies are a group of techniques that alter or modify the surface properties of the material in order to obtain a product with desired functionalities. There are two categories of surface engineering methods: conventional surface engineering methods (such as coating, bioactive coating, plasma spray coating, hydrothermal, lithography, shot peening, and electrophoretic deposition) and emerging surface engineering methods (laser treatment, robot laser treatment, electrospinning, electrospray, additive manufacturing, and radio frequency magnetron sputtering technique). Atomic-scale engineering, such as chemical vapor deposition, atomic layer etching, plasma immersion ion deposition, and atomic layer deposition, is a subsection of emerging technology that has demonstrated improved control and flexibility at finer length scales than compared to the conventional methods. With the advancements in technologies and the demand for even better control of biomaterial surfaces, research efforts in recent years are aimed at the atomic scale and molecular scale while incorporating functional agents in order to elicit optimal in situ performance. The functional agents include synthetic materials (monolithic ZnO, quaternary ammonium salts, silver nano-clusters, titanium dioxide, and graphene) and natural materials (chitosan, totarol, botanical extracts, and nisin). This review highlights the various strategies of surface engineering of biomaterial including their functional mechanism, applications, and shortcomings. Additionally, this review article emphasizes atomic scale engineering of biomaterials for fabricating antimicrobial biomaterials and explores their challenges.
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Affiliation(s)
- Afreen Sultana
- Center for Nanotechnology & Sustainability, Department of Mechanical Engineering, National University of Singapore, Singapore 117581, Singapore; (A.S.); (S.R.)
| | - Mina Zare
- Center for Nanotechnology & Sustainability, Department of Mechanical Engineering, National University of Singapore, Singapore 117581, Singapore; (A.S.); (S.R.)
| | - Hongrong Luo
- Engineering Research Center in Biomaterials, Sichuan University, Chengdu 610064, China
| | - Seeram Ramakrishna
- Center for Nanotechnology & Sustainability, Department of Mechanical Engineering, National University of Singapore, Singapore 117581, Singapore; (A.S.); (S.R.)
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Russo R, Guastafierro A, Della Rotonda G, Viglione S, Ciccarelli M, Fiorentino F, Minopoli P, Mortellaro M, Pietroluongo LR, Langella F. Osteochondral allograft transplantation for complex distal humeral fractures assisted by 3D computer planning and printing technology: technical note. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1443-1450. [PMID: 34524509 DOI: 10.1007/s00590-021-03118-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The surgical treatment of comminuted distal humeral articular fractures (DHF) is challenging and is jeopardized by the high rate of complications. The study aims to describe the application of osteochondral allograft (OCA) transplantation for the treatment of complex DHF assisted with a 3D printed specific instrumentation. METHODS Retrospective study. Inclusion criteria were the presence of an articular multi-fragmented DHF treated with frozen OCA. Clinical, self-reported and radiographic outcomes were collected every 6 months. CT were performed at 2 years FU. RESULTS Four patients were included. At a mean follow-up of 37.3 months (24-49) MEPS, DASH and VAS were 90 (80-100), 11.8 (0-25) and 1 (0-3) points, respectively. Not significant complication or reoperation was recorded. Graft healing was observed in 3 cases. In all cases, we observed arthritic progression after 2 years of follow-up. CONCLUSION OCA transplantation can be considered a reliable and safe procedure in patients affected by a complex DHF. LEVEL OF EVIDENCE Level V. Technical Notes.
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Affiliation(s)
- Raffaele Russo
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | - Antonio Guastafierro
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | | | - Stefano Viglione
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | - Michele Ciccarelli
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
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Chang CY, Wu CT, Numan H, Kuo FC, Wang JW, Lee MS. Survival Analysis of Allografting and Antiprotrusio Cage in Treating Massive Acetabular Bone Defects. J Arthroplasty 2021; 36:682-687. [PMID: 32943318 DOI: 10.1016/j.arth.2020.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Massive acetabular bone defects reconstructed with allografting and antiprotrusio cage in revision hip arthroplasty is less reported in the literature. We here report a series of 84 antiprotrusio cages and analyze the risk factors associated with failure. METHODS All instances of use of an antiprotrusio cage for massive acetabular defect (Paprosky type IIc, III, and pelvic discontinuity) between 2002 and 2017 in the authors' institute were reviewed after institutional review board's approval. Survival analyses based on clinical data, bone defect (Paprosky system), type of allograft, size of cage, fixation quality, and position of cage were performed. Failure was defined as cage loosening or breakage, poor hip function, or cage revision for any reason. RESULTS A total of 84 cages in 77 patients (mean age, 62.9 years), with a mean follow-up period of 6.2 years, had a survival rate of 82.1%. Failure was noted in 15 hips, including mechanical failure in 8 hips, recurrent dislocation in 1 hip, poor hip function in 1 hip, and periprosthetic joint infection in 5 hips. Pelvic discontinuity, reconstruction with morselized allograft alone, and fewer than 4 fixation points to the host bone were associated with higher failure rates (hazard ratios, 4.02, 3.42, and 9.9, respectively). CONCLUSION We found that an antiprotrusio cage combined with strut allografts, fixed securely to the host bone (>4 fixation points), are beneficial for the management of massive acetabular bone defects. However, pelvic discontinuity remains a challenge that warrants the further study of technical or prosthetic innovations, such as triflange implants, cup cage, and 3D-printed implants.
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Affiliation(s)
- Cheh-Yung Chang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Ta Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Husam Numan
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Feng-Chi Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Tuncay İ, Tözün R, Aliyev O, Dikmen G, Uzer G, Özden VE, Yıldız F. Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur. INTERNATIONAL ORTHOPAEDICS 2020; 45:71-81. [PMID: 33206205 DOI: 10.1007/s00264-020-04876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft. METHODS A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes. RESULTS In FG and CG groups, the median ages were 69.5(44-90) and 62(38-88) years, follow-ups were 59(28-72) and 120(48-216) months, defect lengths were seven (1-10) and ten (1-17) cm, and grafts lengths were 16.5(10-30) and 20(12-37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4-12) and 12(6-24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan-Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group. CONCLUSION In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.
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Affiliation(s)
- İbrahim Tuncay
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Remzi Tözün
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Göksel Dikmen
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Vahit Emre Özden
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey.
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15
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Kumar P, Saini M, Dehiya BS, Sindhu A, Kumar V, Kumar R, Lamberti L, Pruncu CI, Thakur R. Comprehensive Survey on Nanobiomaterials for Bone Tissue Engineering Applications. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E2019. [PMID: 33066127 PMCID: PMC7601994 DOI: 10.3390/nano10102019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
One of the most important ideas ever produced by the application of materials science to the medical field is the notion of biomaterials. The nanostructured biomaterials play a crucial role in the development of new treatment strategies including not only the replacement of tissues and organs, but also repair and regeneration. They are designed to interact with damaged or injured tissues to induce regeneration, or as a forest for the production of laboratory tissues, so they must be micro-environmentally sensitive. The existing materials have many limitations, including impaired cell attachment, proliferation, and toxicity. Nanotechnology may open new avenues to bone tissue engineering by forming new assemblies similar in size and shape to the existing hierarchical bone structure. Organic and inorganic nanobiomaterials are increasingly used for bone tissue engineering applications because they may allow to overcome some of the current restrictions entailed by bone regeneration methods. This review covers the applications of different organic and inorganic nanobiomaterials in the field of hard tissue engineering.
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Affiliation(s)
- Pawan Kumar
- Department of Materials Science and Nanotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal 131039, India; (M.S.); (B.S.D.)
| | - Meenu Saini
- Department of Materials Science and Nanotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal 131039, India; (M.S.); (B.S.D.)
| | - Brijnandan S. Dehiya
- Department of Materials Science and Nanotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal 131039, India; (M.S.); (B.S.D.)
| | - Anil Sindhu
- Department of Biotechnology, Deenbandhu Chhotu Ram University of Science and Technology, Murthal 131039, India;
| | - Vinod Kumar
- Department of Bio and Nanotechnology, Guru Jambheshwar University of Science and Technology, Hisar 125001, India; (V.K.); (R.T.)
| | - Ravinder Kumar
- School of Mechanical Engineering, Lovely Professional University, Phagwara 144411, India
| | - Luciano Lamberti
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, 70125 Bari, Italy;
| | - Catalin I. Pruncu
- Department of Design, Manufacturing & Engineering Management, University of Strathclyde, Glasgow G1 1XJ, UK
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Rajesh Thakur
- Department of Bio and Nanotechnology, Guru Jambheshwar University of Science and Technology, Hisar 125001, India; (V.K.); (R.T.)
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16
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Widner M, Dunleavy M, Lynch S. Outcomes Following ACL Reconstruction Based on Graft Type: Are all Grafts Equivalent? Curr Rev Musculoskelet Med 2019; 12:460-465. [PMID: 31734844 DOI: 10.1007/s12178-019-09588-w] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament reconstruction is one of the most common orthopedic procedures performed, accounting for over 200,000 cases annually. Despite the high prevalence, there is still much debate as to the optimal graft choice. The purpose of this review is to evaluate the current literature and discuss the reported outcomes for the most common graft choices. RECENT FINDINGS The most common autografts being used include bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Hamstring tendon might have a slightly higher re-tear rate when compared with BPTB (2.84 versus 2.80). However, BPTB has a higher rate of anterior knee and kneeling pain in the short- and mid-term follow-up. This has not been shown to be the case in long-term follow-up. Allograft is a viable option for revisions and primaries in patients greater than 35 years old; however, re-tear rate increases significantly in younger patients. ACL reconstruction graft choice is a highly studied and yet still exceedingly debated topic. Most large studies report either no significant difference or a small difference in failure rate and outcome scores between the different autograft choices. Allografts have been demonstrated to have an increased risk of failure in younger athletes and should be reserved for revision cases and those aged 35 years and older. Graft choice should ultimately be decided upon based on surgeon comfort and experience and individual patient characteristics.
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Affiliation(s)
- Matthew Widner
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA.
| | - Mark Dunleavy
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA
| | - Scott Lynch
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA, 17033, USA
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17
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Conti ADB, Santrock RD. Unipolar Osteochondral Allograft Transplantation of the Ankle for Posttraumatic Tibial Necrosis: A Case Report. J Foot Ankle Surg 2019; 58:1262-1266. [PMID: 31679679 DOI: 10.1053/j.jfas.2019.03.008] [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: 02/19/2019] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 02/03/2023]
Abstract
We present the case of a 31-year-old male with debilitating post-traumatic arthritis of the ankle secondary to osteonecrosis of the tibial plafond. He was treated with a custom-cut tibial osteochondral allograft transplantation. At 1-year follow-up, radiographs confirmed incorporation of the graft. He had demonstrated significant improvement in terms of both subjective pain and functionality of the ankle and was ready to return to work. Our observation in this case suggests that osteochondral allograft implantation may be a viable alternative treatment in cases of ankle arthritis in the younger patient.
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Affiliation(s)
- Alexander D B Conti
- Resident, Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV.
| | - Robert D Santrock
- Associate Professor, Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV
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18
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Masaeli R, Zandsalimi K, Rasoulianboroujeni M, Tayebi L. Challenges in Three-Dimensional Printing of Bone Substitutes. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:387-397. [DOI: 10.1089/ten.teb.2018.0381] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Reza Masaeli
- Department of Dental Biomaterials, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavosh Zandsalimi
- Department of Life Sciences Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | | | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, Wisconsin
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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19
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Abstract
Use of orthobiologics in sports medicine and musculoskeletal surgery has gained significant interest. However, many of the commercially available and advertised products are lacking in clinical evidence. Widespread use of products before fully understanding their true indications may result in unknown adverse outcomes and may also lead to increased health care costs. As more products become available, it is important to remain judicial in use and to practice evidence-based medicine. Likewise, it is important to continue advances in research in hopes to improve surgical outcomes. This article reviews clinical evidence behind common orthobiologics in the treatment of foot and ankle pathology.
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20
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Lahr CA, Wagner F, Shafiee A, Rudert M, Hutmacher DW, Holzapfel BM. Recombinant Human Bone Morphogenetic Protein 7 Exerts Osteo-Catabolic Effects on Bone Grafts That Outweigh Its Osteo-Anabolic Capacity. Calcif Tissue Int 2019; 105:331-340. [PMID: 31214730 DOI: 10.1007/s00223-019-00574-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate the effects of recombinant human bone morphogenetic protein (rhBMP-7) on human cancellous bone grafts (BGs) while differentiating between anabolic and catabolic events. Human BGs alone or supplemented with rhBMP-7 were harvested 14 weeks after subcutaneous implantation into NOD/Scid mice, and studied via micro-CT, histomorphometry, immunohistochemistry and flow cytometry. Immunohistochemical staining for human-specific proteins made it possible to differentiate between grafted human bone and newly formed murine bone. Only BGs implanted with rhBMP-7 formed an ossicle containing a functional hematopoietic compartment. The total ossicle volume in the BMP+ group was higher than in the BMP- group (835 mm3 vs. 365 mm3, respectively, p < 0.001). The BMP+ group showed larger BM spaces (0.47 mm vs. 0.28 mm, p = 0.002) and lower bone volume-to-total volume ratio (31% vs. 47%, p = 0.002). Immunohistochemical staining for human-specific proteins confirmed a higher ratio of newly formed bone area (murine) to total area (0.12 vs. 0.001, p < 0.001) in the BMP+ group, while the ratio of grafted bone (human) area to total area was smaller (0.14 vs. 0.34, p = 0.004). The results demonstrate that rhBMP-7 induces BG resorption at a higher rate than new bone formation while creating a haematopoietic niche. Clinicians therefore need to consider the net catabolic effect when rhBMP-7 is used with BGs. Overall, this model indicates its promising application to further decipher BMPs action on BGs and its potential in complex bone tissue regeneration.
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Affiliation(s)
- Christoph A Lahr
- Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Ferdinand Wagner
- Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Abbas Shafiee
- Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Maximilian Rudert
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Dietmar W Hutmacher
- Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Boris Michael Holzapfel
- Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia.
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany.
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21
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A review of materials for managing bone loss in revision total knee arthroplasty. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 104:109941. [PMID: 31500053 DOI: 10.1016/j.msec.2019.109941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022]
Abstract
In 2014-2015, 61,421 total knee arthroplasties (TKAs) were performed in Canada; an increase of about 20% over 2000-2001. Revision total knee arthroplasties (rTKAs) accounted for 6.8% of TKAs performed between 2014 and 2015, and this is estimated to grow another 12% by 2025. rTKAs are typically more complicated than primary TKAs due to the significant loss of femoral and tibial bone stock. The escalating demand and limitations associated with total knee arthroplasty and their revision drives the development of novel treatments. A variety of materials have been utilized to facilitate regeneration of healthy bone around the site of a knee arthroplasty. The selection of these materials is based on the bone defect size and includes bone grafts, graft substitutes and cements. However, all these materials have certain disadvantages such as blood loss, disease transmission (bone grafts), inflammatory response, insufficient mechanical properties (bone graft substitutes) thermal necrosis and stress shielding (bone cement). Recently, the use of metal augments for large bone defects has attracted attention, however they can undergo fretting, corrosion, and stress shielding. All things considered, this review indicates the necessity of developing augments that have structural integrities and biodegradation rates similar to that of human bone. Therefore, the future of bone loss management may lie in fabricating novel bioactive glass augments as they can promote bone healing and implant stability and can degrade with time.
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22
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Tsai J, McDonald E, Sutton R, Raikin SM. Severe Flexible Pes Planovalgus Deformity Correction Using Trabecular Metallic Wedges. Foot Ankle Int 2019; 40:402-407. [PMID: 30565478 DOI: 10.1177/1071100718816054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Lateral column lengthening and plantarflexion dorsal opening wedge osteotomy of the medial cuneiform are 2 commonly used procedures to address the deformity seen in severe flexible pes planovalgus deformity. Traditionally, iliac crest allograft or autograft has been used to fill the osteotomy sites. Porous metallic wedges can be used as an alternative to avoid the concerns associated with both autograft and allograft. METHODS: We performed a retrospective review of patients who had corrective osteotomies utilizing metallic wedges to address flexible pes planovalgus with at least 2 years of follow-up data. Preoperative radiographic measurements (anteroposterior [AP] and talo-first metatarsal angle, calcaneal pitch, talocalcaneal angle, and talonavicular uncoverage angle) and functional scores (visual analog scale [VAS] pain, Foot and Ankle Ability Measure [FAAM] Activities of Daily Living [ADL], FAAM Sports) were compared to postoperative radiographic measurements and functional scores. RESULTS: There were statistically significant improvements in all radiographic parameters and functional scores. Two nonunions were seen, one of which healed with revision surgery while the other was asymptomatic. At the time of last radiographic follow-up, there were no recurrences of deformity or collapse. CONCLUSION: Porous metallic wedges offer an attractive alternative to autograft and/or allograft in the setting of corrective osteotomies for severe flexible pes planovalgus. Patients who underwent corrective osteotomies using these wedges demonstrated reliable, effective, and stable radiographic correction as well as significant improvements in function and pain. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- Justin Tsai
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Elizabeth McDonald
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ryan Sutton
- 2 Sidney Kimmel Medical College, Ivyland, PA, USA
| | - Steven M Raikin
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Barati D, Karaman O, Moeinzadeh S, Kader S, Jabbari E. Material and regenerative properties of an osteon-mimetic cortical bone-like scaffold. Regen Biomater 2019; 6:89-98. [PMID: 30967963 PMCID: PMC6446997 DOI: 10.1093/rb/rbz008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
The objective of this work was to fabricate a rigid, resorbable and osteoconductive scaffold by mimicking the hierarchical structure of the cortical bone. Aligned peptide-functionalize nanofiber microsheets were generated with calcium phosphate (CaP) content similar to that of the natural cortical bone. Next, the CaP-rich fibrous microsheets were wrapped around a microneedle to form a laminated microtube mimicking the structure of an osteon. Then, a set of the osteon-mimetic microtubes were assembled around a solid rod and the assembly was annealed to fuse the microtubes and form a shell. Next, an array of circular microholes were drilled on the outer surface of the shell to generate a cortical bone-like scaffold with an interconnected network of Haversian- and Volkmann-like microcanals. The CaP content, porosity and density of the bone-mimetic microsheets were 240 wt%, 8% and 1.9 g/ml, respectively, which were close to that of natural cortical bone. The interconnected network of microcanals in the fused microtubes increased permeability of a model protein in the scaffold. The cortical scaffold induced osteogenesis and vasculogenesis in the absence of bone morphogenetic proteins upon seeding with human mesenchymal stem cells and endothelial colony-forming cells. The localized and timed-release of morphogenetic factors significantly increased the extent of osteogenic and vasculogenic differentiation of human mesenchymal stem cells and endothelial colony-forming cells in the cortical scaffold. The cortical bone-mimetic nature of the cellular construct provided balanced rigidity, resorption rate, osteoconductivity and nutrient diffusivity to support vascularization and osteogenesis.
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Affiliation(s)
- Danial Barati
- Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, SC, USA
| | - Ozan Karaman
- Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, SC, USA
| | - Seyedsina Moeinzadeh
- Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, SC, USA
| | - Safaa Kader
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, USA
| | - Esmaiel Jabbari
- Biomimetic Materials and Tissue Engineering Laboratory, Department of Chemical Engineering, University of South Carolina, Columbia, SC, USA
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24
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Krause KL, Obayashi JT, Bridges KJ, Raslan AM, Than KD. Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion. J Neurosurg Spine 2019; 30:46-51. [PMID: 30485200 DOI: 10.3171/2018.7.spine18531] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
In BriefThe authors examined fusion rates after single-level anterior cervical discectomy and fusion, comparing use of a structural allograft with use of polyetheretherketone (PEEK) interbody devices packed with bone graft. The results demonstrate superior results of structural allograft in terms of arthrodesis rates and reoperation rates. Currently, reimbursement rates substantially favor the use of PEEK and other synthetic devices, which the authors believe should be changed based on the results of this study.
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25
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DeBaun MR, Stahl AM, Daoud AI, Pan CC, Bishop JA, Gardner MJ, Yang YP. Preclinical induced membrane model to evaluate synthetic implants for healing critical bone defects without autograft. J Orthop Res 2019; 37:60-68. [PMID: 30273977 DOI: 10.1002/jor.24153] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023]
Abstract
Critical bone defects pose a formidable orthopaedic problem in patients with bone loss. We developed a preclinical model based on the induced membrane technique using a synthetic graft to replace autograft for healing critical bone defects. Additionally, we used a novel osteoconductive scaffold coupled with a synthetic membrane to evaluate the potential for single-stage bone regeneration. Three experimental conditions were investigated in critical femoral defects in rats. Group A underwent a two-stage procedure with insertion of a polymethylmethacrylate (PMMA) spacer followed by replacement with a 3D printed polycaprolactone(PCL)/β-tricalcium phosphate (β-TCP) osteoconductive scaffold after 4 weeks. Group B received a single-stage PCL/β-TCP scaffold wrapped in a PCL-based microporous polymer film creating a synthetic membrane. Group C received a single-stage bare PCL/β-TCP scaffold. All groups were examined by serial radiographs for callus formation. After 12 weeks, the femurs were explanted and analyzed with micro-CT and histology. Mean callus scores tended to be higher in Group A. Group A showed statistically significant greater bone formation on micro-CT compared with other groups, although bone volume fraction was similar between groups. Histology results suggested extensive bone ingrowth and new bone formation within the macroporous scaffolds in all groups and cell infiltration into the microporous synthetic membrane. This study supports the use of a critical size femoral defect in rats as a suitable model for investigating modifications to the induced membrane technique without autograft harvest. Future investigations should focus on bioactive synthetic membranes coupled with growth factors for single-stage bone healing. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Malcolm R DeBaun
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Alexander M Stahl
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California.,Departiment of Chemistry, Stanford University, Stanford, California
| | - Adam I Daoud
- School of Medicine, Stanford University, Stanford, California
| | - Chi-Chun Pan
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California.,Departiment of Mechanical Engineering, Stanford University, Stanford, California
| | - Julius A Bishop
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Michael J Gardner
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Yunzhi P Yang
- Departiment of Orthopaedic Surgery, Stanford University, Stanford, California.,Material Science and Engineering, Stanford University, Stanford, California.,Departiment of Bioengineering, Stanford University, Stanford, California
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Ramachandran V, Wang R, Ramachandran SS, Ahmed AS, Phan K, Antonsen EL. Effects of spaceflight on cartilage: implications on spinal physiology. JOURNAL OF SPINE SURGERY 2018; 4:433-445. [PMID: 30069539 DOI: 10.21037/jss.2018.04.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spaceflight alters normal physiology of cells and tissues observed on Earth. The effects of spaceflight on the musculoskeletal system have been thoroughly studied, however, the effects on cartilage have not. This area is gaining more relevance as long duration missions, such as Mars, are planned. The impact on intervertebral discs and articular cartilage are of particular interest to astronauts and their physicians. This review surveys the literature and reports on the current body of knowledge regarding the effects of spaceflight on cartilage, and specifically changes to the spine and intervertebral disc integrity and physiology. A systematic literature review was conducted using PubMed, MEDLINE, and Google Scholar. Eighty-six unique papers were identified, 15 of which were included. The effect of spaceflight on cartilage is comprehensively presented due to limited research on the effect of microgravity on the spine/intervertebral discs. Cellular, animal, and human studies are discussed, focusing on human physiologic changes, cartilage histology, mineralization, biomechanics, chondrogenesis, and tissue engineering. Several common themes were found, such as decreased structural integrity of intervertebral disks and impaired osteogenesis/ossification. However, studies also presented conflicting results, rendering strong conclusions difficult. The paucity of human cartilage studies in spaceflight leaves extrapolation from other model systems the only current option for drawing conclusions despite known and unknown limitations in applicability to human physiology, especially spinal pathophysiology which is special interest. The aerospace and biomedical research communities would benefit from further human spaceflight articular cartilage and intervertebral disc studies. Further research may yield beneficial application for spaceflight, and crossover in understanding and treating terrestrial diseases like osteoarthritis and vertebral disc degeneration.
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Affiliation(s)
| | - Ruifei Wang
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Shyam S Ramachandran
- Department of Kinesiology and Health Education, University of Texas, Austin, TX, USA
| | - Adil S Ahmed
- Department of Orthopedic Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Randwick, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Erik L Antonsen
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.,National Aeronautics and Space Administration, Houston, TX, USA
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Reuss JM, Pi-Anfruns J, Moy PK. Is Bone Morphogenetic Protein-2 as Effective as Alveolar Distraction Osteogenesis for Vertical Bone Regeneration? J Oral Maxillofac Surg 2018; 76:752-760. [DOI: 10.1016/j.joms.2017.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022]
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Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2364269. [PMID: 29511673 PMCID: PMC5817297 DOI: 10.1155/2018/2364269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/10/2017] [Indexed: 11/18/2022]
Abstract
Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.
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Treatment of critical-sized bone defects: clinical and tissue engineering perspectives. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:351-362. [PMID: 29080923 DOI: 10.1007/s00590-017-2063-0] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/08/2017] [Indexed: 12/11/2022]
Abstract
Critical-sized bone defects are defined as those that will not heal spontaneously within a patient's lifetime. Current treatment options include vascularized bone grafts, distraction osteogenesis, and the induced membrane technique. The induced membrane technique is an increasingly utilized method with favorable results including high rates of union. Tissue engineering holds promise in the treatment of large bone defects due to advancement of stem cell biology, novel biomaterials, and 3D bioprinting. In this review, we provide an overview of the current operative treatment strategies of critical-sized bone defects as well as the current state of tissue engineering for such defects.
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Abstract
The treatment of chronic bone and joint infections is characterized by obstinate persistency of the causing microorganisms and resulting long term disability to patients, associated with remarkable costs for the health care system. Difficulties derive from biofilm formed on dead bone and eventual implants, with resistance against immunological defences and antimicrobial substances. Biofilm embedded bacteria require up to 1000 times the antibiotic concentration of planktonic bacteria for elimination. Systemic antibiotic treatment alone cannot provide the concentrations required and surgical intervention is always prerequisite for potentially providing a cure. A second issue is that osseous defects are almost always present after surgical debridement, and it is difficult to address their reconstruction. One option is to use bone grafts, either from the patient´s own body or from foreign donors (allografts). Grafts are usually unvascularized and are prone to colonization with bacteria. Loading of allografts with antibiotics may not only protect grafts from bacterial adhesion but, using appropriate processing methods, may also provide high local antibiotic concentrations that may eliminate remaining sessile pathogens. For efficient action as antibiotic carriers, the release of antibiotics should be above the minimum biofilm eradication concentration (MBEC) for a prolonged period of time. Cleaning the bone from bone marrow opens a large reservoir for storage of antimicrobial substances that, after implantation, may be released to the surrounding in a sustained mode, possibly eliminating remaining biofilm remnants. Removal of bone marrow, leaving a pure matrix, provides increased safety and improved revascularization of the graft. Local provision of antibiotic concentrations above the MBEC may enable simultaneous internal fixation with osteosynthetic material and single stage exchange of infected endoprostheses, resulting in shorter hospital stays with reduced pain and faster rehabilitation of patients.
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Affiliation(s)
- Heinz Winkler
- Osteitis Centre, Privatklinik Döbling Wien, Heiligenstaedter Strasse 57-63, A-1190 Wien, AUSTRIA
| | - Peter Haiden
- Department of Traumatology, Landesklinikum Korneuburg, Wiener Ring 3-5, 2100 Korneuburg, AUSTRIA
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Griffith M, Islam MM, Edin J, Papapavlou G, Buznyk O, Patra HK. The Quest for Anti-inflammatory and Anti-infective Biomaterials in Clinical Translation. Front Bioeng Biotechnol 2016; 4:71. [PMID: 27668213 PMCID: PMC5016531 DOI: 10.3389/fbioe.2016.00071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Biomaterials are now being used or evaluated clinically as implants to supplement the severe shortage of available human donor organs. To date, however, such implants have mainly been developed as scaffolds to promote the regeneration of failing organs due to old age or congenital malformations. In the real world, however, infection or immunological issues often compromise patients. For example, bacterial and viral infections can result in uncontrolled immunopathological damage and lead to organ failure. Hence, there is a need for biomaterials and implants that not only promote regeneration but also address issues that are specific to compromised patients, such as infection and inflammation. Different strategies are needed to address the regeneration of organs that have been damaged by infection or inflammation for successful clinical translation. Therefore, the real quest is for multifunctional biomaterials with combined properties that can combat infections, modulate inflammation, and promote regeneration at the same time. These strategies will necessitate the inclusion of methodologies for management of the cellular and signaling components elicited within the local microenvironment. In the development of such biomaterials, strategies range from the inclusion of materials that have intrinsic anti-inflammatory properties, such as the synthetic lipid polymer, 2-methacryloyloxyethyl phosphorylcholine (MPC), to silver nanoparticles that have antibacterial properties, to inclusion of nano- and micro-particles in biomaterials composites that deliver active drugs. In this present review, we present examples of both kinds of materials in each group along with their pros and cons. Thus, as a promising next generation strategy to aid or replace tissue/organ transplantation, an integrated smart programmable platform is needed for regenerative medicine applications to create and/or restore normal function at the cell and tissue levels. Therefore, now it is of utmost importance to develop integrative biomaterials based on multifunctional biopolymers and nanosystem for their practical and successful clinical translation.
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Affiliation(s)
- May Griffith
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
- Department of Neuroscience, Swedish Medical Nanoscience Center, Karolinska Institutet, Stockholm, Sweden
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Mohammad M. Islam
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
- Department of Neuroscience, Swedish Medical Nanoscience Center, Karolinska Institutet, Stockholm, Sweden
| | - Joel Edin
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
- Department of Neuroscience, Swedish Medical Nanoscience Center, Karolinska Institutet, Stockholm, Sweden
| | - Georgia Papapavlou
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - Oleksiy Buznyk
- Department of Eye Burns, Ophthalmic Reconstructive Surgery, Keratoplasty and Keratoprosthesis, Filatov Institute of Eye diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Hirak K. Patra
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
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Bottoni CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM, Rowles DJ. Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up. Am J Sports Med 2015; 43:2501-9. [PMID: 26311445 DOI: 10.1177/0363546515596406] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of allografts for anterior cruciate ligament (ACL) reconstruction in young athletes is controversial. No long-term results have been published comparing tibialis posterior allografts to hamstring autografts. PURPOSE To evaluate the long-term results of primary ACL reconstruction using either an allograft or autograft. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS From June 2002 to August 2003, patients with a symptomatic ACL-deficient knee were randomized to receive either a hamstring autograft or tibialis posterior allograft. All allografts were from a single tissue bank, aseptically processed, and fresh-frozen without terminal irradiation. Graft fixation was identical in all knees. All patients followed the same postoperative rehabilitation protocol, which was blinded to the therapists. Preoperative and postoperative assessments were performed via examination and/or telephone and Internet-based questionnaire to ascertain the functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status. RESULTS There were 99 patients (100 knees); 86 were men, and 95% were active-duty military. Both groups were similar in demographics and preoperative activity level. The mean and median ages of both groups were identical at 29 and 26 years, respectively. Concomitant meniscal and chondral pathologic abnormalities, microfracture, and meniscal repair performed at the time of reconstruction were similar in both groups. At a minimum of 10 years (range, 120-132 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased, and 1 was unable to be located). There were 4 (8.3%) autograft and 13 (26.5%) allograft failures that required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean Single Assessment Numeric Evaluation, Tegner, or International Knee Documentation Committee scores. CONCLUSION At a minimum of 10 years after ACL reconstruction in a young athletic population, over 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate over 3 times higher than those with an autograft.
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Affiliation(s)
- Craig R Bottoni
- Sports Medicine Section, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Eric L Smith
- Tufts Medical Center, Boston, Massachusetts, USA
| | - James Shaha
- Sports Medicine Section, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | | | - Sarah G Raybin
- Sports Medicine Section, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - John M Tokish
- Sports Medicine Section, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Douglas J Rowles
- Sports Medicine Section, Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
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Griffin KS, Davis KM, McKinley TO, Anglen JO, Chu TMG, Boerckel JD, Kacena MA. Evolution of Bone Grafting: Bone Grafts and Tissue Engineering Strategies for Vascularized Bone Regeneration. Clin Rev Bone Miner Metab 2015. [DOI: 10.1007/s12018-015-9194-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Angelozzi M, Miotto M, Penolazzi L, Mazzitelli S, Keane T, Badylak SF, Piva R, Nastruzzi C. Composite ECM-alginate microfibers produced by microfluidics as scaffolds with biomineralization potential. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 56:141-53. [PMID: 26249575 DOI: 10.1016/j.msec.2015.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/05/2015] [Accepted: 06/06/2015] [Indexed: 12/16/2022]
Abstract
A novel approach to produce artificial bone composites (microfibers) with distinctive features mimicking natural tissue was investigated. Currently proposed inorganic materials (e.g. apatite matrixes) lack self-assembly and thereby limit interactions between cells and the material. The present work investigates the feasibility of creating "bio-inspired materials" specifically designed to overcome certain limitations inherent to current biomaterials. We examined the dimensions, morphology, and constitutive features of a composite hydrogel which combined an alginate based microfiber with a gelatin solution or a particulate form of urinary bladder matrix (UBM). The effectiveness of the composite microfibers to induce and modulate osteoblastic differentiation in three-dimensional (3D) scaffolds without altering the viability and morphological characteristics of the cells was investigated. The present study describes a novel alginate microfiber production method with the use of microfluidics. The microfluidic procedure allowed for precise tuning of microfibers which resulted in enhanced viability and function of embedded cells.
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Affiliation(s)
- Marco Angelozzi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Martina Miotto
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Letizia Penolazzi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Stefania Mazzitelli
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Timothy Keane
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roberta Piva
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Claudio Nastruzzi
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
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β-Tricalcium phosphate for bone replacement: Stability and integration in sheep. J Biomech 2015; 48:1023-31. [DOI: 10.1016/j.jbiomech.2015.01.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/09/2015] [Accepted: 01/28/2015] [Indexed: 11/20/2022]
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Ono M, Sonoyama W, Yamamoto K, Oida Y, Akiyama K, Shinkawa S, Nakajima R, Pham HT, Hara ES, Kuboki T. Efficient Bone Formation in a Swine Socket Lift Model Using Escherichia coli-Derived Recombinant Human Bone Morphogenetic Protein-2 Adsorbed in β-Tricalcium Phosphate. Cells Tissues Organs 2015; 199:249-55. [DOI: 10.1159/000369061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 11/19/2022] Open
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Nelson C, Khan Y, Laurencin CT. Nanofiber-microsphere (nano-micro) matrices for bone regenerative engineering: a convergence approach toward matrix design. Regen Biomater 2014; 1:3-9. [PMID: 26816620 PMCID: PMC4669008 DOI: 10.1093/rb/rbu002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 12/24/2022] Open
Abstract
Bone is an essential organ for health and quality of life. Due to current shortfalls in therapy for bone tissue engineering, scientists have sought the application of synthetic materials as bone graft substitutes. As a composite organic/inorganic material with significant extra cellular matrix (ECM), one way to improve bone graft substitutes may be to engineer a synthetic matrix that is influenced by the physical appearance of natural ECM networks. In this work, the authors evaluate composite, hybrid scaffolds for bone tissue engineering based on composite ceramic/polymer microsphere scaffolds with synthetic ECM-mimetic networks in their pore spaces. Using thermally induced phase separation, nanoscale fibers were deposited in the pore spaces of structurally sound microsphere-based scaffold with a density proportionate to the initial polymer concentration. Porosimetry and mechanical testing indicated no significant changes in overall pore characteristics or mechanical integrity as a result of the fiber deposition process. These scaffolds displayed adequate mechanical integrity on the scale of human trabecular bone and supported the adhesion and proliferation of cultured mouse calvarial osteoblasts. Drawing from natural cues, these scaffolds may represent a new avenue forward for advanced bone tissue engineering scaffolds.
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Affiliation(s)
- Clarke Nelson
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA, Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA, Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA, Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Yusuf Khan
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA, Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA, Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA, Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T Laurencin
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA, Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA, Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA, Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
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The synthesis, characterisation and in vivo study of a bioceramic for potential tissue regeneration applications. Sci Rep 2014; 4:6235. [PMID: 25168046 PMCID: PMC4148651 DOI: 10.1038/srep06235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/12/2014] [Indexed: 01/05/2023] Open
Abstract
Hydroxyapatite (HAP) is a biocompatible ceramic that is currently used in a number of current biomedical applications. Recently, nanometre scale forms of HAP have attracted considerable interest due to their close similarity to the inorganic mineral component of the bone matrix found in humans. In this study ultrafine nanometre scale HAP powders were prepared via a wet precipitation method under the influence of ultrasonic irradiation. The resulting powders were compacted and sintered to form a series of ceramic pellets with a sponge-like structure with varying density and porosity. The crystalline structure, size and morphology of the powders and the porous ceramic pellets were investigated using advanced characterization techniques. The pellets demonstrated good biocompatibility, including mixed cell colonisation and matrix deposition, in vivo following surgical implantation into sheep M. latissimus dorsi.
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Sustained delivery of biomolecules from gelatin carriers for applications in bone regeneration. Ther Deliv 2014; 5:943-58. [DOI: 10.4155/tde.14.42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Local delivery of therapeutic biomolecules to stimulate bone regeneration has matured considerably during the past decades, but control over the release of these biomolecules still remains a major challenge. To this end, suitable carriers that allow for tunable spatial and temporal delivery of biomolecules need to be developed. Gelatin is one of the most widely used natural polymers for the controlled and sustained delivery of biomolecules because of its biodegradability, biocompatibility, biosafety and cost–effectiveness. The current study reviews the applications of gelatin as carriers in form of bulk hydrogels, microspheres, nanospheres, colloidal gels and composites for the programmed delivery of commonly used biomolecules for applications in bone regeneration with a specific focus on the relationship between carrier properties and delivery characteristics.
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Abstract
The conventional method for reconstructing acetabular bone loss at revision surgery includes using structural bone allograft. The disadvantages of this technique promoted the advent of metallic but biocompatible porous implants to fill bone defects enhancing initial and long-term stability of the acetabular component. This paper presents the indications, surgical technique and the outcome of using porous metal acetabular augments for reconstructing acetabular defects. Cite this article: Bone Joint J 2013;95-B, Supple A:103–8.
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Affiliation(s)
- M. Abolghasemian
- Iran University of Medical Sciences, Shafa
hospital, Jaleh Street, Baharestan
Square, Tehran, 1157637131, Iran
| | - S. Tangsataporn
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - A. Sternheim
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - D. J. Backstein
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - O. A. Safir
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - A. E. Gross
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
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