1
|
Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
Collapse
Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| |
Collapse
|
2
|
Mesenchymal stem cell-seeded porous tantalum-based biomaterial: A promising choice for promoting bone regeneration. Colloids Surf B Biointerfaces 2022; 215:112491. [PMID: 35405535 DOI: 10.1016/j.colsurfb.2022.112491] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 12/17/2022]
Abstract
Porous tantalum-based biomaterial is a novel tissue engineering material widely used in repairing bone defects due to its corrosion resistance, low elastic modulus, high friction coefficient, and excellent biocompatibility. Bone marrow-derived mesenchymal stem cells (BMSCs), a type of pluripotent stem cell, can travel from their original ecological niche to bone injury sites, where they differentiate into osteoblasts and osteocytes. Multiple factors regulate the proliferation, migration, and differentiation of BMSCs. In recent years, the regulatory effects of porous tantalum on BMSCs have been widely studied. Hence, in this study, we reviewed the characteristics of porous tantalum-based biomaterials and the mechanism of action of their regulatory effects on BMSCs. Further, we discuss the feasibility of seeding BMSCs in porous tantalum-based biomaterials for use in tissue repair.
Collapse
|
3
|
Liu B, Ma Z, Li J, Xie H, Wei X, Wang B, Tian S, Yang J, Yang L, Cheng L, Li L, Zhao D. Experimental study of a 3D printed permanent implantable porous Ta-coated bone plate for fracture fixation. Bioact Mater 2021; 10:269-280. [PMID: 34901545 PMCID: PMC8636709 DOI: 10.1016/j.bioactmat.2021.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/25/2021] [Accepted: 09/04/2021] [Indexed: 12/12/2022] Open
Abstract
Metal plates have always been the gold standard in the clinic for internal fracture fixation due to their high strength advantages. However, high elastic modulus can cause stress shielding and lead to bone embrittlement. This study used an electron beam melting method to prepare personalized porous Ti6Al4V (pTi) bone plates. Then, chemical vapor deposition (CVD) technology coats tantalum (Ta) metal on the pTi bone plates. The prepared porous Ta-coated bone plate has an elastic modulus similar to cortical bone, and no stress shielding occurred. In vitro experiments showed that compared with pTi plates, Ta coating significantly enhances the attachment and proliferation of cells on the surface of the scaffold. To better evaluate the function of the Ta-coated bone plate, animal experiments were conducted using a coat tibia fracture model. Our results showed that the Ta-coated bone plate could effectively fix the fracture. Both imaging and histological analysis showed that the Ta-coated bone plate had prominent indirect binding of callus formation. Histological results showed that new bone grew at the interface and formed good osseointegration with the host bone. Therefore, this study provides an alternative to bio-functional Ta-coated bone plates with improved osseointegration and osteogenic functions for orthopaedic applications. Porous Ta coated bone plate has a low elastic modulus, which can avoid stress shielding. Porous Ta coated bone plate has excellent biocompatibility and can be permanently implanted in the body. Porous Ta coated bone plate has excellent osseointegration properties and can promote fracture healing.
Collapse
Affiliation(s)
- Baoyi Liu
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Zhijie Ma
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Junlei Li
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Hui Xie
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Xiaowei Wei
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Benjie Wang
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Simiao Tian
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Jiahui Yang
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Lei Yang
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Liangliang Cheng
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Lu Li
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| | - Dewei Zhao
- Orthopaedic of Department, Affiliated ZhongShan Hospital of Dalian University, Dalian, 116001, China
| |
Collapse
|
4
|
Brodie EG, Robinson KJ, Sigston E, Molotnikov A, Frith JE. Osteogenic Potential of Additively Manufactured TiTa Alloys. ACS APPLIED BIO MATERIALS 2021. [DOI: 10.1021/acsabm.0c01450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Erin G. Brodie
- Department of Materials Science and Engineering, Monash University, Clayton, Victoria 3800, Australia
- Monash Centre for Additive Manufacturing (MCAM), 11 Normanby Road, Nottinghill, Victoria 3168, Australia
| | - Kye J. Robinson
- Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest-Ansermet 30, CH-1211 Geneva, Switzerland
| | - Elizabeth Sigston
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3800, Australia
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Clayton, Victoria 3168, Australia
| | - Andrey Molotnikov
- Department of Materials Science and Engineering, Monash University, Clayton, Victoria 3800, Australia
- Monash Centre for Additive Manufacturing (MCAM), 11 Normanby Road, Nottinghill, Victoria 3168, Australia
- RMIT Centre for Additive Manufacturing, School of Engineering, RMIT University, 3001 Melbourne, Australia
| | - Jessica E. Frith
- Department of Materials Science and Engineering, Monash University, Clayton, Victoria 3800, Australia
| |
Collapse
|
5
|
Wang C, Xu D, Li S, Yi C, Zhang X, He Y, Yu D. Effect of Pore Size on the Physicochemical Properties and Osteogenesis of Ti6Al4V Porous Scaffolds with Bionic Structure. ACS OMEGA 2020; 5:28684-28692. [PMID: 33195921 PMCID: PMC7658928 DOI: 10.1021/acsomega.0c03824] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2020] [Indexed: 05/08/2023]
Abstract
Ti6Al4V is widely used in implants in the fields of orthopedics and dentistry due to its high compressive strength and good biocompatibility. Nevertheless, Ti6Al4V has a certain degree of biological inertness and the elastic modulus of Ti6Al4V is much higher than the cortex and trabecular bone. In this study, we designed and printed a new type of pore size Ti6Al4V with like-trabecular structure scaffold (the pore size is 800/900/1000 μm, named P8/P9/P10, respectively) with electron beam melting (EBM). Its elastic modulus, compressive strength, and other physical and chemical properties, as well as cell adhesion, proliferation, and differentiation ability and in vitro biological properties were studied. The physical and chemical performance test results showed that as the pore size increased, the surface wettability increased and the elastic modulus decreased. As the pore size increased, F-actin and alkaline phosphatase (ALP) increased significantly, and osteogenesis-related genes including BMP2, OCN, RUNX2, and ALP were upregulated significantly. The reason may be that the components on the Ti6Al4V pore size may have an influence on intracellular signal conversion and then change the mode of cell proliferation and diffusion. In summary, the like-trabecular porous structure can effectively reduce the elastic modulus of metal materials, thereby avoiding stress concentration and promoting the adhesion and proliferation of osteoblasts. Porous materials with larger pores are more conducive to the proliferation and differentiation of osteoblasts. The irregular porous Ti6Al4V scaffold prepared by the EBM technology has good mechanical properties and the potential to promote adhesion, proliferation, and differentiation of osteoblasts, and has the possibility of application in the field of implantation.
Collapse
Affiliation(s)
- Chao Wang
- Guanghua
School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
- Guangdong
Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510050, China
| | - Duoling Xu
- Guanghua
School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
- Guangdong
Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510050, China
| | - Shujun Li
- Institute
of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Chen Yi
- Guanghua
School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
- Guangdong
Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510050, China
| | - Xiliu Zhang
- Guanghua
School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
- Guangdong
Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510050, China
| | - Yi He
- Guanghua
School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
- Guangdong
Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510050, China
| | - Dongsheng Yu
- Guanghua
School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
- Guangdong
Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510050, China
| |
Collapse
|
6
|
Zhang Y, Li C, Li L, Sun Y, Li Z, Mei Y, Feng X. Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis. J Orthop Surg Res 2020; 15:244. [PMID: 32631369 PMCID: PMC7339419 DOI: 10.1186/s13018-020-01764-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To design a new type of screw for minimally invasive atlantoaxial anterior transarticular screw (AATS) fixation with a diameter that is significantly thicker than that of traditional screws, threaded structures at both ends, and a porous metal structure in the middle. The use of a porous metal structure can effectively promote bone fusion and compensate for the disadvantages of traditional AATSs in terms of insufficient fixation strength and difficulty of bone fusion. The biomechanical stability of this screw was verified through finite element analysis. This instrument may provide a new surgical option for the treatment of atlantoaxial disorders. METHODS According to the surgical procedure, the new type of AATS was placed in a three-dimensional atlantoaxial model to determine the setting of relevant parameters such as the diameter, length, and thread to porous metal ratio of the structure. According to the results of measurement, the feasibility and safety of the new AATS were verified, and a representative finite element model of the upper cervical vertebrae was chosen to establish, and the validity of the model was verified. Then, finite element-based biomechanical analysis was performed using three models, i.e., atlantoaxial posterior pedicle screw fixation, traditional atlantoaxial AATS fixation, and atlantoaxial AATS fixation with the new type of screw, and the biomechanical effectiveness of the novel AATS was verified. RESULTS By measuring the atlantoaxial parameters, the atlantoaxial CT data of the representative 30-year-old normal adult male were selected to create a personalized 3D printing AATS screw. In this case, the design parameters of the new screw were determined as follows: diameter, 6 mm; length of the head thread structure, 10 mm; length of the middle porous metal structure, 8 mm (a middle porous structure containing an annular cylinder ); length of the tail thread structure, 8 mm; and total length, 26 mm. Applying the same load conditions to the atlantoaxial complex along different directions in the established finite element models of the three types of atlantoaxial fusion modes, the immediate stability of the new AATS is similar with Atlantoaxial posterior pedicle screw fixation.They are both superior to traditional atlantoaxial anterior screw fixation.The maximum local stress on the screw head in the atlantoaxial anterior surgery was less than those of traditional atlantoaxial anterior surgery. CONCLUSIONS By measuring relevant atlantoaxial data, we found that screws with a larger diameter can be used in AATS surgery, and the new AATS can make full use of the atlantoaxial lateral mass space and increase the stability of fixation. The finite element analysis and verification revealed that the biomechanical stability of the new AATS was superior to the AATS used in traditional atlantoaxial AATS fixation. The porous metal structure of the new AATS may promote fusion between atlantoaxial joints and allow more effective bone fusion in the minimally invasive anterior approach surgery.
Collapse
Affiliation(s)
- Yingkai Zhang
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Cheng Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Lei Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China.
| | - Yanyan Sun
- Shandong Weigao Orthopaedic Device co., Ltd., Weihai, 264300, People's Republic of China
| | - Zeqing Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Yunli Mei
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Xinyuan Feng
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| |
Collapse
|
7
|
Affiliation(s)
- Hans-Joerg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost, Halle, Germany
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost, Halle, Germany
| |
Collapse
|
8
|
Xu Y, Chen C, Hellwarth PB, Bao X. Biomaterials for stem cell engineering and biomanufacturing. Bioact Mater 2019; 4:366-379. [PMID: 31872161 PMCID: PMC6909203 DOI: 10.1016/j.bioactmat.2019.11.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 12/15/2022] Open
Abstract
Recent years have witnessed the expansion of tissue failures and diseases. The uprising of regenerative medicine converges the sight onto stem cell-biomaterial based therapy. Tissue engineering and regenerative medicine proposes the strategy of constructing spatially, mechanically, chemically and biologically designed biomaterials for stem cells to grow and differentiate. Therefore, this paper summarized the basic properties of embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs) and adult stem cells. The properties of frequently used biomaterials were also described in terms of natural and synthetic origins. Particularly, the combination of stem cells and biomaterials for tissue repair applications was reviewed in terms of nervous, cardiovascular, pancreatic, hematopoietic and musculoskeletal system. Finally, stem-cell-related biomanufacturing was envisioned and the novel biofabrication technologies were discussed, enlightening a promising route for the future advancement of large-scale stem cell-biomaterial based therapeutic manufacturing.
Collapse
Affiliation(s)
- Yibo Xu
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, West Lafayette, IN, 47907, USA
| | - Chuanxin Chen
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, West Lafayette, IN, 47907, USA
| | - Peter B Hellwarth
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, West Lafayette, IN, 47907, USA
| | - Xiaoping Bao
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, West Lafayette, IN, 47907, USA
| |
Collapse
|
9
|
Li N, Hu WQ, Xin WQ, Li QF, Tian P. Comparison between porous tantalum metal implants and autograft in anterior cervical discectomy and fusion: a meta-analysis. J Comp Eff Res 2019; 8:511-521. [PMID: 30907632 DOI: 10.2217/cer-2018-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Aim: The objective of this study was to systematically compare the safety and efficacy of porous tantalum metal (TM) implants and autograft in single-level anterior cervical discectomy and fusion. Methods: Potential academic articles were acquired from the Cochrane Library, Medline, PubMed, Embase, Science Direct and other databases. The time range used was from the inception of the electronic databases to March 2018. Gray studies were identified from the references of included literature reports. STATA version 11.0 (Stata Corporation, TX, USA) was used to analyze the pooled data. Results: Four randomized, controlled trials (RCTs) were identified according to the retrieval process. There were significant differences in operation time (mean difference [MD]: -28.846, 95% confidence interval [CI: -47.087, -10.604], p = 0.002) and satisfaction rate (odds ratio [OR]: 2.196, 95% CI: [1.061-4. 546]; p = 0.034). However, no significant difference was detected in blood loss (MD: -73.606, 95% CI: [-217.720, 70.509], p = 0.317), hospital stay (MD: -0.512, 95% CI [-1.082, 0.058]; p = 0.079), fusion rate (OR: 0.497, 95% CI [0.079, 3.115]; p = 0.455), visual analog scale (MD: -0.310, 95% CI [-0.433, -0.186]; p < 0.001) or complication rate (risk difference [RD]: -0.140, 95% CI: [-0.378, 0.099]; p = 0.251). Conclusion: Porous TM implants are equally as effective and safe as autograft in anterior cervical discectomy and fusion processes. In addition, porous TM implants could reduce operation time and improve clinical satisfaction significantly.
Collapse
Affiliation(s)
- Na Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China, 300052
| | - Wen-Qing Hu
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China, 300052
| | - Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China, 30052
| | - Qi-Feng Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China, 30052
| | - Peng Tian
- Department of Orthopedics, Tianjin Hospital, Tianjin, PR China, 300211
| |
Collapse
|
10
|
Abstract
Limb salvage is widely practiced as standard of care in most cases of extremity bone sarcoma. Allograft and endoprosthesis reconstructions are the most widely utilized modalities for the reconstruction of large segment defects, however complication rates remain high. Aseptic loosening and infection remain the most common modes of failure. Implant integration, soft-tissue function, and infection prevention are crucial for implant longevity and function. Macro and micro alterations in implant design are reviewed in this manuscript. Tissue engineering principles using nanoparticles, cell-based, and biological augments have been utilized to develop implant coatings that improve osseointegration and decrease infection. Similar techniques have been used to improve the interaction between soft tissues and implants. Tissue engineered constructs (TEC) used in combination with, or in place of, traditional reconstructive techniques may represent the next major advancement in orthopaedic oncology reconstructive science, although preclinical results have yet to achieve durable translation to the bedside.
Collapse
|
11
|
Paim Á, Tessaro IC, Cardozo NSM, Pranke P. Mesenchymal stem cell cultivation in electrospun scaffolds: mechanistic modeling for tissue engineering. J Biol Phys 2018; 44:245-271. [PMID: 29508186 PMCID: PMC6082795 DOI: 10.1007/s10867-018-9482-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/19/2018] [Indexed: 12/17/2022] Open
Abstract
Tissue engineering is a multidisciplinary field of research in which the cells, biomaterials, and processes can be optimized to develop a tissue substitute. Three-dimensional (3D) architectural features from electrospun scaffolds, such as porosity, tortuosity, fiber diameter, pore size, and interconnectivity have a great impact on cell behavior. Regarding tissue development in vitro, culture conditions such as pH, osmolality, temperature, nutrient, and metabolite concentrations dictate cell viability inside the constructs. The effect of different electrospun scaffold properties, bioreactor designs, mesenchymal stem cell culture parameters, and seeding techniques on cell behavior can be studied individually or combined with phenomenological modeling techniques. This work reviews the main culture and scaffold factors that affect tissue development in vitro regarding the culture of cells inside 3D matrices. The mathematical modeling of the relationship between these factors and cell behavior inside 3D constructs has also been critically reviewed, focusing on mesenchymal stem cell culture in electrospun scaffolds.
Collapse
Affiliation(s)
- Ágata Paim
- Department of Chemical Engineering, Universidade Federal do Rio Grande do Sul (UFRGS), R. Eng. Luis Englert, s/n, Porto Alegre, Rio Grande do Sul, 90040-040, Brazil.
| | - Isabel C Tessaro
- Department of Chemical Engineering, Universidade Federal do Rio Grande do Sul (UFRGS), R. Eng. Luis Englert, s/n, Porto Alegre, Rio Grande do Sul, 90040-040, Brazil
| | - Nilo S M Cardozo
- Department of Chemical Engineering, Universidade Federal do Rio Grande do Sul (UFRGS), R. Eng. Luis Englert, s/n, Porto Alegre, Rio Grande do Sul, 90040-040, Brazil
| | - Patricia Pranke
- Faculty of Pharmacy, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ipiranga, 2752, Porto Alegre, Rio Grande do Sul, 90610-000, Brazil
- Stem Cell Research Institute, Porto Alegre, Rio Grande do Sul, 90020-010, Brazil
| |
Collapse
|
12
|
Kapat K, Srivas PK, Rameshbabu AP, Maity PP, Jana S, Dutta J, Majumdar P, Chakrabarti D, Dhara S. Influence of Porosity and Pore-Size Distribution in Ti 6Al 4 V Foam on Physicomechanical Properties, Osteogenesis, and Quantitative Validation of Bone Ingrowth by Micro-Computed Tomography. ACS APPLIED MATERIALS & INTERFACES 2017; 9:39235-39248. [PMID: 29058878 DOI: 10.1021/acsami.7b13960] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Cementless fixation for orthopedic implants aims to obviate challenges associated with bone cement, providing long-term stability of bone prostheses after implantation. The application of porous titanium and its alloy-based implants is emerging for load-bearing applications due to their high specific strength, low stiffness, corrosion resistance, and superior osteoconductivity. In this study, coagulant-assisted foaming was utilized for the fabrication of porous Ti6Al4 V using egg-white foam. Samples with three different porosities of 68.3%, 75.4%, and 83.1% and average pore sizes of 92, 178, and 297 μm, respectively, were prepared and subsequently characterized for mechanical properties, osteogenesis, and tissue ingrowth. A microstructure-mechanical properties relationship study revealed that an increase of porosity from 68.3 to 83.1% increased the average pore size from 92 to 297 μm with the subsequent reduction of compresive strength by 85% and modulus by 90%. Samples with 75.4% porosity and a 178 μm average pore size produced signifcant osteogenic effects on human mesenchymal stem cells, which was further supported by immunocytochemistry and real-time polymerase chain reaction data. Quantitative assessment of bone ingrowth by micro-computed tomography revealed that there was an approximately 52% higher bone formation and more than 90% higher bone penetration at the center of femoral defects in rabbit when implanted with Ti6Al4 V foam (75.4% porosity) compared to the empty defects after 12 weeks. Hematoxylin and eosin (H&E) and Masson trichrome (MT) staining along with energy-dispersive X-ray mapping on the sections obtained from the retrieved bone samples support bone ingrowth into the implanted region.
Collapse
Affiliation(s)
- Kausik Kapat
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Pavan Kumar Srivas
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Arun Prabhu Rameshbabu
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Priti Prasanna Maity
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Subhodeep Jana
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Joy Dutta
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Pallab Majumdar
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Debalay Chakrabarti
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| | - Santanu Dhara
- Biomaterials & Tissue Engineering Laboratory, School of Medical Science & Technology and ‡Department of Metallurgical and Materials Engineering, Indian Institute of Technology , Kharagpur, India , 721302
| |
Collapse
|
13
|
Metals in Spine. World Neurosurg 2017; 100:619-627. [DOI: 10.1016/j.wneu.2016.12.105] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 02/06/2023]
|
14
|
Lewallen EA, Jones DL, Dudakovic A, Thaler R, Paradise CR, Kremers HM, Abdel MP, Kakar S, Dietz AB, Cohen RC, Lewallen DG, van Wijnen AJ. Osteogenic potential of human adipose-tissue-derived mesenchymal stromal cells cultured on 3D-printed porous structured titanium. Gene 2016; 581:95-106. [PMID: 26774799 PMCID: PMC5054723 DOI: 10.1016/j.gene.2016.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/12/2016] [Indexed: 01/08/2023]
Abstract
Integration of porous metal prosthetics, which restore form and function of irreversibly damaged joints, into remaining healthy bone is critical for implant success. We investigated the biological properties of adipose-tissue-derived mesenchymal stromal/stem cells (AMSCs) and addressed their potential to alter the in vitro microenvironment of implants. We employed human AMSCs as a practical source for musculoskeletal applications because these cells can be obtained in large quantities, are multipotent, and have trophic paracrine functions. AMSCs were cultured on surgical-grade porous titanium disks as a model for orthopedic implants. We monitored cell/substrate attachment, cell proliferation, multipotency, and differentiation phenotypes of AMSCs upon osteogenic induction. High-resolution scanning electron microscopy and histology revealed that AMSCs adhere to the porous metallic surface. Compared to standard tissue culture plastic, AMSCs grown in the porous titanium microenvironment showed differences in temporal expression for genes involved in cell cycle progression (CCNB2, HIST2H4), extracellular matrix production (COL1A1, COL3A1), mesenchymal lineage identity (ACTA2, CD248, CD44), osteoblastic transcription factors (DLX3, DLX5, ID3), and epigenetic regulators (EZH1, EZH2). We conclude that metal orthopedic implants can be effectively seeded with clinical-grade stem/stromal cells to create a pre-conditioned implant.
Collapse
Affiliation(s)
- Eric A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Dakota L Jones
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Department of Biomedical Engineering and Physiology, Mayo Graduate School, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Roman Thaler
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Christopher R Paradise
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Hilal M Kremers
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW Rochester, MN 55905, USA
| | - Robert C Cohen
- Stryker Orthopedics, 325 Corporate Drive, Mahwah, NJ 07430, USA
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Department of Biomedical Engineering and Physiology, Mayo Graduate School, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| |
Collapse
|
15
|
Additively manufactured porous tantalum implants. Acta Biomater 2015; 14:217-25. [PMID: 25500631 DOI: 10.1016/j.actbio.2014.12.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/25/2014] [Accepted: 12/04/2014] [Indexed: 12/27/2022]
Abstract
The medical device industry's interest in open porous, metallic biomaterials has increased in response to additive manufacturing techniques enabling the production of complex shapes that cannot be produced with conventional techniques. Tantalum is an important metal for medical devices because of its good biocompatibility. In this study selective laser melting technology was used for the first time to manufacture highly porous pure tantalum implants with fully interconnected open pores. The architecture of the porous structure in combination with the material properties of tantalum result in mechanical properties close to those of human bone and allow for bone ingrowth. The bone regeneration performance of the porous tantalum was evaluated in vivo using an orthotopic load-bearing bone defect model in the rat femur. After 12 weeks, substantial bone ingrowth, good quality of the regenerated bone and a strong, functional implant-bone interface connection were observed. Compared to identical porous Ti-6Al-4V structures, laser-melted tantalum shows excellent osteoconductive properties, has a higher normalized fatigue strength and allows for more plastic deformation due to its high ductility. It is therefore concluded that this is a first step towards a new generation of open porous tantalum implants manufactured using selective laser melting.
Collapse
|
16
|
Abstract
Since Brånemark discovered the favorable effects of titanium in bone healing in 1965, titanium has emerged as the gold standard bulk material for present-time dental implantology. In the course of years researchers aimed for improvement of the implants performance in bone even at compromised implant sites and multiple factors were investigated influencing osseointegration. This review summarizes and clarifies the four factors that are currently recognized being relevant to influence the tissue-implant contact ratio: bulk materials and coatings, topography, surface energy, and biofunctionalization. The macrodesigns of bulk materials (e.g., titanium, zirconium, stainless steel, tantalum, and magnesium) provide the mechanical stability and their influence on bone cells can be additionally improved by surface treatment with various materials (calcium phosphates, strontium, bioglasses, diamond-like carbon, and diamond). Surface topography can be modified via different techniques to increase the bone-implant contact, for example, plasma-spraying, grit-blasting, acid-etching, and microarc oxidation. Surface energy (e.g., wettability and polarity) showed a strong effect on cell behavior and cell adhesion. Functionalization with bioactive molecules (via physisorption, covalent binding, or carrier systems) targets enhanced osseointegration. Despite the satisfying clinical results of presently used dental implant materials, further research on innovative implant surfaces is inevitable to pursuit perfection in soft and hard tissue performance.
Collapse
|
17
|
Lewallen EA, Riester SM, Bonin CA, Kremers HM, Dudakovic A, Kakar S, Cohen RC, Westendorf JJ, Lewallen DG, van Wijnen AJ. Biological strategies for improved osseointegration and osteoinduction of porous metal orthopedic implants. TISSUE ENGINEERING PART B-REVIEWS 2014; 21:218-30. [PMID: 25348836 DOI: 10.1089/ten.teb.2014.0333] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The biological interface between an orthopedic implant and the surrounding host tissue may have a dramatic effect upon clinical outcome. Desired effects include bony ingrowth (osseointegration), stimulation of osteogenesis (osteoinduction), increased vascularization, and improved mechanical stability. Implant loosening, fibrous encapsulation, corrosion, infection, and inflammation, as well as physical mismatch may have deleterious clinical effects. This is particularly true of implants used in the reconstruction of load-bearing synovial joints such as the knee, hip, and the shoulder. The surfaces of orthopedic implants have evolved from solid-smooth to roughened-coarse and most recently, to porous in an effort to create a three-dimensional architecture for bone apposition and osseointegration. Total joint surgeries are increasingly performed in younger individuals with a longer life expectancy, and therefore, the postimplantation lifespan of devices must increase commensurately. This review discusses advancements in biomaterials science and cell-based therapies that may further improve orthopedic success rates. We focus on material and biological properties of orthopedic implants fabricated from porous metal and highlight some relevant developments in stem-cell research. We posit that the ideal primary and revision orthopedic load-bearing metal implants are highly porous and may be chemically modified to induce stem cell growth and osteogenic differentiation, while minimizing inflammation and infection. We conclude that integration of new biological, chemical, and mechanical methods is likely to yield more effective strategies to control and modify the implant-bone interface and thereby improve long-term clinical outcomes.
Collapse
|
18
|
Rivard J, Brailovski V, Dubinskiy S, Prokoshkin S. Fabrication, morphology and mechanical properties of Ti and metastable Ti-based alloy foams for biomedical applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 45:421-33. [DOI: 10.1016/j.msec.2014.09.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/08/2014] [Accepted: 09/23/2014] [Indexed: 01/20/2023]
|
19
|
Chang YY, Huang HL, Chen YC, Hsu JT, Shieh TM, Tsai MT. Biological characteristics of the MG-63 human osteosarcoma cells on composite tantalum carbide/amorphous carbon films. PLoS One 2014; 9:e95590. [PMID: 24760085 PMCID: PMC3997409 DOI: 10.1371/journal.pone.0095590] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/28/2014] [Indexed: 02/06/2023] Open
Abstract
Tantalum (Ta) is a promising metal for biomedical implants or implant coating for orthopedic and dental applications because of its excellent corrosion resistance, fracture toughness, and biocompatibility. This study synthesizes biocompatible tantalum carbide (TaC) and TaC/amorphous carbon (a-C) coatings with different carbon contents by using a twin-gun magnetron sputtering system to improve their biological properties and explore potential surgical implant or device applications. The carbon content in the deposited coatings was regulated by controlling the magnetron power ratio of the pure graphite and Ta cathodes. The deposited TaC and TaC/a-C coatings exhibited better cell viability of human osteosarcoma cell line MG-63 than the uncoated Ti and Ta-coated samples. Inverted optical and confocal imaging was used to demonstrate the cell adhesion, distribution, and proliferation of each sample at different time points during the whole culture period. The results show that the TaC/a-C coating, which contained two metastable phases (TaC and a-C), was more biocompatible with MG-63 cells compared to the pure Ta coating. This suggests that the TaC/a-C coatings exhibit a better biocompatible performance for MG-63 cells, and they may improve implant osseointegration in clinics.
Collapse
Affiliation(s)
- Yin-Yu Chang
- Department of Mechanical and Computer-Aided Engineering, National Formosa University, Yunlin, Taiwan
| | - Heng-Li Huang
- School of Dentistry, China Medical University, Taichung, Taiwan
| | - Ya-Chi Chen
- Department of Materials Science and Engineering, Mingdao University, Changhua, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, China Medical University, Taichung, Taiwan
| | - Tzong-Ming Shieh
- Department of Dental Hygiene, China Medical University, Taichung, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
20
|
Ninomiya JT, Struve JA, Krolikowski J, Hawkins M, Weihrauch D. Porous ongrowth surfaces alter osteoblast maturation and mineralization. J Biomed Mater Res A 2014; 103:276-81. [DOI: 10.1002/jbm.a.35140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- James T. Ninomiya
- Department of Orthopaedic Surgery; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Janine A. Struve
- Department of Orthopaedic Surgery; Medical College of Wisconsin; Milwaukee Wisconsin
| | - John Krolikowski
- Department of Anesthesiology; Medical College of Wisconsin; Milwaukee Wisconsin
| | | | - Dorothee Weihrauch
- Department of Anesthesiology; Medical College of Wisconsin; Milwaukee Wisconsin
| |
Collapse
|
21
|
Evans NR, Davies EM, Dare CJ, Oreffo RO. Tissue engineering strategies in spinal arthrodesis: the clinical imperative and challenges to clinical translation. Regen Med 2013; 8:49-64. [PMID: 23259805 DOI: 10.2217/rme.12.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Skeletal disorders requiring the regeneration or de novo production of bone present considerable reconstructive challenges and are one of the main driving forces for the development of skeletal tissue engineering strategies. The skeletal or mesenchymal stem cell is a fundamental requirement for osteogenesis and plays a pivotal role in the design and application of these strategies. Research activity has focused on incorporating the biological role of the mesenchymal stem cell with the developing fields of material science and gene therapy in order to create a construct that is not only capable of inducing host osteoblasts to produce bone, but is also osteogenic in its own right. This review explores the clinical need for reparative approaches in spinal arthrodesis, identifying recent tissue engineering strategies employed to promote spinal fusion, and considers the ongoing challenges to successful clinical translation.
Collapse
Affiliation(s)
- Nick R Evans
- Bone & Joint Research Group, Centre for Human Development, Stem Cells & Regeneration, Human Development & Health, Institute of Developmental Sciences, Southampton General Hospital, Southampton, UK.
| | | | | | | |
Collapse
|
22
|
Preparation, modification, and characterization of alginate hydrogel with nano-/microfibers: a new perspective for tissue engineering. BIOMED RESEARCH INTERNATIONAL 2013; 2013:307602. [PMID: 23862142 PMCID: PMC3687604 DOI: 10.1155/2013/307602] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 05/10/2013] [Indexed: 01/22/2023]
Abstract
We aimed to develop an alginate hydrogel (AH) modified with nano-/microfibers of titanium dioxide (nfTD) and hydroxyapatite (nfHY) and evaluated its biological and chemical properties. Nano-/microfibers of nfTD and nfHY were combined with AH, and its chemical properties were evaluated by FTIR spectroscopy, X-ray diffraction, energy dispersive X-Ray analysis, and the cytocompatibility by the WST-1 assay. The results demonstrate that the association of nfTD and nfHY nano-/microfibers to AH did not modified the chemical characteristics of the scaffold and that the association was not cytotoxic. In the first 3 h of culture with NIH/3T3 cells nfHY AH scaffolds showed a slight increase in cell viability when compared to AH alone or associated with nfTD. However, an increase in cell viability was observed in 24 h when nfTD was associated with AH scaffold. In conclusion our study demonstrates that the combination of nfHY and nfTD nano-/microfibers in AH scaffold maintains the chemical characteristics of alginate and that this association is cytocompatible. Additionally the combination of nfHY with AH favored cell viability in a short term, and the addition of nfTD increased cell viability in a long term.
Collapse
|
23
|
Xiao Q, Bu W, Ren Q, Zhang S, Xing H, Chen F, Li M, Zheng X, Hua Y, Zhou L, Peng W, Qu H, Wang Z, Zhao K, Shi J. Radiopaque fluorescence-transparent TaOx decorated upconversion nanophosphors for in vivo CT/MR/UCL trimodal imaging. Biomaterials 2012; 33:7530-9. [DOI: 10.1016/j.biomaterials.2012.06.028] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/16/2012] [Indexed: 12/26/2022]
|
24
|
Guerado E, Andrist T, Andrades J, Santos L, Cerván A, Guerado G, Becerra J. Spinal arthrodesis. Basic science. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
25
|
Guerado E, Andrist T, Andrades JA, Santos L, Cerván A, Guerado G, Becerra J. [Spinal arthrodesis. basic science]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 56:227-44. [PMID: 23594811 DOI: 10.1016/j.recot.2012.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 01/19/2012] [Indexed: 01/01/2023] Open
Abstract
Spinal arthrodesis consists of a combination of a system of mechanical stabilisation of one or more vertebral segments with a biological substance that promotes osteoneogenesis, with aim of achieving the permanent fusion between areas more or less the same size of these segments. In spinal arthrodesis, the biological support par excellence is the autograft. However, obtaining this involves a high incidence of morbidity and, in cases of arthrodesis of more than one intervertebral space, the quantity available is usually insufficient. The extraction and implantation time prolongs the surgery, increasing the exposure to and risk of bleeding and infection. For these reasons, there is a search for substances that possess the properties of the autograft, avoiding the morbidity and added surgical time required to extract the autograft. The biomechanical-biological interaction in vertebral arthrodesis has been studied in this article.
Collapse
Affiliation(s)
- E Guerado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Costa del Sol, Universidad de Málaga, Marbella, Málaga, España.
| | | | | | | | | | | | | |
Collapse
|