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Schröter L, Kaiser F, Preißler AL, Wohlfahrt P, Küppers O, Gbureck U, Ignatius A. Ready-To-Use and Rapidly Biodegradable Magnesium Phosphate Bone Cement: In Vivo Evaluation in Sheep. Adv Healthc Mater 2023; 12:e2300914. [PMID: 37224104 DOI: 10.1002/adhm.202300914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Indexed: 05/26/2023]
Abstract
In clinical practice, hydroxyapatite (HA) cements for bone defect treatment are frequently prepared by mixing a powder component and a liquid component shortly before implantation in the operation theater, which is time-consuming and error-prone. In addition, HA cements are only slightly resorbed, that is, cement residues can still be found in the bone years after implantation. Here, these challenges are addressed by a prefabricated magnesium phosphate cement paste based on glycerol, which is ready-to-use and can be directly applied during surgery. By using a trimodal particle size distribution (PSD), the paste is readily injectable and exhibits a compressive strength of 9-14 MPa after setting. Struvite (MgNH4 PO4 ·6H2 O), dittmarite (MgNH4 PO4 ·H2 O), farringtonite (Mg3 (PO4 )2 ), and newberyite (MgHPO4 ·3H2 O) are the mineral phases present in the set cement. The paste developed here features a promising degradation of 37% after four months in an ovine implantation model, with 25% of the implant area being newly formed bone. It is concluded that the novel prefabricated paste improves application during surgery, has a suitable degradation rate, and supports bone regeneration.
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Affiliation(s)
- Lena Schröter
- Institute for Orthopedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081, Ulm, Germany
| | - Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070, Würzburg, Germany
| | - Anna-Lena Preißler
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070, Würzburg, Germany
| | - Philipp Wohlfahrt
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070, Würzburg, Germany
| | - Oliver Küppers
- Institute for Orthopedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081, Ulm, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, D-97070, Würzburg, Germany
| | - Anita Ignatius
- Institute for Orthopedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstraße 14, D-89081, Ulm, Germany
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Injectable bioactive polymethyl methacrylate–hydrogel hybrid bone cement loaded with BMP-2 to improve osteogenesis for percutaneous vertebroplasty and kyphoplasty. Biodes Manuf 2022. [DOI: 10.1007/s42242-021-00172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kinne RW, Gunnella F, Kunisch E, Heinemann S, Nies B, Maenz S, Horbert V, Illerhaus B, Huber R, Firkowska-Boden I, Bossert J, Jandt KD, Sachse A, Bungartz M, Brinkmann O. Performance of Calcium Phosphate Cements in the Augmentation of Sheep Vertebrae-An Ex Vivo Study. MATERIALS 2021; 14:ma14143873. [PMID: 34300793 PMCID: PMC8307240 DOI: 10.3390/ma14143873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
Oil-based calcium phosphate cement (Paste-CPC) shows not only prolonged shelf life and injection times, but also improved cohesion and reproducibility during application, while retaining the advantages of fast setting, mechanical strength, and biocompatibility. In addition, poly(L-lactide-co-glycolide) (PLGA) fiber reinforcement may decrease the risk for local extrusion. Bone defects (diameter 5 mm; depth 15 mm) generated ex vivo in lumbar (L) spines of female Merino sheep (2–4 years) were augmented using: (i) water-based CPC with 10% PLGA fiber reinforcement (L3); (ii) Paste-CPC (L4); or (iii) clinically established polymethylmethacrylate (PMMA) bone cement (L5). Untouched (L1) and empty vertebrae (L2) served as controls. Cement performance was analyzed using micro-computed tomography, histology, and biomechanical testing. Extrusion was comparable for Paste-CPC(-PLGA) and PMMA, but significantly lower for CPC + PLGA. Compressive strength and Young’s modulus were similar for Paste-CPC and PMMA, but significantly higher compared to those for empty defects and/or CPC + PLGA. Expectedly, all experimental groups showed significantly or numerically lower compressive strength and Young’s modulus than those of untouched controls. Ready-to-use Paste-CPC demonstrates a performance similar to that of PMMA, but improved biomechanics compared to those of water-based CPC + PLGA, expanding the therapeutic arsenal for bone defects. O, significantly lower extrusion of CPC + PLGA fibers into adjacent lumbar spongiosa may help to reduce the risk of local extrusion in spinal surgery.
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Affiliation(s)
- Raimund W. Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Correspondence: ; Tel.: +49-36691-81228
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Sascha Heinemann
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany; (S.H.); (B.N.)
| | - Berthold Nies
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany; (S.H.); (B.N.)
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Bernhard Illerhaus
- BAM Bundesanstalt für Materialforschung und –Prüfung (BAM), 12205 Berlin, Germany;
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany;
| | - Izabela Firkowska-Boden
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
| | - Klaus D. Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
- Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, 07743 Jena, Germany
| | - André Sachse
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
| | - Matthias Bungartz
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
| | - Olaf Brinkmann
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
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Schröter L, Kaiser F, Stein S, Gbureck U, Ignatius A. Biological and mechanical performance and degradation characteristics of calcium phosphate cements in large animals and humans. Acta Biomater 2020; 117:1-20. [PMID: 32979583 DOI: 10.1016/j.actbio.2020.09.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/21/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
Calcium phosphate cements (CPCs) have been used to treat bone defects and support bone regeneration because of their good biocompatibility and osteointegrative behavior. Since their introduction in the 1980s, remarkable clinical success has been achieved with these biomaterials, because they offer the unique feature of being moldable and even injectable into implant sites, where they harden through a low-temperature setting reaction. However, despite decades of research efforts, two major limitations concerning their biological and mechanical performance hamper a broader clinical use. Firstly, achieving a degradation rate that is well adjusted to the dynamics of bone formation remains a challenging issue. While apatite-forming CPCs frequently remain for years at the implant site without major signs of degradation, brushite-forming CPCs are considered to degrade to a greater extent. However, the latter tend to convert into lower soluble phases under physiological conditions, which makes their degradation behavior rather unpredictable. Secondly, CPCs exhibit insufficient mechanical properties for load bearing applications because of their inherent brittleness. This review places an emphasis on these limitations and provides an overview of studies that have investigated the biological and biomechanical performance as well as the degradation characteristics of different CPCs after implantation into trabecular bone. We reviewed studies performed in large animals, because they mimic human bone physiology more closely in terms of bone metabolism and mechanical loading conditions compared with small laboratory animals. We compared the results of these studies with clinical trials that have dealt with the degradation behavior of CPCs after vertebroplasty and kyphoplasty.
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Affiliation(s)
- Lena Schröter
- Institute for Orthopedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstrasse 14, D-89081 Ulm, Germany
| | - Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Svenja Stein
- Institute for Orthopedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstrasse 14, D-89081 Ulm, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany.
| | - Anita Ignatius
- Institute for Orthopedic Research and Biomechanics, Ulm University Medical Center, Helmholtzstrasse 14, D-89081 Ulm, Germany
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de Lacerda Schickert S, van den Beucken JJ, Leeuwenburgh SC, Jansen JA. Pre-Clinical Evaluation of Biological Bone Substitute Materials for Application in Highly Loaded Skeletal Sites. Biomolecules 2020; 10:E883. [PMID: 32526829 PMCID: PMC7356650 DOI: 10.3390/biom10060883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The development of bone substitute materials (BSMs) intended for load-bearing bone defects is highly complicated, as biological and mechanical requirements are often contradictory. In recent years, biological BSMs have been developed which allow for a more efficient integration of the material with the surrounding osseous environment and, hence, a higher mechanical stability of the treated defect. However, while these materials are promising, they are still far from ideal. Consequently, extensive preclinical experimentation is still required. The current review provides a comprehensive overview of biomechanical considerations relevant for the design of biological BSMs. Further, the preclinical evaluation of biological BSMs intended for application in highly loaded skeletal sites is discussed. The selected animal models and implantation site should mimic the pathophysiology and biomechanical loading patterns of human bone as closely as possible. In general, sheep are among the most frequently selected animal models for the evaluation of biomaterials intended for highly loaded skeletal sites. Regarding the anatomical sites, segmental bone defects created in the limbs and spinal column are suggested as the most suitable. Furthermore, the outcome measurements used to assess biological BSMs for regeneration of defects in heavily loaded bone should be relevant and straightforward. The quantitative evaluation of bone defect healing through ex vivo biomechanical tests is a valuable addition to conventional in vivo tests, as it determines the functional efficacy of BSM-induced bone healing. Finally, we conclude that further standardization of preclinical studies is essential for reliable evaluation of biological BSMs in highly loaded skeletal sites.
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Affiliation(s)
| | | | | | - John A. Jansen
- Department of Dentistry—Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Philips van Leydenlaan 25, 6525EX Nijmegen, The Netherlands; (S.d.L.S.); (J.J.J.P.v.d.B.); (S.C.G.L.)
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Pahlevanzadeh F, Ebrahimian-Hosseinabadi M. Poly (Methyl Methacrylate)/Biphasic Calcium Phosphate/Nano Graphene Bone Cement for Orthopedic Application. JOURNAL OF MEDICAL SIGNALS & SENSORS 2019; 9:33-41. [PMID: 30967988 PMCID: PMC6419566 DOI: 10.4103/jmss.jmss_34_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: The aim of this study was to make a bioactive bone cement based on poly (methyl methacrylate) (PMMA) with suitable mechanical properties. Methods: PMMA has been modified by fabricating a composite consisting of biphasic calcium phosphate (BCP) 68 wt%, PMMA 31 wt% and graphene (Gr) 1 wt% (PMMA/BCP/Gr), 32 wt% of PMMA, and 68 wt% of BCP (PMMA/BCP) and pure PMMA by milling, mixing with monomer liquid, and casting. The modified cements were evaluated regarding mechanical properties, bioactivity, degradation rate, and biocompatibility. Results: The scanning electron microscopy (SEM) images of hydroxyapatite (HA) formed on samples surface after 28 days of immersion in simulated body fluid (SBF) demonstrated that bioactivity was obtained due to the addition of BCP, and the degradation rate of the cement was enhanced as well. Investigations of mechanical properties revealed that BCP increased the elastic modulus of PMMA more than 1.5 times, but predictably decreased elongation. The addition of 1 wt% Gr increased elongation and yield strength from 16.39% ± 1.02% and 61.67 ± 1.52 Mpa for PMMA/BCP to 35.18% ± 2.42% and 78.40 ± 2.06 Mpa for PMMA/BCP/Gr, respectively. MG63 cells survival and proliferation improved from 127.55% ± 7.03% for PMMA to 201.41% ± 10.7% for PMMA/BCP/Gr on Day 4 of culture. Conclusion: According to the obtained results of mechanical and biological tests, it seems that new PMMA/BCP/Gr bone cement has a potentiality for usage in orthopedic applications.
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Affiliation(s)
- Farnoosh Pahlevanzadeh
- Department of Tissue Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran
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Komang-Agung IS, Hydravianto L, Sindrawati O, William PS. Effect of Polymethylmethacrylate-Hydroxyapatite Composites on Callus Formation and Compressive Strength in Goat Vertebral Body. Malays Orthop J 2018; 12:6-13. [PMID: 30555640 PMCID: PMC6287135 DOI: 10.5704/moj.1811.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Percutaneous vertebroplasty (PV) is one of the available treatments for vertebral compression fracture (VCF). Polymethylmethacrylate (PMMA) is the most common bone substitute used in the procedure, but it has several disadvantages. Bioceramic material, such as hydroxyapatite (HA), has better biological activity compared to PMMA. The aim of this study was to find an optimal biomaterial compound which offers the best mechanical and biological properties to be used in PV. Materials and Methods: This was an experimental study with goat (Capra aegagrus hircus) as an animal model. The animals’ vertebral columns were injected with PMMA-HA compound. Animal samples were divided into four groups, and each group received a different proportion of PMMA:HA compound. The mechanical and biological effects of the compound on the bone were then analysed. The mechanical effect was assessed by measuring the vertebral body’s compressive strength. Meanwhile, the biological effect was assessed by analysing the callus formation in the vertebral body. Results: The optimal callus formation and compressive strength was observed in the group receiving PMMA:HA with a 1:2 ratio. Conclusion: A mixture of PMMA and HA increases the quality of callus formation and the material’s compressive strength. The optimum ratio of PMMA:HA in the compound is 1:2.
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Affiliation(s)
- I S Komang-Agung
- Department of Orthopaedics, Airlangga University, Surabaya, Indonesia
| | - L Hydravianto
- Department of Orthopaedics, Airlangga University, Surabaya, Indonesia
| | - O Sindrawati
- Department of Pathology, Widya Mandala Katholic University, Surabaya, Indonesia
| | - P S William
- *Emergency Room Department, Jombang General Hospital, Jombang, Indonesia
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Dias IR, Camassa JA, Bordelo JA, Babo PS, Viegas CA, Dourado N, Reis RL, Gomes ME. Preclinical and Translational Studies in Small Ruminants (Sheep and Goat) as Models for Osteoporosis Research. Curr Osteoporos Rep 2018; 16:182-197. [PMID: 29460175 DOI: 10.1007/s11914-018-0431-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW This review summarizes research on the use of sheep and goats as large animal models of human osteoporosis for preclinical and translational studies. RECENT FINDINGS The most frequent osteoporotic sheep model used is the ovariectomized sheep with 12 months post-operatively or more and the combined treatment of ovariectomized sheep associated to calcium/vitamin D-deficient diet and glucocorticoid applications for 6 months, but other methods are also described, like pinealectomy or hypothalamic-pituitary disconnection in ovariectomized sheep. The goat model for osteoporosis research has been used in a very limited number of studies in osteoporosis research relative to sheep. These osteoporotic small ruminant models are applied for biomaterial research, bone augmentation, efficacy of implant fixation, fragility fracture-healing process improvement, or bone-defect repair studies in the osteopenic or osteoporotic bone. Sheep are a recognized large animal model for preclinical and translational studies in osteoporosis research and the goat to a lesser extent. Recently, the pathophysiological mechanism underlying induction of osteoporosis in glucocorticoid-treated ovariectomized aged sheep was clarified, being similar to what occurs in postmenopausal women with glucocorticoid-induced osteoporosis. It was also concluded that the receptor activator of NF-κB ligand was stimulated in the late progressive phase of the osteoporosis induced by steroids in sheep. The knowledge of the pathophysiological mechanisms at the cellular and molecular levels of the induction of osteoporosis in small ruminants, if identical to humans, will allow in the future, the use of these animal models with greater confidence in the preclinical and translational studies for osteoporosis research.
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Affiliation(s)
- Isabel R Dias
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal.
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal.
| | - José A Camassa
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
| | - João A Bordelo
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
| | - Pedro S Babo
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Carlos A Viegas
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Nuno Dourado
- CMEMS-UMinho, Department of Mechanical Engineering, University of Minho, Campus de Azurém, 4804-533, Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Manuela E Gomes
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
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Decreased extrusion of calcium phosphate cement versus high viscosity PMMA cement into spongious bone marrow-an ex vivo and in vivo study in sheep vertebrae. Spine J 2016; 16:1468-1477. [PMID: 27496285 DOI: 10.1016/j.spinee.2016.07.529] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebroplasty or kyphoplasty of osteoporotic vertebral fractures bears the risk of pulmonary cement embolism (3.5%-23%) caused by leakage of commonly applied acrylic polymethylmethacrylate (PMMA) cement to spongious bone marrow or outside of the vertebrae. Ultraviscous cement and specific augmentation systems have been developed to reduce such adverse effects. Rapidly setting, resorbable, physiological calcium phosphate cement (CPC) may also represent a suitable alternative. PURPOSE This study aimed to compare the intravertebral extrusion of CPC and PMMA cement in an ex vivo and in vivo study in sheep. STUDY DESIGN/SETTING A prospective experimental animal study was carried out. METHODS Defects (diameter 5 mm; 15 mm depth) were created by a ventrolateral percutaneous approach in lumbar vertebrae of female Merino sheep (2-4 years) either ex vivo (n=17) or in vivo (n=6), and injected with: (1) CPC (L3); (2) CPC reinforced with 10% poly(l-lactide-co-glycolide) (PLGA) fibers (L4); or (3) PMMA cement (L5; Kyphon HV-R). Controls were untouched (L1) or empty defects (L2). The effects of the cement injections were assessed in vivo by blood gas analysis and ex vivo by computed tomography (CT), micro-CT (voxel size: 67 µm), histology, and biomechanical testing. RESULTS Following ex vivo injection, micro-CT documented significantly increased extrusion of PMMA cement in comparison to CPC (+/- fibers) starting at a distance of 1 mm from the edge of the defect (confirmed by histology); this was also demonstrated by micro-CT following in vivo cement injection. In addition, blood gas analysis showed consistently significantly lower values for the fraction of oxygenized hemoglobin/total hemoglobin (FO2Hb) in the arterial blood until 25 minutes following injection of the PMMA cement (p ≤ .05 vs. CPC; 7, 15 minutes). Biomechanical testing following ex vivo injection showed significantly lower compressive strength and Young modulus than untouched controls for the empty defect (40% and 34% reduction, respectively) and all three cement-injected defects (21%-27% and 29%-32% reduction, respectively), without significant differences among the cements. CONCLUSIONS Because of comparable compressive strength, but significantly lower cement extrusion into spongious bone marrow than PMMA cement, physiological CPC (+/- PLGA fibers) may represent an attractive alternative to PMMA for vertebroplasty or kyphoplasty of osteoporotic vertebral fractures to reduce the frequency or severity of adverse effects.
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Oliveira MT, Potes J, Queiroga MC, Castro JL, Pereira AF, Rehman S, Dalgarno K, Ramos A, Vitale-Brovarone C, Reis JC. Percutaneous vertebroplasty: a new animal model. Spine J 2016; 16:1253-1262. [PMID: 27374111 DOI: 10.1016/j.spinee.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/25/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty (PVP) is a minimally invasive surgical procedure and is frequently performed in humans who need surgical treatment of vertebral fractures. PVP involves cement injection into the vertebral body, thereby providing rapid and significant pain relief. PURPOSE The testing of novel biomaterials depends on suitable animal models. The aim of this study was to develop a reproducible and safe model of PVP in sheep. STUDY DESIGN This study used ex vivo and in vivo large animal model study (Merino sheep). METHODS Ex vivo vertebroplasty was performed through a bilateral modified parapedicular access in 24 ovine lumbar hemivertebrae, divided into four groups (n=6). Cerament (Bone Support, Lund, Sweden) was the control material. In the experimental group, a novel composite was tested-Spine-Ghost-which consisted of an alpha-calcium sulfate matrix enriched with micrometric particles of mesoporous bioactive glass. All vertebrae were assessed by micro-computed tomography (micro-CT) and underwent mechanical testing. For the in vivo study, 16 sheep were randomly allocated into control and experimental groups (n=8), and underwent PVP using the same bone cements. All vertebrae were assessed postmortem by micro-CT, histology, and reverse transcription-polymerase chain reaction (rt-PCR). This work has been supported by the European Commission under the 7th Framework Programme for collaborative projects (600,000-650,000 USD). RESULTS In the ex vivo model, the average defect volume was 1,275.46±219.29 mm3. Adequate defect filling with cement was observed. No mechanical failure was observed under loads which were higher than physiological. In the in vivo study, cardiorespiratory distress was observed in two animals, and one sheep presented mild neurologic deficits in the hind limbs before recovering. CONCLUSIONS The model of PVP is considered suitable for preclinical in vivo studies, mimicking clinical application. All sheep recovered and completed a 6-month implantation period. There was no evidence of cement leakage into the vertebral foramen in the postmortem examination.
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Affiliation(s)
- Maria Teresa Oliveira
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal.
| | - José Potes
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal
| | - Maria Cristina Queiroga
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal
| | - José L Castro
- Departamento de Zootecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Apartado 94, 7002-554 Évora, Portugal
| | - Alfredo F Pereira
- Departamento de Zootecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Apartado 94, 7002-554 Évora, Portugal
| | - Sarrawat Rehman
- JRI Orthopaedics Limited, 18 Churchill Way, Sheffield, S35 2PY, UK
| | - Kenneth Dalgarno
- School of Mechanical and Systems Engineering, Newcastle University, Stephenson Building, Claremont Rd, Newcastle upon Tyne, NE1 7RU, UK
| | - António Ramos
- Biomechanics Research Group, Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Chiara Vitale-Brovarone
- Politecnico di Torino, Corso Duca degli Abruzzi, 24-10129, Torino, Italy; Consorzio per la Ricerca e l'Educazione Permanente (Corep), Sede legale Via Ventimiglia, 115-10126, Torino, Italy
| | - Joana C Reis
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Apartado 94, 7002-554 Évora, Portugal; Complexo de Laboratórios Tecnológicos (CICECO), Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Bungartz M, Maenz S, Kunisch E, Horbert V, Xin L, Gunnella F, Mika J, Borowski J, Bischoff S, Schubert H, Sachse A, Illerhaus B, Günster J, Bossert J, Jandt KD, Kinne RW, Brinkmann O. First-time systematic postoperative clinical assessment of a minimally invasive approach for lumbar ventrolateral vertebroplasty in the large animal model sheep. Spine J 2016; 16:1263-1275. [PMID: 27345746 DOI: 10.1016/j.spinee.2016.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/20/2016] [Accepted: 06/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Large animal models are highly recommended for meaningful preclinical studies, including the optimization of cement augmentation for vertebral body defects by vertebroplasty/kyphoplasty. PURPOSE The aim of this study was to perform a systematic characterization of a strictly minimally invasive in vivo large animal model for lumbar ventrolateral vertebroplasty. STUDY DESIGN/ SETTING This is a prospective experimental animal study. METHODS Lumbar defects (diameter 5 mm; depth approximately 14 mm) were created by a ventrolateral percutaneous approach in aged, osteopenic, female sheep (40 Merino sheep; 6-9 years; 68-110 kg). L1 remained untouched, L2 was left with an empty defect, and L3 carried a defect injected with a brushite-forming calcium phosphate cement (CPC). Trauma/functional impairment, surgical techniques (including drill sleeve and working canula with stop), reproducibility, bone defects, cement filling, and functional cement augmentation were documented by intraoperative incision-to-suture time and X-ray, postoperative trauma/impairment scores, and ex vivo osteodensitometry, microcomputed tomography (CT), histology, static/fluorescence histomorphometry, and biomechanical testing. RESULTS Minimally invasive vertebroplasty resulted in short operation times (28±2 minutes; mean±standard error of the mean) and X-ray exposure (1.59±0.12 minutes), very limited local trauma (score 0.00±0.00 at 24 hours), short postoperative recovery (2.95±0.29 hours), and rapid decrease of the postoperative impairment score to 0 (3.28±0.36 hours). Reproducible defect creation and cement filling were documented by intraoperative X-ray and ex vivo conventional/micro-CT. Vertebral cement augmentation and osteoconductivity of the CPC was verified by osteodensitometry (CPC>control), micro-CT (CPC>control and empty defect), histology/static histomorphometry (CPC>control and empty defect), fluorescence histomorphometry (CPC>control; all p<.05 for 3 and 9 months), and compressive strength measurements (CPC numerically higher than control; 102% for 3 months and 110% for 9 months). CONCLUSIONS This first-time systematic clinical assessment of a minimally invasive, ventrolateral, lumbar vertebroplasty model in aged, osteopenic sheep resulted in short operation times, rapid postoperative recovery, and high experimental reproducibility. This model represents an optimal basis for standardized evaluation of future studies on vertebral augmentation with resorbable and osteoconductive CPC.
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Affiliation(s)
- Matthias Bungartz
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany; Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany.
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, D-07743 Jena, Germany; Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, D-07743 Jena, Germany
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Long Xin
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Joerg Mika
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Juliane Borowski
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Sabine Bischoff
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Str. 23, D-07743 Jena, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Str. 23, D-07743 Jena, Germany
| | - Andre Sachse
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Bernhard Illerhaus
- BAM Bundesanstalt für Materialforschung und - prüfung (BAM), Unter den Eichen 87, D-12205 Berlin, Germany
| | - Jens Günster
- BAM Bundesanstalt für Materialforschung und - prüfung (BAM), Unter den Eichen 87, D-12205 Berlin, Germany
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, D-07743 Jena, Germany
| | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, D-07743 Jena, Germany; Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, D-07743 Jena, Germany; Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldstr. 10, D-07743 Jena, Germany
| | - Raimund W Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Olaf Brinkmann
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany; Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
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Tan E, Wang T, Pelletier MH, Walsh WR. Effects of cement augmentation on the mechanical stability of multilevel spine after vertebral compression fracture. JOURNAL OF SPINE SURGERY 2016; 2:111-21. [PMID: 27683707 DOI: 10.21037/jss.2016.06.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Studies on the effects of cement augmentation or vertebroplasty on multi-level spine after vertebral compression fractures are lacking. This paper seeks to establish a 3-vertebrae ovine model to determine the impact of compression fracture on spine biomechanics, and to discover if cement augmentation can restore mechanical stability to fractured spine. METHODS Five lumbar spine segments (L1-L3) were obtained from 5-year-old female Merino sheep. Standardized wedge-compression fractures were generated in each L2 vertebra, and then augmented with polymethyl methacrylate (PMMA) cement mixed with 30% barium sulphate powder. Biomechanical pure moment testing in axial rotation (AR), flexion/extension (FE) and lateral bending (LB) was carried out in the intact, fractured and repaired states. Range of motion (ROM) and neutral zone (NZ) parameters were compared, and plain radiographs taken at every stage. RESULTS Except for a significant increase in ROM between the intact and fractured states in AR between L1 and L2 (P<0.05), there were no other significant differences in ROM or NZ between the other groups. There was a trend towards an increase in ROM and NZ in all directions after fracture, but this did not reach significance. Normal biomechanics was only minimally restored after augmentation. CONCLUSIONS Results suggest that cement augmentation could not restore mechanical stability of fractured spine. Model-specific factors may have had a role in these findings. Caution should be exercised when applying these results to humans.
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Affiliation(s)
- Eelin Tan
- University of New South Wales, Sydney, NSW 2052, Australia
| | - Tian Wang
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Level 1, Clinical Sciences Building, Gate 6, Randwick, Sydney, NSW 2031, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Level 1, Clinical Sciences Building, Gate 6, Randwick, Sydney, NSW 2031, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Level 1, Clinical Sciences Building, Gate 6, Randwick, Sydney, NSW 2031, Australia
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Wu CC, Hsu LH, Sumi S, Yang KC, Yang SH. Injectable and biodegradable composite bone filler composed of poly(propylene fumarate) and calcium phosphate ceramic for vertebral augmentation procedure: An in vivo
porcine study. J Biomed Mater Res B Appl Biomater 2016; 105:2232-2243. [DOI: 10.1002/jbm.b.33678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Chang-Chin Wu
- Department of Orthopedics; National Taiwan University Hospital, College of Medicine, National Taiwan University; Taipei 10002 Taiwan
- Department of Orthopedics; En Chu Kong Hospital; New Taipei City 23702 Taiwan
| | - Li-Ho Hsu
- Department of Orthopedics; National Taiwan University Hospital, College of Medicine, National Taiwan University; Taipei 10002 Taiwan
- Department of Orthopedics; En Chu Kong Hospital; New Taipei City 23702 Taiwan
| | - Shoichiro Sumi
- Department of Organ Reconstruction; Institute for Frontier Medical Sciences, Kyoto University; Kyoto 606-8507 Japan
| | - Kai-Chiang Yang
- Department of Organ Reconstruction; Institute for Frontier Medical Sciences, Kyoto University; Kyoto 606-8507 Japan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University; Taipei 11031 Taiwan
| | - Shu-Hua Yang
- Department of Orthopedics; National Taiwan University Hospital, College of Medicine, National Taiwan University; Taipei 10002 Taiwan
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El-Fiki M. Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures. World Neurosurg 2016; 91:628-32. [DOI: 10.1016/j.wneu.2016.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 01/28/2023]
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Cementless Titanium Mesh Fixation of Osteoporotic Burst Fractures of the Lumbar Spine Leads to Bony Healing: Results of an Experimental Sheep Model. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4094161. [PMID: 27019848 PMCID: PMC4785241 DOI: 10.1155/2016/4094161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/04/2016] [Indexed: 01/12/2023]
Abstract
Introduction. Current treatment strategies for osteoporotic vertebral compression fractures (VCFs) focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1) evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs) and (2) demonstrate the healing capabilities in osteoporotic VCFs. Methods. Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1) were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1) or no augmentation was performed (G2, n = 6 each). Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation. Results. Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%). Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing. Conclusions. Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications.
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16
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Liu X, Wei D, Zhong J, Ma M, Zhou J, Peng X, Ye Y, Sun G, He D. Electrospun Nanofibrous P(DLLA-CL) Balloons as Calcium Phosphate Cement Filled Containers for Bone Repair: in Vitro and in Vivo Studies. ACS APPLIED MATERIALS & INTERFACES 2015; 7:18540-18552. [PMID: 26258872 DOI: 10.1021/acsami.5b04868] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The spinal surgeon community has expressed significant interest in applying calcium phosphate cement (CPC) for the treatment of vertebral compression fractures (VCFs) and minimizing its disadvantages, such as its water-induced collapsibility and poor mechanical properties, limiting its clinical use. In this work, novel biodegradable electrospun nanofibrous poly(d,l-lactic acid-ϵ-caprolactone) balloons (ENPBs) were prepared, and the separation, pressure, degradation, and new bone formation behaviors of the ENPBs when used as CPC-filled containers in vitro and in vivo were systematically analyzed and compared. CPC could be separated from surrounding bone tissues by ENPBs in vitro and in vivo. ENPB-CPCs (ENPBs serving as CPC-filled containers) exerted pressure on the surrounding bone microenvironment, which was enough to crush trabecular bone. Compared with the CPC implantation, ENPB-CPCs delayed the degradation of CPC (i.e., its water-induced collapsilibity). Finally, possible mechanisms behind the in vivo effects caused by ENPB-CPCs implanted into rabbit thighbones and pig vertebrae were proposed. This work suggests that ENPBs can be potentially applied as CPC-filled containers in vivo and provides an experimental basis for the clinical application of ENPBs for the treatment of VCFs. In addition, this work will be of benefit to the development of polymer-based medical implants in the future.
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Affiliation(s)
- Xunwei Liu
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Daixu Wei
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Jian Zhong
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Mengjia Ma
- School of Materials Science and Engineering, Shanghai Jiao Tong University , No. 800 Dongchuang Road, Minhang District, Shanghai 200240, People's Republic of China
| | - Juan Zhou
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Xiangtao Peng
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Yong Ye
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Dannong He
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
- School of Materials Science and Engineering, Shanghai Jiao Tong University , No. 800 Dongchuang Road, Minhang District, Shanghai 200240, People's Republic of China
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Bialorucki C, Subramanian G, Elsaadany M, Yildirim-Ayan E. In situ osteoblast mineralization mediates post-injection mechanical properties of osteoconductive material. J Mech Behav Biomed Mater 2014; 38:143-53. [PMID: 25051152 DOI: 10.1016/j.jmbbm.2014.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 12/14/2022]
Abstract
The objective of this study was to understand the temporal relationship between in situ generated calcium content (mineralization) and the mechanical properties of an injectable orthobiologic bone-filler material. Murine derived osteoblast progenitor cells were differentiated using osteogenic factors and encapsulated within an injectable polycaprolactone nanofiber-collagen composite scaffold (PN-COL +osteo) to evaluate the effect of mineralization on the mechanical properties of the PN-COL scaffold. A comprehensive study was conducted using both an experimental and a predictive analytical mechanical analysis for mechanical property assessment as well as an extensive in vitro biological analysis for in situ mineralization. Cell proliferation was evaluated using a PicoGreen dsDNA quantification assay and in situ mineralization was analyzed using both an alkaline phosphatase (ALP) assay and an Alizarin Red stain-based assay. Mineralized matrix formation was further evaluated using energy dispersive x-ray spectroscopy (EDS) and visualized using SEM and histological analyses. Compressive mechanical properties of the PN-COL scaffolds were determined using a confined compression stress-relaxation protocol and the obtained data was fit to the standard linear solid viscoelastic material mathematical model to demonstrate a relationship between increased in situ mineralization and the mechanical properties of the PN-COL scaffold. Cell proliferation was constant over the 21 day period. ALP activity and calcium concentration significantly increased at day 14 and 21 as compared to PN-COL -osteo with undifferentiated osteoblast progenitor cells. Furthermore, at day 21 EDS, SEM and von Kossa histological staining confirmed mineralized matrix formation within the PN-COL scaffolds. After 21 days, compressive modulus, peak stress, and equilibrium stress demonstrate significant increases of 3.4-fold, 3.3-fold, and 4.0-fold respectively due to in situ mineralization. Viscoelastic parameters calculated through the standard linear solid mathematical model fit to the stress-relaxation data also indicate improved mechanical properties after in situ mineralization. This investigation clearly demonstrates that in situ mineralization can increase the mechanical properties of an injectable orthobiologic scaffold and can possibly guide the design of an effective osteoconductive injectable material.
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Affiliation(s)
- Callan Bialorucki
- Department of Bioengineering, College of Engineering, University of Toledo, Toledo, OH 43606, USA
| | - Gayathri Subramanian
- Department of Bioengineering, College of Engineering, University of Toledo, Toledo, OH 43606, USA
| | - Mostafa Elsaadany
- Department of Bioengineering, College of Engineering, University of Toledo, Toledo, OH 43606, USA
| | - Eda Yildirim-Ayan
- Department of Bioengineering, College of Engineering, University of Toledo, Toledo, OH 43606, USA; Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA.
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El Saman A, Kelm A, Meier S, Sander AL, Eichler K, Marzi I, Laurer H. Intraoperative PEEP-ventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery. Eur J Trauma Emerg Surg 2013; 39:461-8. [PMID: 26815441 DOI: 10.1007/s00068-013-0319-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Within the last two decades the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been established widely. Several techniques of cement application in spinal surgery have been described. Besides classical vertebroplasty, kyphoplasty and related techniques that reinforce stability of the fractured vertebral body itself, augmentation of pedicle screws became an issue in the past 10 years. Aim of this technique is strengthening of the implant-bone-interface and the prevention of loosening and failure of posterior instrumentation in limited bone quality due to osteoporosis. PMMA use in spinal surgery always bears the risk of cement leakage and cement embolism. There are only few publications dealing with cement leakage in pedicle screw augmentation. We examined our cohort concerning incidence and type of leakage in comparison to the literature. In particular, we evaluated a possible role of intrathoracic pressure during cementation procedure. PATIENTS AND METHODS In this retrospective study 42 patients were included. Mean age was 74 (57-89) years. 311 fenestrated, augmented screws were analyzed postoperatively concerning leakage and subsequent pulmonary embolism of cement particles. Overall, there was a leakage rate of 38.3 %, and 28.6 % of patients showed pulmonary embolism of PMMA. During surgery, patients were in part ventilated with a positive end-expiratory pressure (PEEP) of 15 cmH2O during cement injection. These individuals showed significantly less leakage locally as well as less PMMA-emboli in the pulmonary circulation in contrast to patients ventilated without increased PEEP. CONCLUSION PEEP elevation during administration of PMMA via fenestrated pedicle screws is reducing the leakage rate in spinal surgery. These beneficial effects warrant further evaluation in prospective studies.
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Affiliation(s)
- A El Saman
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
| | - A Kelm
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - S Meier
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - A L Sander
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - K Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - H Laurer
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
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Klein K, Zamparo E, Kronen PW, Kämpf K, Makara M, Steffen T, von Rechenberg B. Bone augmentation for cancellous bone- development of a new animal model. BMC Musculoskelet Disord 2013; 14:200. [PMID: 23819858 PMCID: PMC3706338 DOI: 10.1186/1471-2474-14-200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproducible and suitable animal models are required for in vivo experiments to investigate new biodegradable and osteoinductive biomaterials for augmentation of bones at risk for osteoporotic fractures. Sheep have especially been used as a model for the human spine due to their size and similar bone metabolism. However, although sheep and human vertebral bodies have similar biomechanical characteristics, the shape of the vertebral bodies, the size of the transverse processes, and the different orientation of the facet joints of sheep are quite different from those of humans making the surgical approach complicated and unpredictable. Therefore, an adequate and safe animal model for bone augmentation was developed using a standardized femoral and tibia augmentation site in sheep. METHODS The cancellous bone of the distal femur and proximal tibia were chosen as injection sites with the surgical approach via the medial aspects of the femoral condyle and proximal tibia metaphysis (n = 4 injection sites). For reproducible drilling and injection in a given direction and length, a custom-made c-shaped aiming device was designed. Exact positioning of the aiming device and needle positioning within the intertrabecular space of the intact bone could be validated in a predictable and standardized fashion using fluoroscopy. After sacrifice, bone cylinders (Ø 32 mm) were harvested throughout the tibia and femur by means of a diamond-coated core drill, which was especially developed to harvest the injected bone area exactly. Thereafter, the extracted bone cylinders were processed as non-decalcified specimens for μCT analysis, histomorphometry, histology, and fluorescence evaluation. RESULTS The aiming device could be easily placed in 63 sheep and assured a reproducible, standardized injection area. In four sheep, cardiovascular complications occurred during surgery and pulmonary embolism was detected by computed tomography post surgery in all of these animals. The harvesting and evaluative methods assured a standardized analysis of all samples. CONCLUSIONS This experimental animal model provides an excellent basis for testing new biomaterials for their suitability as bone augmentation materials. Concomitantly, similar cardiovascular changes occur during vertebroplasties as in humans, thus making it a suitable animal model for studies related to vertebroplasty.
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Affiliation(s)
- Karina Klein
- Musculoskeletal Research Unit (MSRU), Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich CH-8057, Switzerland.
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Kiyasu K, Takemasa R, Ikeuchi M, Tani T. Differential blood contamination levels and powder-liquid ratios can affect the compressive strength of calcium phosphate cement (CPC): a study using a transpedicular vertebroplasty model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1643-9. [PMID: 23645204 DOI: 10.1007/s00586-013-2800-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 03/30/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Calcium phosphate cement (CPC) is a potentially useful alternative to polymethylmethacrylate (PMMA) for transpedicular injection into osteoporotic vertebral fractures. Unlike PMMA, CPC is both biocompatible and osteoconductive without producing heat from polymerization, but it has lower compressive strength compared to PMMA. This in vitro model experiment analyzed how different CPC powder-liquid ratios (P/L ratios) and injection methods may minimize blood contamination in the CPC and, thereby its reduction in compressive strength. METHODS (1) CPC of different P/L ratios of 4.0, 3.5, and 3.2 was equally mixed with different amounts of freshly obtained human venous blood, producing cylindrically shaped CPC samples. (2) Using a transpedicular vertebroplasty model containing blood in the bottom, CPC pastes of different P/L ratios were injected with the nozzle of an injection gun affixed either to the bottom (Bottom method) or to the top of the container (Top method). All cylindrical CPC samples thus obtained were immersed in simulated body fluid and then underwent compressive strength tests at 3 h-7 days post-immersion. RESULTS In CPC equally mixed with blood, lower P/L ratios and a larger amount of blood contamination reduced compressive strength more significantly. Of the two methods of CPC injection, the 'Bottom method' produced significantly greater compressive strength values than the 'Top method'. CONCLUSIONS When performing CPC-assisted vertebroplasty, a greater load bearing-support can be obtained by injecting CPC paste of a high P/L ratio of 4.0 into the deepest part of the space inside the vertebral body to minimize blood contamination.
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Affiliation(s)
- Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kohasu Oko-cho, Nankoku, Kochi 783-8505, Japan.
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