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Machado A, Pereira I, Costa F, Brandão A, Pereira JE, Maurício AC, Santos JD, Amaro I, Falacho R, Coelho R, Cruz N, Gama M. Randomized clinical study of injectable dextrin-based hydrogel as a carrier of a synthetic bone substitute. Clin Oral Investig 2023; 27:979-994. [PMID: 36707442 PMCID: PMC9985577 DOI: 10.1007/s00784-023-04868-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/14/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study aimed to improve the performance and mode of administration of a glass-reinforced hydroxyapatite synthetic bone substitute, Bonelike by Biosckin® (BL®), by association with a dextrin-based hydrogel, DEXGEL, to achieve an injectable and moldable device named DEXGEL Bone. METHODS Twelve participants requiring pre-molar tooth extraction and implant placement were enrolled in this study. BL® granules (250-500 µm) were administered to 6 randomized participants whereas the other 6 received DEXGEL Bone. After 6 months, a bone biopsy of the grafted area was collected for histological and histomorphometric evaluation, prior to implant placement. The performance of DEXGEL Bone and BL® treatments on alveolar preservation were further analyzed by computed tomography and Hounsfield density analysis. Primary implant stability was analyzed by implant stability coefficient technique. RESULTS The healing of defects was free of any local or systemic complications. Both treatments showed good osseointegration with no signs of adverse reaction. DEXGEL Bone exhibited increased granule resorption (p = 0.029) accompanied by a tendency for more new bone ingrowth (although not statistically significant) compared to the BL® group. The addition of DEXGEL to BL® granules did not compromise bone volume or density, being even beneficial for implant primary stability (p = 0.017). CONCLUSIONS The hydrogel-reinforced biomaterial exhibited an easier handling, a better defect filling, and benefits in implant stability. CLINICAL RELEVANCE This study validates DEXGEL Bone safety and performance as an injectable carrier of granular bone substitutes for alveolar ridge preservation. TRIAL REGISTRATION European Databank on Medical Devices (EUDAMED) No. CIV-PT-18-01-02,705; Registo Nacional de Estudos Clínicos, RNEC, No. 30122.
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Affiliation(s)
- Alexandra Machado
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal
| | - Isabel Pereira
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal
| | - Filomena Costa
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal
| | - Ana Brandão
- Biosckin, Molecular and Cell Therapies S.A., TecMaia, Rua Engenheiro Frederico Ulrich 2650, 4470-605, Maia, Portugal
| | - José Eduardo Pereira
- CECAV, Animal and Veterinary Research Centre, University of Trás-os-Montes and Alto Douro, 5001-801, Vila Real, Portugal.,Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5001-801, Vila Real, Portugal
| | - Ana Colette Maurício
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, N° 228, 4050-313, Porto, Portugal.,Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401, Porto, Portugal
| | - José Domingos Santos
- REQUIMTE/LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-495, Porto, Portugal
| | - Inês Amaro
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-504, Coimbra, Portugal
| | - Rui Falacho
- Institute of Oral Implantology and Prosthodontics, Faculty of Medicine, University of Coimbra, 3004-504, Coimbra, Portugal
| | - Rui Coelho
- RESDEVMED, Unipessoal Lda., Travessa do Navega, 436 C, 3885-183, Ovar, Portugal
| | - Nuno Cruz
- Faculty of Dentistry, Universitat Internacional de Catalunya, 08017, Barcelona, Spain
| | - Miguel Gama
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. .,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal.
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Pinto PO, Branquinho MV, Caseiro AR, Sousa AC, Brandão A, Pedrosa SS, Alvites RD, Campos JM, Santos FL, Santos JD, Mendonça CM, Amorim I, Atayde LM, Maurício AC. The application of Bonelike® Poro as a synthetic bone substitute for the management of critical-sized bone defects - A comparative approach to the autograft technique - A preliminary study. Bone Rep 2021; 14:101064. [PMID: 33981810 PMCID: PMC8082556 DOI: 10.1016/j.bonr.2021.101064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 12/26/2022] Open
Abstract
The effective treatment of non-unions and critical-sized defects remains a challenge in the orthopedic field. From a tissue engineering perspective, this issue can be addressed through the application bioactive matrixes to support bone regeneration, such as Bonelike®, as opposed to the widespread autologous grafting technique. An improved formulation of Bonelike® Poro, was assessed as a synthetic bone substitute in an ovine model for critical-sized bone defects. Bone regeneration was assessed after 5 months of recovery through macro and microscopic analysis of the healing features of the defect sites. Both the application of natural bone graft or Bonelike® Poro resulted in bridging of the defects margins. Untreated defect remained as fibrous non-unions at the end of the study period. The characteristics of the newly formed bone and its integration with the host tissue were assessed through histomorphometric and histological analysis, which demonstrated Bonelike® Poro to result in improved healing of the defects. The group treated with synthetic biomaterial presented bone bridges of increased thickness and bone features that more closely resembled the native spongeous and cortical bone. The application of Bonelike® Poro enabled the regeneration of critical-sized lesions and performed comparably to the autograph technique, validating its octeoconductive and osteointegrative potential for clinical application as a therapeutic strategy in human and veterinary orthopedics.
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Affiliation(s)
- P O Pinto
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal.,Vasco da Gama Research Center (CIVG), Vasco da Gama University School (EUVG), Av. José R. Sousa Fernandes 197, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
| | - M V Branquinho
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - A R Caseiro
- Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal.,Vasco da Gama Research Center (CIVG), Vasco da Gama University School (EUVG), Av. José R. Sousa Fernandes 197, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
| | - A C Sousa
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - A Brandão
- Biosckin, Molecular and Cell Therapies, SA, Parque de Ciência e Tecnologia da Maia, Rua Eng. Frederico Ulrich, 2650, 4470-605 Moreira da Maia, Portugal
| | - S S Pedrosa
- Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - R D Alvites
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - J M Campos
- Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal.,Vasco da Gama Research Center (CIVG), Vasco da Gama University School (EUVG), Av. José R. Sousa Fernandes 197, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
| | - F L Santos
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - J D Santos
- Network of Chemistry and Technology - Associated Laboratory for Green Chemistry (REQUIMTE-LAQV), Department of Metallurgy and Materials, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias s/n, 4200-465 Porto, Portugal
| | - C M Mendonça
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - I Amorim
- Department of Pathology and Molecular Immunology, Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto (UP), Rua Jorge Viterbo Ferreira, n ° 228, 4050-313 Porto, Portugal.,Institute of Research and Innovation in Health (i3S), University of Porto (UP), Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - L M Atayde
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - A C Maurício
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
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Campos JM, Sousa AC, Pinto PO, Ribeiro J, França ML, Caseiro AR, Branquinho MV, Pedrosa SS, Mendonça C, Brandão A, Santos JD, Afonso A, Atayde LM, Luís AL, Maurício AC. Application of Bonelike® as synthetic bone graft in orthopaedic and oral surgery in veterinary clinical cases. Biomater Res 2018; 22:38. [PMID: 30619619 PMCID: PMC6310926 DOI: 10.1186/s40824-018-0150-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/07/2018] [Indexed: 01/01/2023] Open
Abstract
Autologous bone remains the gold standard grafting substrate for bone fusions used for small gaps and critical defects. However, significant morbidity is associated with the harvesting of autologous bone grafts and, for that reason, alternative bone graft substitutes have been developed. In the present case series, a glass-reinforced hydroxyapatite synthetic bone substitute, with osteoinductive and osteoconductive proprieties, was applied. This synthetic bone substitute comprises the incorporation of P2O5-CaO glass-based system within a hydroxyapatite matrix, moulded into spherical pellets with 250-500 μm of diameter. A total of 14 veterinary clinical cases of appendicular bone defects and maxillary / mandibular bone defects are described. In all clinical cases, the synthetic bone substitute was used to fill bone defects, enhancing bone regeneration and complementing the recommended surgical techniques. Results demonstrated that it is an appropriate synthetic bone graft available to be used in veterinary patients. It functioned as a space filler in association with standard orthopaedic and odontological procedures of stabilization, promoting a faster bone fusion without any local or systemic adverse reactions. This procedure improves the animals' quality of life, decreasing pain and post-operative recovery period, as well as increasing bone stability improving positive clinical outcomes.
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Affiliation(s)
- José Miguel Campos
- Escola Universitária Vasco da Gama (EUVG), Hospital Veterinário Universitário de Coimbra, Coimbra, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Ana Catarina Sousa
- REQUIMTE/LAQV – U. Porto – Porto/Portugal, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Pedro Olivério Pinto
- Escola Universitária Vasco da Gama (EUVG), Hospital Veterinário Universitário de Coimbra, Coimbra, Portugal
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Jorge Ribeiro
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Miguel Lacueva França
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Ana Rita Caseiro
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
- REQUIMTE/LAQV – U. Porto – Porto/Portugal, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Mariana Vieira Branquinho
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Sílvia Santos Pedrosa
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Carla Mendonça
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Ana Brandão
- Biosckin, Molecular and Cell Therapies S.A., Laboratório Criovida, TecMaia, Rua Engenheiro Frederico Ulrich 2650, 4470-605 Moreira da Maia, Portugal
| | - José Domingos Santos
- REQUIMTE/LAQV – U. Porto – Porto/Portugal, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Américo Afonso
- Faculdade de Medicina Dentária da Universidade do Porto (FMDUP), 4200-393 Porto, Portugal
| | - Luís Miguel Atayde
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Ana Lúcia Luís
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
| | - Ana Colette Maurício
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313 Porto, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Porto, Portugal
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Torres J, Gutierres M, Atayde L, Cortez P, Lopes MA, Santos JD, Cabral AT, van Eck CF. The benefit of bone marrow concentrate in addition to a glass-reinforced hydroxyapatite for bone regeneration: An in vivo ovine study. J Orthop Res 2017; 35:1176-1182. [PMID: 25490876 DOI: 10.1002/jor.22800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/04/2014] [Indexed: 02/04/2023]
Abstract
This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non-critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy-LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well-organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176-1182, 2017.
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Affiliation(s)
- Joao Torres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal
| | - Luis Atayde
- Departamento de Clinicas Veterinarias, Instituto de Ciencias Biomedicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n228, 4050-313, Porto, Portugal
| | - Paulo Cortez
- Departamento de Clinicas Veterinarias, Instituto de Ciencias Biomedicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n228, 4050-313, Porto, Portugal
| | - M Ascenção Lopes
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal
| | - J Domingos Santos
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal
| | - Abel T Cabral
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal
| | - Carola F van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufman building suite 1011, Pittsburgh, Pennsylvania, 15213
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Bellucci D, Sola A, Cannillo V. Hydroxyapatite and tricalcium phosphate composites with bioactive glass as second phase: State of the art and current applications. J Biomed Mater Res A 2015; 104:1030-56. [DOI: 10.1002/jbm.a.35619] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Devis Bellucci
- Department of Engineering “E. Ferrari,”; University of Modena and Reggio Emilia; via P. Vivarelli 10 Modena 41125 Italy
| | - Antonella Sola
- Department of Engineering “E. Ferrari,”; University of Modena and Reggio Emilia; via P. Vivarelli 10 Modena 41125 Italy
| | - Valeria Cannillo
- Department of Engineering “E. Ferrari,”; University of Modena and Reggio Emilia; via P. Vivarelli 10 Modena 41125 Italy
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Lash NJ, Feller JA, Batty LM, Wasiak J, Richmond AK. Bone grafts and bone substitutes for opening-wedge osteotomies of the knee: a systematic review. Arthroscopy 2015; 31:720-30. [PMID: 25595695 DOI: 10.1016/j.arthro.2014.09.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/03/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish the rate of use of various void fillers in the setting of opening-wedge osteotomy around the knee, the types of fixation used, and the rates of delayed union or nonunion related to these variables. In addition, this review addressed short-term to midterm outcomes and complication rates associated with such procedures. METHODS The electronic databases Medline, Embase, and PubMed were searched using the methodology for systematic review as recommended by the Cochrane Collaboration. The search terms used were as follows: knee, osteotomy, knee joint, bone grafting, opening osteotomy, opening wedge, tibial osteotomy, femoral osteotomy, and bone substitute. We screened 1,383 articles and applied exclusion criteria. Fifty-six articles were included. RESULTS We included 3,033 cases of osteotomy in 2,910 patients. The mean age of patients was 50 years, with a mean follow-up period of 42 months. Male patients comprised 52% of patients. The mean alignment change was 10.8°, shifting the mechanical axis to 5.1° valgus. Delayed union/nonunion rates were 2.6%, 4.6%, and 4.5% for autograft, allograft bone, and synthetic bone substitutes, respectively (P = .03). Delayed union/nonunion rates were significantly lower for autograft compared with allograft (P = .03) and for autograft and allograft compared with synthetic bone substitutes (P < .0001). Non-locking plates (n = 2,148) had a rate of delayed union/nonunion of 3.7% and a mean loss of correction over time of 0.5°. Locking plates (n = 681) had a rate of delayed union/nonunion of 2.6% and a loss of correction of 2.3°. All mean knee outcome scores improved, and an overall complication rate of 14% was found. CONCLUSIONS Opening-wedge osteotomy had good short-term to midterm outcomes with acceptable complication rates. The lowest rates of delayed union/nonunion were in autograft bone-filled osteotomies. Plate type does not appear to affect osteotomy union or loss of correction. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Nicholas J Lash
- OrthoSport Victoria Research Unit, Deakin University, and Epworth Healthcare, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Deakin University, and Epworth Healthcare, Melbourne, Australia
| | - Lachlan M Batty
- OrthoSport Victoria Research Unit, Deakin University, and Epworth Healthcare, Melbourne, Australia
| | - Jason Wasiak
- OrthoSport Victoria Research Unit, Deakin University, and Epworth Healthcare, Melbourne, Australia
| | - Anneka K Richmond
- OrthoSport Victoria Research Unit, Deakin University, and Epworth Healthcare, Melbourne, Australia.
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Torres J, Gutierres M, Lopes MA, Santos JD, Cabral AT, Pinto R, van Eck C. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. BIOMED RESEARCH INTERNATIONAL 2014; 2014:451781. [PMID: 24955356 PMCID: PMC4052697 DOI: 10.1155/2014/451781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. MATERIAL AND METHODS 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B). RESULTS There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P < 0.05). DISCUSSION These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. CONCLUSION Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.
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Affiliation(s)
- Joao Torres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M. Ascenção Lopes
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal
| | - J. Domingos Santos
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal
| | - A. T. Cabral
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - R. Pinto
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carola van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufman building suite 1011, Pittsburgh, PA 15213, USA
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Cortez PP, Silva MA, Santos M, Armada-da-Silva P, Afonso A, Lopes MA, Santos JD, Maurício AC. A glass-reinforced hydroxyapatite and surgical-grade calcium sulfate for bone regeneration: In vivo biological behavior in a sheep model. J Biomater Appl 2011; 27:201-17. [PMID: 21602251 DOI: 10.1177/0885328211399479] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A glass-reinforced hydroxyapatite (HA) composite (Bonelike®) was developed for bone grafting. This biomaterial is composed of a modified HA matrix with α- and β-tricalcium phosphate secondary phases, resulting in higher solubility than single HA type of materials. Several in vitro and in vivo studies demonstrated that Bonelike® has a highly bioactive behavior, which was also confirmed by employing granular forms of this biomaterial in orthopedics and dental applications. However, a fast consolidation vehicle was needed to promote the fixation of Bonelike® granules if applied in larger defects or in unstable sites. Surgical-grade calcium sulfate (CS), which is widely recognized as a well-tolerated and inexpensive bone graft material, was the chosen vehicle to improve the handling characteristics of Bonelike® as it can be used in the form of a powder that is mixed with a liquid to form a paste that sets in situ. After application in non-critical monocortical defects in sheep, histological, and scanning electron microscopy evaluations demonstrated that Bonelike® associated to CS functioned as a very satisfactory scaffold for bone regeneration as it achieved synchronization of the ingrowing bone with biomaterial resorption and subsequent preservation of the bone graft initial volume. Therefore, our results indicate that CS is an effective vehicle for Bonelike® granules as it facilitates their application and does not interfere with their proven highly osteoconductive properties. In the opposite way, the incorporation of Bonelike® improves the bone regeneration capabilities of CS.
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Affiliation(s)
- Paulo Pegado Cortez
- Centro de Estudos de Ciência Animal-CECA, Instituto de Ciências e Tecnologias Agrárias e Agro-Alimentares-ICETA, Universidade do Porto, Campus Agrário de Vairão, 4485-661 Vairão, Portugal.
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Lim HC, Bae JH, Song HR, Teoh SH, Kim HK, Kum DH. High tibial osteotomy using polycaprolactone-tricalcium phosphate polymer wedge in a micro pig model. ACTA ACUST UNITED AC 2011; 93:120-5. [DOI: 10.1302/0301-620x.93b1.24767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medial open-wedge high tibial osteotomy has been gaining popularity in recent years, but adequate supporting material is required in the osteotomy gap for early weight-bearing and rapid union. The purpose of this study was to investigate whether the implantation of a polycaprolactone-tricalcium phosphate composite scaffold wedge would enhance healing of the osteotomy in a micro pig model. We carried out open-wedge high tibial osteotomies in 12 micro pigs aged from 12 to 16 months. A scaffold wedge was inserted into six of the osteotomies while the other six were left open. Bone healing was evaluated after three and six months using plain radiographs, CT scans, measurement of the bone mineral density and histological examination. Complete bone union was obtained at six months in both groups. There was no collapse at the osteotomy site, loss of correction or failure of fixation in either group. Staining with haematoxylin and eosin demonstrated that there was infiltration of new bone tissue into the macropores and along the periphery of the implanted scaffold in the scaffold group. The CT scans and measurement of the bone mineral density showed that at six months specimens in the scaffold group had a higher bone mineral density than in the control group, although the implantation of the polycaprolactone-tricalcium phosphate composite scaffold wedge did not enhance healing of the osteotomy.
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Affiliation(s)
- H.-C. Lim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-703, Korea
| | - J.-H. Bae
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Gojan 1-Dong, Danwon Gu, Ansan-Si, Gyeonggi-Do 425-707, Korea
| | - H.-R. Song
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-703, Korea
| | - S. H. Teoh
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576
| | - H.-K. Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-703, Korea
| | - D.-H. Kum
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Gojan 1-Dong, Danwon Gu, Ansan-Si, Gyeonggi-Do 425-707, Korea
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Zenha H, Azevedo L, Rios L, Pinto A, Luz Barroso M, Cunha C, Costa H. The application of 3-D biomodeling technology in complex mandibular reconstruction—experience of 47 clinical cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0503-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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In vitro biological characterization of macroporous 3D Bonelike® structures prepared through a 3D machining technique. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2009. [DOI: 10.1016/j.msec.2008.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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3-D biomodelling technology for maxillofacial reconstruction. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2008. [DOI: 10.1016/j.msec.2008.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Aryee S, Imhoff AB, Rose T, Tischer T. Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 2008; 29:3497-502. [PMID: 18555524 DOI: 10.1016/j.biomaterials.2008.05.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 05/11/2008] [Indexed: 01/30/2023]
Abstract
High tibial osteotomy (HTO) is an increasing popular method to treat unicompartimental osteoarthritis of the knee in younger, active patients. In so doing one tries to delay the need for total or unicompartimental joint replacement. The augmentation of HTO opening gaps with supporting material is discussed controversially, especially after the introduction of locking plates, which contribute to the decline of the non-union rate. Currently, we do not recommend synthetic augmentation, when using locking plates in HTO with opening angles less than 10 degrees . In our recent randomized study we could histologically and radiologically demonstrate the complete rebuilding of lamelliform bone in patients without synthetic augmentation, whilst bony ingrowth into the hydroxyapatite/tricalcium phosphate (HA/TCP) wedge of augmented osteotomies just slowly progressed. In contrast to unaugmented osteotomies, there was no advantage in using HA/TCP wedges or the combination of HA/TCP wedges and platelet rich plasma (PRP) as supporting material after 12 months. In osteotomies where an opening angle bigger than 7.5 degrees is chosen, rigid locking plates should be used. In our opinion, autologous iliac crest graft should be used in the high-risk patients (obese, smoker, opening angle bigger than 10 degrees ). Whether synthetic augmentation combined with PRP is equal or even superior to autologous iliac crest graft in openings bigger than 10 degrees has not been proven yet.
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Affiliation(s)
- Sebastian Aryee
- Department of Orthopaedic Sport Medicine, Technical University of Munich, Germany
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