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Choi SR, Kwon JW, Suk KS, Kim HS, Moon SH, Park SY, Lee BH. The Clinical Use of Osteobiologic and Metallic Biomaterials in Orthopedic Surgery: The Present and the Future. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16103633. [PMID: 37241260 DOI: 10.3390/ma16103633] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
As the area and range of surgical treatments in the orthopedic field have expanded, the development of biomaterials used for these treatments has also advanced. Biomaterials have osteobiologic properties, including osteogenicity, osteoconduction, and osteoinduction. Natural polymers, synthetic polymers, ceramics, and allograft-based substitutes can all be classified as biomaterials. Metallic implants are first-generation biomaterials that continue to be used and are constantly evolving. Metallic implants can be made from pure metals, such as cobalt, nickel, iron, or titanium, or from alloys, such as stainless steel, cobalt-based alloys, or titanium-based alloys. This review describes the fundamental characteristics of metals and biomaterials used in the orthopedic field and new developments in nanotechnology and 3D-printing technology. This overview discusses the biomaterials that clinicians commonly use. A complementary relationship between doctors and biomaterial scientists is likely to be necessary in the future.
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Affiliation(s)
- Sung-Ryul Choi
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Si-Young Park
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Bonit Coating Leads to Macroscopic Bone Ingrowth at 8 Weeks After Primary Total Hip Arthroplasty. Arthroplast Today 2022; 16:203-206. [PMID: 35874147 PMCID: PMC9304667 DOI: 10.1016/j.artd.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
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Yedekçi B, Tezcaner A, Alshemary AZ, Yılmaz B, Demir T, Evis Z. Synthesis and sintering of B, Sr, Mg multi-doped hydroxyapatites: Structural, mechanical and biological characterization. J Mech Behav Biomed Mater 2021; 115:104230. [DOI: 10.1016/j.jmbbm.2020.104230] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
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Self-Setting Calcium Orthophosphate (CaPO4) Formulations. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2018. [DOI: 10.1007/978-981-10-5975-9_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Dorozhkin SV. Self-setting calcium orthophosphate formulations. J Funct Biomater 2013; 4:209-311. [PMID: 24956191 PMCID: PMC4030932 DOI: 10.3390/jfb4040209] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 01/08/2023] Open
Abstract
In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are bioactive and biodegradable grafting bioceramics in the form of a powder and a liquid. After mixing, both phases form pastes, which set and harden forming either a non-stoichiometric calcium deficient hydroxyapatite or brushite. Since both of them are remarkably biocompartible, bioresorbable and osteoconductive, self-setting calcium orthophosphate formulations appear to be promising bioceramics for bone grafting. Furthermore, such formulations possess excellent molding capabilities, easy manipulation and nearly perfect adaptation to the complex shapes of bone defects, followed by gradual bioresorption and new bone formation. In addition, reinforced formulations have been introduced, which might be described as calcium orthophosphate concretes. The discovery of self-setting properties opened up a new era in the medical application of calcium orthophosphates and many commercial trademarks have been introduced as a result. Currently such formulations are widely used as synthetic bone grafts, with several advantages, such as pourability and injectability. Moreover, their low-temperature setting reactions and intrinsic porosity allow loading by drugs, biomolecules and even cells for tissue engineering purposes. In this review, an insight into the self-setting calcium orthophosphate formulations, as excellent bioceramics suitable for both dental and bone grafting applications, has been provided.
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Hall A, Eilers M, Hansen R, Robinson BS, Maloney WJ, Paprosky WG, Ries MD, Saleh KJ. Advances in acetabular reconstruction in revision total hip arthroplasty: maximizing function and outcomes after treatment of periacetabular osteolysis around the well-fixed shell. J Bone Joint Surg Am 2013; 95:1709-18. [PMID: 24048559 DOI: 10.2106/jbjs.9518icl] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Adam Hall
- Division of Orthopaedics, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL 62794-9679. E-mail address for K.J. Saleh:
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Laird DF, Mucalo MR, Dias GJ. Vacuum-assisted infiltration of chitosan or polycaprolactone as a structural reinforcement for sintered cancellous bovine bone graft. J Biomed Mater Res A 2012; 100:2581-92. [DOI: 10.1002/jbm.a.34193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/04/2012] [Accepted: 03/12/2012] [Indexed: 11/10/2022]
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O'Dowd-Booth CJ, White J, Smitham P, Khan W, Marsh DR. Bone cement: perioperative issues, orthopaedic applications and future developments. J Perioper Pract 2011; 21:304-308. [PMID: 22474774 DOI: 10.1177/175045891102100902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Bone cement has been increasingly used in orthopaedic surgery over the last 50 years. Since Sir John Charnley pioneered the use of polymethylmethacrylate cement in total hip replacements, there have been developments in cementing techniques and an expansion in the number of orthopaedic procedures that use cement. This review covers the perioperative issues surrounding bone cement including storage, cementing techniques and complications. It also discusses specific orthopaedic applications of bone cement and future developments.
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Affiliation(s)
- Christopher John O'Dowd-Booth
- UCL Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP
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Park SH, Tofighi A, Wang X, Strunk M, Ricketts T, Chang J, Kaplan DL. Calcium phosphate combination biomaterials as human mesenchymal stem cell delivery vehicles for bone repair. J Biomed Mater Res B Appl Biomater 2011; 97:235-44. [PMID: 21384543 DOI: 10.1002/jbm.b.31805] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/30/2010] [Accepted: 11/22/2010] [Indexed: 11/09/2022]
Abstract
A new class of biomimetic, bioresorbable apatitic calcium phosphate cement (CPC) was recently developed. The handling characteristics, and the ability to harden at body temperature in the presence of physiological saline, make this material an attractive clinical bone substitute and delivery vehicle for therapeutic agents in orthopedic applications. The major challenge with the material is formulating an injectable paste with options for cell delivery, in order to regenerate new bone faster and with high quality. In this study, three different additives and/or viscosity modifiers (carboxymethylcellulose, silk, and alginate) were incorporated into a CPC matrix. Injectability, cell viability, cell proliferation, surface morphology, and gene expression for osteogenesis of hMSCs were all evaluated. Injectable CPC-gel composites with cell protection were achieved. The CPC modified with alginate provided the best results based on cell proliferation, ALP and collagen production, and osteogenic transcript increases (for ALP, type I collagen, BSP, and OP). Furthermore, osteogenic analysis indicated lineage-specific differentiation of hMSCs into osteogenic outcomes. The results suggest that CPC mixed with alginate can be used as a cell delivery vehicle for bone regeneration.
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Affiliation(s)
- Sang-Hyug Park
- ETEX Corporation, University Park at MIT, Cambridge, Massachusetts 02139, USA
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Combes C, Rey C. Amorphous calcium phosphates: synthesis, properties and uses in biomaterials. Acta Biomater 2010; 6:3362-78. [PMID: 20167295 DOI: 10.1016/j.actbio.2010.02.017] [Citation(s) in RCA: 336] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 02/07/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
This review paper on amorphous calcium phosphates (ACPs) provides an update on several aspects of these compounds which have led to many studies and some controversy since the 1970s, particularly because of the lack of irrefutable proof of the occurrence of an ACP phase in mineralised tissues of vertebrates. The various synthesis routes of ACPs with different compositions are reported and the techniques used to characterise this phase are reviewed. We focus on the various physico-chemical properties of ACPs, especially the reactivity in aqueous media, which have been exploited to prepare bioactive bone substitutes, particularly in the form of coatings and cements for orthopaedic applications and composites for dental applications.
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A Prospective Randomized Controlled Trial of a Bioresorbable Calcium Phosphate Paste (α-BSM) in Treatment of Displaced Intra-Articular Calcaneal Fractures. ACTA ACUST UNITED AC 2009; 67:875-82. [DOI: 10.1097/ta.0b013e3181ae2d50] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Abstract
In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are a bioactive and biodegradable grafting material in the form of a powder and a liquid. Both phases form after mixing a viscous paste that after being implanted, sets and hardens within the body as either a non-stoichiometric calcium deficient hydroxyapatite (CDHA) or brushite, sometimes blended with unreacted particles and other phases. As both CDHA and brushite are remarkably biocompartible and bioresorbable (therefore, in vivo they can be replaced with newly forming bone), calcium orthophosphate cements represent a good correction technique for non-weight-bearing bone fractures or defects and appear to be very promising materials for bone grafting applications. Besides, these cements possess an excellent osteoconductivity, molding capabilities and easy manipulation. Furthermore, reinforced cement formulations are available, which in a certain sense might be described as calcium orthophosphate concretes. The concepts established by calcium orthophosphate cement pioneers in the early 1980s were used as a platform to initiate a new generation of bone substitute materials for commercialization. Since then, advances have been made in the composition, performance and manufacturing; several beneficial formulations have already been introduced as a result. Many other compositions are in experimental stages. In this review, an insight into calcium orthophosphate cements and concretes, as excellent biomaterials suitable for both dental and bone grafting application, has been provided.
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Shona Pek Y, Kurisawa M, Gao S, Chung JE, Ying JY. The development of a nanocrystalline apatite reinforced crosslinked hyaluronic acid–tyramine composite as an injectable bone cement. Biomaterials 2009; 30:822-8. [DOI: 10.1016/j.biomaterials.2008.10.053] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
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Abstract
Pelvic discontinuity is a complex entity with a high surgical complication rate and no standardized treatment to date. Revision hip arthroplasty in cases of massive bone loss remains a difficult and unsolved problem. The goal of the surgeon is to preserve limb function by restoring bone stock and the biomechanics of the hip. In cases of severe acetabular bone loss, biologic fixation is often inadequate, requiring extensive bone grafting and reconstructive cages. Reconstructive cages are the most commonly used devices and are designed to bridge bone defects, protect the bone graft, and reestablish the rotation center of the hip. A major limitation of current cages is that they do not allow for biologic fixation. We review the options for treating patients with massive bone loss and pelvic discontinuity and discuss therapeutic options and the clinical and radiological criteria for success.
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Hannink G, Wolke JGC, Schreurs BW, Buma P. In vivo behavior of a novel injectable calcium phosphate cement compared with two other commercially available calcium phosphate cements. J Biomed Mater Res B Appl Biomater 2008; 85:478-88. [DOI: 10.1002/jbm.b.30969] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Heiner AD, Callaghan JJ, Brown TD. Stability of fused versus nonfused THA femoral impaction grafts. J Orthop Res 2007; 25:351-60. [PMID: 17143908 PMCID: PMC2718431 DOI: 10.1002/jor.20316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 08/18/2006] [Indexed: 02/04/2023]
Abstract
Impaction grafting for THA involves compacting morselized cancellous bone (MCB) into a cavitary defect to build up bone stock. Ideally, the MCB subsequently remodels into a new contiguous cancellous lattice. A recent laboratory model of MCB fusion allows simulating an impaction graft construct in this ideal eventual clinical state. The purpose of the present study was to determine the relative stability of femoral impaction graft constructs in which the MCB has fused versus that for MCB in the freshly impacted nonfused condition. Cemented femoral impaction graft constructs were created in composite femurs. For fused constructs, the MCB was mixed with an amine epoxy that causes the MCB to set up into a contiguous structure biomechanically comparable to intact cancellous bone in compression. The constructs were loaded with 500,000 physiologic gait cycles. Three-dimensional motion was measured between the femur and the stem. The fused femoral impaction grafts were much more stable than the nonfused grafts at the proximal stem location, but MCB fusion had only a modest effect on distal stem stability. These results indicate that most of the opportunity to reduce femoral stem micromotion and migration lies proximal, and that steps to enhance impaction graft remodeling and fusion are most effectively focused proximally.
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Affiliation(s)
- Anneliese D Heiner
- University of Iowa, Department of Orthopaedics and Rehabilitation, Biomechanics Laboratory, 2181 Westlawn Building, Iowa City, Iowa 52242, USA.
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Ni GX, Chiu KY, Lu WW, Wang Y, Zhang YG, Hao LB, Li ZY, Lam WM, Lu SB, Luk KDK. Strontium-containing hydroxyapatite bioactive bone cement in revision hip arthroplasty. Biomaterials 2006; 27:4348-55. [PMID: 16647752 DOI: 10.1016/j.biomaterials.2006.03.048] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 03/27/2006] [Indexed: 02/05/2023]
Abstract
Clinical outcome of cemented implants to revision total hip replacement (THR) is not as satisfactory as primary THR, due to the loss of bone stock and normal trabecular pattern. This study evaluated a bioactive bone cement, strontium-containing hydroxyapatite (Sr-HA) bone cement, in a goat revision hip hemi-arthroplasty model, and compared outcomes with polymethylmethacrylate (PMMA) bone cement. Nine months after operation, significantly higher bonding strength was found in the Sr-HA group (3.36+/-1.84 MPa) than in the PMMA bone cement group (1.23+/-0.73 MPa). After detached from the femoral component, the surface of PMMA bone cement mantle was shown relatively smooth, whereas the surface of the Sr-HA bioactive bone cement mantle was uneven, by SEM observation. EDX analysis detected little calcium and no phosphorus on the surface of PMMA bone cement mantle, while high content of calcium (14.03%) and phosphorus (10.37%) was found on the surface of the Sr-HA bone cement mantle. Even higher content of calcium (17.37%) and phosphorus (10.84%) were detected in the concave area. Intimate contact between Sr-HA bioactive bone cement and bone was demonstrated by histological and SEM observation. New bone bonded to the surface of Sr-HA cement and grew along its surface. However, fibrous tissue was observed between PMMA bone cement and bone. The results showed good bioactivity of Sr-HA bioactive bone cement in this revision hip replacement model using goats. This in vivo study also suggested that Sr-HA bioactive bone cement was superior to PMMA bone cement in terms of bone-bonding strength. Use of bioactive bone cement may be a possible solution overcoming problems associated with the use of PMMA bone cement in revision hip replacement.
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Affiliation(s)
- G X Ni
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, and Department of Orthopaedics Surgery, The General Hospital of PLA, Beijing, China
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