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Sui P, Yu T, Sun S, Chao B, Qin C, Wang J, Wang E, Zheng C. Advances in materials used for minimally invasive treatment of vertebral compression fractures. Front Bioeng Biotechnol 2023; 11:1303678. [PMID: 37954022 PMCID: PMC10634476 DOI: 10.3389/fbioe.2023.1303678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Vertebral compression fractures are becoming increasingly common with aging of the population; minimally invasive materials play an essential role in treating these fractures. However, the unacceptable processing-performance relationships of materials and their poor osteoinductive performance have limited their clinical application. In this review, we describe the advances in materials used for minimally invasive treatment of vertebral compression fractures and enumerate the types of bone cement commonly used in current practice. We also discuss the limitations of the materials themselves, and summarize the approaches for improving the characteristics of bone cement. Finally, we review the types and clinical efficacy of new vertebral implants. This review may provide valuable insights into newer strategies and methods for future research; it may also improve understanding on the application of minimally invasive materials for the treatment of vertebral compression fractures.
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Affiliation(s)
| | | | | | | | | | | | | | - Changjun Zheng
- Orthopaedic Medical Center, Second Hospital of Jilin University, Changchun, China
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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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Kaiser F, Schröter L, Wohlfahrt P, Geroneit I, Murek J, Stahlhut P, Weichhold J, Ignatius A, Gbureck U. Exploring the potential of magnesium oxychloride, an amorphous magnesium phosphate, and newberyite as possible bone cement candidates. J Biomater Appl 2023; 38:438-454. [PMID: 37525613 PMCID: PMC10494481 DOI: 10.1177/08853282231190908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Magnesium phosphate-based bone cements, particularly struvite (MgNH4PO4∙6H2O)-forming cements, have attracted increased scientific interest in recent years because they exhibit similar biocompatibility to hydroxyapatite while degrading much more rapidly in vivo. However, other magnesium-based minerals which might be promising are, to date, little studied. Therefore, in this study, we investigated three magnesium-based bone cements: a magnesium oxychloride cement (Mg3(OH)5Cl∙4H2O), an amorphous magnesium phosphate cement based on Mg3(PO4)2, MgO, and NaH2PO4, and a newberyite cement (MgHPO4·3H2O). Because it is not sufficiently clear from the literature to what extent these cements are suitable for clinical use, all of them were characterized and optimized regarding setting time, setting temperature, compressive strength and passive degradation in phosphate-buffered saline. Because the in vitro properties of the newberyite cement were most promising, it was orthotopically implanted into a partially weight-bearing tibial bone defect in sheep. The cement exhibited excellent biocompatibility and degraded more rapidly compared to a hydroxyapatite reference cement; after 4 months, 18% of the cement was degraded. We conclude that the newberyite cement was the most promising candidate of the investigated cements and has clear advantages over calcium phosphate cements, especially in terms of setting time and degradation behavior.
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Affiliation(s)
- Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Lena Schröter
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Philipp Wohlfahrt
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Isabel Geroneit
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Jérôme Murek
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Philipp Stahlhut
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Jan Weichhold
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
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Quan Q, Gongping X, Ruisi N, Shiwen L. New Research Progress of Modified Bone Cement Applied to Vertebroplasty. World Neurosurg 2023; 176:10-18. [PMID: 37087028 DOI: 10.1016/j.wneu.2023.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide patients with pain relief, prevent further height loss of the vertebral body, and help correct kyphosis. Many clinical studies have investigated the characteristics of bone cement. Bone cement is a biomaterial injected into the vertebral body that must have good biocompatibility and biosafety. The optimization of the characteristics of bone cement has become of great interest. Bone cement can be mainly divided into 3 types: polymethyl methacrylate, calcium phosphate cement, and calcium sulfate cement. Each type of cement has its own advantages and disadvantages. In the past 10 years, the performance of bone cement has been greatly improved via different methods. The aim of our review is to provide an overview of the current progress in the types of modified bone cement and summarize the key clinical findings.
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Affiliation(s)
- Qi Quan
- Department of Spine Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xu Gongping
- Department of Spine Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Na Ruisi
- Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Li Shiwen
- Department of Spine Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Schulz MC, Holtzhausen S, Nies B, Heinemann S, Muallah D, Kroschwald L, Paetzold-Byhain K, Lauer G, Sembdner P. Three-Dimensional Plotted Calcium Phosphate Scaffolds for Bone Defect Augmentation—A New Method for Regeneration. J Pers Med 2023; 13:jpm13030464. [PMID: 36983646 PMCID: PMC10058839 DOI: 10.3390/jpm13030464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
For sinus grafting, different methods and materials are available. One possible shortcoming of particulate bone grafts is either overfilling or augmenting the planned implant area insufficiently. To overcome this risk and to determine the implant position prior augmentation, we present an approach using three-dimensional printed scaffolds. A patient with a remaining anterior dentition and bilateral severely atrophied posterior maxilla was seeking oral rehabilitation. The cone beam computed tomography (CBCT) showed residual bone heights between one and two millimeters. Following the three-dimensional reconstruction of the CBCT data, the positions of the implants were determined in areas 16 and 26. Three-dimensional scaffolds adapted to the topography of the sinus were virtually designed and printed using a calcium phosphate cement paste. Bilateral sinus floor augmentation applying the printed scaffolds with an interconnecting porosity followed. After nine months, a satisfying integration of the scaffolds was obvious. At the re-entry, vital bone with sufficient blood supply was found. One implant could be placed in positions 16 and 26, respectively. After five months, the implants could be uncovered and were provided with a temporary denture. The application of three-dimensionally printed scaffolds from calcium phosphate cement paste seems to be a promising technique to graft the severely atrophied posterior maxilla for the placement of dental implants.
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Affiliation(s)
- Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Osianderstraße 2-8, 72076 Tübingen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-7071-2986-174
| | - Stefan Holtzhausen
- Institute of Machine Elements and Machine Design, Chair of Virtual Product Development, Technische Universität Dresden, 01062 Dresden, Germany
| | - Berthold Nies
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany
| | | | - David Muallah
- Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Lysann Kroschwald
- Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Kristin Paetzold-Byhain
- Institute of Machine Elements and Machine Design, Chair of Virtual Product Development, Technische Universität Dresden, 01062 Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Philipp Sembdner
- Institute of Machine Elements and Machine Design, Chair of Virtual Product Development, Technische Universität Dresden, 01062 Dresden, Germany
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Wang Y, Liu C, Liu H, Fu H, Li C, Yang L, Sun H. A Novel Calcium Phosphate-Based Nanocomposite for Augmentation of Cortical Bone Trajectory Screw Fixation. Int J Nanomedicine 2022; 17:3059-3071. [PMID: 35844971 PMCID: PMC9278980 DOI: 10.2147/ijn.s365149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of cement augmentation of cortical bone trajectory (CBT) screws using a novel calcium phosphate–based nanocomposite (CPN). Material and Methods CBT screws were placed into cadaveric lumbar vertebrae. Depending on the material used for augmentation, they were divided into the following three groups: CPN, polymethylmethacrylate (PMMA), and control. Radiological imaging was used to evaluate the cement dispersion. Biomechanical tests were conducted to measure the stability of CBT screws. A rat cranial defect model was used to evaluate biodegradation and osseointegration of the CPN. Results After cement augmentation, the CPN tended to disperse into the distal part of the screws, whereas PMMA remained limited to the proximal part of the screws (P < 0.05). As for cement morphology, the CPN tended to form a concentrated mass, whereas PMMA arranged itself as a scattered cement cloud, but the difference was not significant (P > 0.05). The axial pullout test showed that the average maximal pullout force (Fmax) of CPN-augmented CBT screws was similar to that of the PMMA group (CPN, 1639.56 ± 358.21 N vs PMMA, 1778.45 ± 399.83 N; P = 0.745) and was significantly greater than that of the control group (1019.01 ± 371.98 N; P < 0.05). The average torque value in the CPN group was higher than that in the control group (CPN, 1.51 ± 0.78 N∙m vs control, 0.97 ± 0.58 N∙m) and lower than that in the PMMA group (1.93 ± 0.81 N∙m), but there were no statistically significant differences (P > 0.05). The CPN could be biodegraded and gradually replaced by newly formed bone tissue after 12 weeks in a rat cranial defect model. Conclusion The biocompatible CPN could be a valuable augmentation material to enhance CBT screw stability.
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Affiliation(s)
- Yuetian Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Chun Liu
- Medical Research Centre, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Jiangsu, People's Republic of China
| | - Huiling Liu
- Institute of Orthopedics, Department of Orthopedics, Soochow University, Suzhou, People's Republic of China
| | - Haoyong Fu
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Chunde Li
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Lei Yang
- Institute of Orthopedics, Department of Orthopedics, Soochow University, Suzhou, People's Republic of China.,Center for Health Sciences and Engineering (CHSE), School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, People's Republic of China
| | - Haolin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
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Moura DFL, Gabriel JP. INTRAVERTEBRAL EXPANDABLE IMPLANTS IN THORACOLUMBAR VERTEBRAL COMPRESSION FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e245117. [PMID: 35694022 PMCID: PMC9150872 DOI: 10.1590/1413-785220223003e245117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.
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Affiliation(s)
- Diogo Filipe Lino Moura
- Centro Hospitalar e Universitário de Coimbra, Portugal; Universidade de Coimbra, Portugal; Grant Medical Center, United States of America
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The Use of a Novel Moldable Calcium Phosphate Putty (Montage) for Periarticular Fractures: Early Clinical Results. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheng L, Lin T, Khalaf AT, Zhang Y, He H, Yang L, Yan S, Zhu J, Shi Z. The preparation and application of calcium phosphate biomedical composites in filling of weight-bearing bone defects. Sci Rep 2021; 11:4283. [PMID: 33608623 PMCID: PMC7896074 DOI: 10.1038/s41598-021-83941-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Abstract
Nowadays, artificial bone materials have been widely applied in the filling of non-weight bearing bone defects, but scarcely ever in weight-bearing bone defects. This study aims to develop an artificial bone with excellent mechanical properties and good osteogenic capability. Firstly, the collagen-thermosensitive hydrogel-calcium phosphate (CTC) composites were prepared as follows: dissolving thermosensitive hydrogel at 4 °C, then mixing with type I collagen as well as tricalcium phosphate (CaP) powder, and moulding the composites at 37 °C. Next, the CTC composites were subjected to evaluate for their chemical composition, micro morphology, pore size, Shore durometer, porosity and water absorption ability. Following this, the CTC composites were implanted into the muscle of mice while the 70% hydroxyapatite/30% β-tricalcium phosphate (HA/TCP) biomaterials were set as the control group; 8 weeks later, the osteoinductive abilities of biomaterials were detected by histological staining. Finally, the CTC and HA/TCP biomaterials were used to fill the large segments of tibia defects in mice. The bone repairing and load-bearing abilities of materials were evaluated by histological staining, X-ray and micro-CT at week 8. Both the CTC and HA/TCP biomaterials could induce ectopic bone formation in mice; however, the CTC composites tended to produce larger areas of bone and bone marrow tissues than HA/TCP. Simultaneously, bone-repairing experiments showed that HA/TCP biomaterials were easily crushed or pushed out by new bone growth as the material has a poor hardness. In comparison, the CTC composites could be replaced gradually by newly formed bone and repair larger segments of bone defects. The CTC composites trialled in this study have better mechanical properties, osteoinductivity and weight-bearing capacity than HA/TCP. The CTC composites provide an experimental foundation for the synthesis of artificial bone and a new option for orthopedic patients.
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Affiliation(s)
- Lijia Cheng
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China.
| | - Tianchang Lin
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China
| | - Ahmad Taha Khalaf
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China
| | - Yamei Zhang
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China
| | - Hongyan He
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China
| | - Liming Yang
- Department of Orthopedics, The First People's Hospital of Chengdu, Chengdu, 610000, China
| | - Shuo Yan
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China
| | - Jiang Zhu
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China
| | - Zheng Shi
- College of Basic Medicine & Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, 610106, China.
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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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11
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Functionalization of Ceramic Coatings for Enhancing Integration in Osteoporotic Bone: A Systematic Review. COATINGS 2019. [DOI: 10.3390/coatings9050312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The success of reconstructive orthopaedic surgery strongly depends on the mechanical and biological integration between the prosthesis and the host bone tissue. Progressive population ageing with increased frequency of altered bone metabolism conditions requires new strategies for ensuring an early implant fixation and long-term stability. Ceramic materials and ceramic-based coatings, owing to the release of calcium phosphate and to the precipitation of a biological apatite at the bone-implant interface, are able to promote a strong bonding between the host bone and the implant. Methods: The aim of the present systematic review is the analysis of the existing literature on the functionalization strategies for improving the implant osteointegration in osteoporotic bone and their relative translation into the clinical practice. The review process, conducted on two electronic databases, identified 47 eligible preclinical studies and 5 clinical trials. Results: Preclinical data analysis showed that functionalization with both organic and inorganic molecules usually improves osseointegration in the osteoporotic condition, assessed mainly in rodent models. Clinical studies, mainly retrospective, have tested no functionalization strategies. Registered trademarks materials have been investigated and there is lack of information about the micro- or nano- topography of ceramics. Conclusions: Ceramic materials/coatings functionalization obtained promising results in improving implant osseointegration even in osteoporotic conditions but preclinical evidence has not been fully translated to clinical applications.
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12
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Schützenberger S, Schwarz SM, Greiner L, Holub O, Grabner S, Huf W, Sailler A, Fialka C. Is vertebral body stenting in combination with CaP cement superior to kyphoplasty? 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 2018; 27:2602-2608. [PMID: 30099668 DOI: 10.1007/s00586-018-5717-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 07/03/2018] [Accepted: 08/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE In the evolution of the minimally invasive treatment of vertebral compression fractures, vertebral body stenting (VBS) was developed to reduce intraoperative and secondary loss of vertebral height. Particularly in combination with the usage of biodegradable cement, the influence of VBS on the rate of intraoperative complications and long-term outcome is unclear. The purpose of this study was to investigate the differences between balloon kyphoplasty (BKP) and VBS regarding their long-term clinical and radiological outcome in combination with calcium phosphate (CaP) application instead of polymethyl methacrylate (PMMA). METHODS This retrospective study included 49 patients with fresh mono-segmental thoracolumbar fractures without neurological signs treated with VBS or BKP and CaP cement (Calcibone). The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry disability score (ODI), and radiologically assessed. RESULTS In the course of the radiological follow-up, the VBS group showed statistically significant less vertebral height loss than the BKP group. However, with respect to VAS and ODI scores there were no statistically significant differences between the VBS and BKP group in the clinical follow-up. The rate of cement leakage was comparable in both groups. CONCLUSIONS Both techniques facilitated good clinical results in combination with absorbable cement augmentation. In particular, the VBS enabled us to benefit from the advantages of the resorbable isothermic CaP cement with an improved radiological outcome in the long term compared to BKP. However, there was a mentionable loss of reduction in the follow-up in both groups compared to previously published data with PMMA cement. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - S M Schwarz
- AUVA Trauma Center Meidling, Vienna, Austria
| | - L Greiner
- AUVA Trauma Center Meidling, Vienna, Austria
| | - O Holub
- AUVA Trauma Center Meidling, Vienna, Austria
| | - S Grabner
- AUVA Trauma Center Meidling, Vienna, Austria
| | - W Huf
- Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | - A Sailler
- AUVA Trauma Center Meidling, Vienna, Austria
| | - C Fialka
- AUVA Trauma Center Meidling, Vienna, Austria
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13
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Abstract
As an extension of percutaneous vertebroplasty (PVP), percutaneous osteoplasty (POP) refers broadly to percutaneous bone cement injected into various parts of the body and narrowly to cement injected into extraspinal bone lesions. POP mainly includes such surgeries as percutaneous sacroplasty, percutaneous acetabuloplasty, percutaneous femoral osteoplasty, and percutaneous iliac osteoplasty (Figure 1). Currently, POP is a positive and an effective treatment for extraspinal bone lesions in that it can rapidly relieve pain, effectively prevent pathological fractures, and partially inactivate tumors, with few complications. The aim of this review is to detail the POP techniques and report their safety and efficacy in the treatment of extraspinal metastases.
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Affiliation(s)
- Qinghua Tian
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Yongde Cheng
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Chungen Wu
- Department of Radiology, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
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Daley E, Kurdziel MD, Koueiter D, Moore DD. Characterization of doxycycline-loaded calcium phosphate cement: implications for treatment of aneurysmal bone cysts. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:109. [PMID: 29987657 DOI: 10.1007/s10856-018-6117-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
Percutaneous doxycycline for treatment for aneurysmal bone cysts (ABCs) has been shown to decrease recurrence rates, however, this requires multiple procedures, includes the risks soft tissue necrosis, and does not provide structural support. We propose utilizing curettage with doxycycline-loaded calcium phosphate cement. This study aimed to evaluate the elution profile of doxycycline from calcium phosphate cement. Calcium phosphate cement underwent an in vitro elution protocol evaluating doxycycline concentrations of 0, 5, 10, and 15 mg/mL. Eluted concentrations were quantified utilizing high performance liquid chromatography at predetermined time points over 96 h. Compressive strength was evaluated both pre- and post-elution and micro-computed tomography was utilized to assess changes in cement porosity. Cement with 15 mg/mL of doxycycline maintained a higher average concentration (mean, 95% confidence intervals) (14.5 µg/mL [9.2-19.9 µg/mL]) compared to both 5 mg/mL (5.8 µg/mL [3.1-8.6 µg/mL]; P < 0.001) and 10 mg/mL (8.4 ± µg/mL [6.0-10.9 µg/mL]; P < 0.001). Ultimate stress significantly decreased between pre- and post-elution samples for 10 mg/mL (P= 0.001) and 15 mg/mL (P = 0.004) groups. This study demonstrated a dose-dependent response in ultimate strength and compressive modulus with addition of doxycycline to calcium phosphate cement.
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Affiliation(s)
- Erika Daley
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Michael D Kurdziel
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI, 48309, USA
| | - Denise Koueiter
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - Drew D Moore
- Department of Orthopaedic Surgery, Beaumont Health, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA.
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI, 48309, USA.
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Calcium Phosphate Cement Leakage During Balloon Kyphoplasty Causing Incomplete Paraplegia: Case Report and Review of the Literature. JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA 2016. [DOI: 10.5812/jost.8894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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[Kyphoplasty-Vertebroplasty. A critical assessment]. Radiologe 2016; 55:854-8. [PMID: 26373663 DOI: 10.1007/s00117-015-0016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CLINICAL ISSUE Painful vertebral compression fractures. STANDARD TREATMENT Analgesia. TREATMENT INNOVATIONS Osteoplastic procedures, such as kyphoplasty and vertebroplasty. DIAGNOSTIC WORKUP Anamnestic and radiological associations of clinical complaints with the radiomorphological findings of vertebral compression fractures are required for an adequate consideration to assess whether an osteoplastic procedure should be carried out. A computed tomography (CT) scan allows a reliable judgement whether an osteoplastic procedure is technically feasible and promising to improve the local vertebral fracture-associated pain. PERFORMANCE Prospective controlled trials have demonstrated a satisfactory improvement of back pain associated with vertebral fractures and parameters of quality of life by osteoplastic interventions. ACHIEVEMENTS No prospective, truly sham-controlled blind trials are currently available which demonstrate an advantage of osteoplastic interventions compared to standard pain treatment; however, the currently published prospective controlled trials show a satisfactory pain reduction by osteoplastic interventions, such as kyphoplasty and vertebroplasty. PRACTICAL RECOMMENDATIONS Painful vertebral fractures and progressive loss of vertebral height of compression fractures should be evaluated in an interdisciplinary team consisting of radiologists, spinal surgeons and internists to assess whether an osteoplastic procedure is technically feasible and promising to improve local pain and immobility associated with vertebral fractures.
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Cementless fixation of osteoporotic VCFs using titanium mesh implants (OsseoFix): preliminary results. BIOMED RESEARCH INTERNATIONAL 2014; 2014:853897. [PMID: 25110699 PMCID: PMC4119652 DOI: 10.1155/2014/853897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Vertebral compression fractures (VCFs) affect 20% of people over the age of 70 with increasing incidence. Kypho-/vertebroplasty as standard operative procedures are associated with limitations like cement leakage, limited reduction capabilities, and risk for adjacent fractures. To address these shortcomings, we introduce a new minimal invasive cementless VCF fixation technique. METHODS Four patients (72.3 years, range 70-76) with VCFs type AO/Müller A1.3 and concomitant osteoporosis were treated by minimal invasive transpedicular placement of two intervertebral mesh cages for fracture reduction and maintenance. Follow-up included functional/radiological assessment and clinical scores and averaged 27.7 months (24-28). RESULTS Endplate reduction was achieved in all cases (mean surgery time: 28.5 minutes). Kyphotic (KA) and Cobb angle revealed considerable improvements postoperatively (KA 14.5° to 10.7°/Cobb 10.1° to 8.3°). Slight loss of vertebral reduction (KA: 12.6°) and segment rekyphosis (Cobb: 10.7°) were observed for final follow-up. Pain improved from 8.8 to 2.8 (visual analogue scale). All cases showed signs of bony healing. No perioperative complications and no adjacent fractures occurred. CONCLUSION Preliminary results in a small, selected patient collective indicate the ability of bony healing for osteoporotic VCFs. Cementless fixation using intravertebral titanium mesh cages revealed substantial pain relief, adequate reduction, and reduction maintenance without complications. Trial registration number is DRKS00005657, German Clinical Trials Register (DKRS).
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