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Kim MJ, Park JH, Seok JM, Jung J, Hwang TS, Lee HC, Lee JH, Park SA, Byun JH, Oh SH. BMP-2-immobilized PCL 3D printing scaffold with a leaf-stacked structure as a physically and biologically activated bone graft. Biofabrication 2024; 16:025014. [PMID: 38306679 DOI: 10.1088/1758-5090/ad2537] [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: 10/16/2023] [Accepted: 02/01/2024] [Indexed: 02/04/2024]
Abstract
Although three-dimensional (3D) printing techniques are used to mimic macro- and micro-structures as well as multi-structural human tissues in tissue engineering, efficient target tissue regeneration requires bioactive 3D printing scaffolds. In this study, we developed a bone morphogenetic protein-2 (BMP-2)-immobilized polycaprolactone (PCL) 3D printing scaffold with leaf-stacked structure (LSS) (3D-PLSS-BMP) as a bioactive patient-tailored bone graft. The unique LSS was introduced on the strand surface of the scaffold via heating/cooling in tetraglycol without significant deterioration in physical properties. The BMP-2 adsorbed on3D-PLSS-BMPwas continuously released from LSS over a period of 32 d. The LSS can be a microtopographical cue for improved focal cell adhesion, proliferation, and osteogenic differentiation.In vitrocell culture andin vivoanimal studies demonstrated the biological (bioactive BMP-2) and physical (microrough structure) mechanisms of3D-PLSS-BMPfor accelerated bone regeneration. Thus, bioactive molecule-immobilized 3D printing scaffold with LSS represents a promising physically and biologically activated bone graft as well as an advanced tool for widespread application in clinical and research fields.
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Affiliation(s)
- Min Ji Kim
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea
| | - Jin-Ho Park
- Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
- Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Ji Min Seok
- Nano-Convergence Mechanical Systems Research Division, Korea Institute of Machinery and Materials (KIMM), 156 Gajeongbuk-ro, Yuseong-gu, Daejeon 304-343, Republic of Korea
| | - Jiwoon Jung
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Tae Sung Hwang
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Hee-Chun Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials, Hannam University, Daejeon 34054, Republic of Korea
| | - Su A Park
- Nano-Convergence Mechanical Systems Research Division, Korea Institute of Machinery and Materials (KIMM), 156 Gajeongbuk-ro, Yuseong-gu, Daejeon 304-343, Republic of Korea
| | - June-Ho Byun
- Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
- Department of Convergence Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science, Dankook University, Cheonan 31116, Republic of Korea
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Castricini R, Mercurio M, Galasso O, Sanzo V, De Gori M, De Benedetto M, Orlando N, Gasparini G. Femoral head allograft for glenoid bone loss in primary reverse shoulder arthroplasty: functional and radiologic outcomes. J Shoulder Elbow Surg 2024; 33:e58-e67. [PMID: 37506998 DOI: 10.1016/j.jse.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Several techniques have been adopted during primary reverse shoulder arthroplasty (RSA) to manage glenoid bone defect. Among bone grafts, humeral head autograft is currently the mainstream option. However, autologous humeral heads may be unavailable or inadequate, and allografts may be a viable alternative. The aim of the present study was to evaluate the functional and radiologic outcomes of femoral head allografts for glenoid bone defects in primary RSA. METHODS We conducted a retrospective study with prospective data collection enrolling 20 consecutive patients who underwent RSA with femoral head allografts for glenoid bone defects. Indications for surgery were eccentric cuff tear arthropathy in 10 cases (50%), concentric osteoarthritis in 9 cases (45%), and fracture sequelae in 1 case (5%). Each patient was evaluated preoperatively and at follow-up by radiologic and computed tomography (CT) and by assessing the range of motion (ROM) and the Constant-Murley score (CMS). A CT-based software, a patient-specific 3D model of the scapula, and patient-specific instrumentation were used to shape the graft and to assess the position of K-wire for the central peg. Postoperatively, CT scans were used to identify graft incorporation and resorption. RESULTS After a median follow-up of 26.5 months (24-38), ROM and CMS showed a statistically significant improvement (all P = .001). The median measures of the graft were as follows: 28 mm (28-29) for diameter, 22° (10°-31°) for angle, 4 mm (2-8 mm) for minimum thickness, and 15 mm (11-21 mm) for maximum thickness. Before the surgery, the median glenoid version was 21.8° (16.5°-33.5°) for the retroverted glenoids and -13.5° (-23° to -12°) for the anteverted glenoids. At the follow-up, the median postoperative baseplate retroversion was 5.7° (2.2°-1.5°) (P = .001), and this value was close to the 4° retroversion planned on the preoperative CT-based software. Postoperative major complications were noted in 4 patients: 2 dislocations, 1 baseplate failure following a high-energy trauma, and 1 septic baseplate failure. Partial graft resorption without glenoid component failure was observed in 3 cases that did not require revision surgery. CONCLUSION The femoral head allograft for glenoid bone loss in primary RSA restores shoulder function, with CMS values comparable to those of sex- and age-matched healthy individuals. A high rate of incorporation of the graft and satisfactory correction of the glenoid version can be expected after surgery. The management of glenoid bone defects remains a challenging procedure, and a 15% risk of major complication must be considered.
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Affiliation(s)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
| | - Valentina Sanzo
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, Basso Ionio Hospital, Soverato, Italy
| | | | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", Fermo, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
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Saskianti T, Wardhani KK, Fadhila N, Wahluyo S, Dewi AM, Nugraha AP, Ernawati DS, Kanawa M. Polymethylmethacrylate-hydroxyapatite antibacterial and antifungal activity against oral bacteria: An in vitro study. J Taibah Univ Med Sci 2024; 19:190-197. [PMID: 38229827 PMCID: PMC10790095 DOI: 10.1016/j.jtumed.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024] Open
Abstract
Objective Reconstruction of alveolar bone defects resulting from aging, trauma, ablative surgery or pathology, remains a significant clinical challenge. The objective of this study was to investigate the antibacterial and antifungal activities of mixed polymethylmethacrylate-hydroxyapatite (PMMA-HA) against oral microorganisms. Our findings could provide valuable insights into the prospective application of PMMA-HA as a synthetic bone graft material to manage alveolar bone defects via tissue engineering. Methods HA powder was obtained from the Center for Ceramics in Indonesia and PMMA granules were obtained from HiMedia Laboratories; these were prepared in 20:80, 30:70, and 40:60 ratios. The antibacterial diffusion method was then performed against Staphylococcusaureus, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum, while the antifungal diffusion method was used to test against Candida albicans. Standardized protocols were used for microbial culturing and inhibition zones were measured with digital calipers. Statistical analyses included one-way ANOVA and Kruskal-Wallis tests, supplemented by post-hoc Tukey HSD tests. Results A PMMA-HA scaffold with a 20:80 ratio demonstrated the highest antibacterial activity against S. aureus, A. actinomycetemcomitans, P. gingivalis, and F. nucleatum. This was followed by the 30:70 and 40:60 ratios in terms of antibacterial activity. Statistical significance was achieved with p < 0.05 in comparison to controls. However, none of the PMMA-HA ratios showed antifungal activity against C. albicans. Conclusion PMMA-HA scaffolds have significant activity against bacteria, but not against fungi.
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Affiliation(s)
- Tania Saskianti
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Karina K. Wardhani
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Naura Fadhila
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Soegeng Wahluyo
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Ardianti M. Dewi
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Alexander P. Nugraha
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Diah S. Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Masami Kanawa
- Department of Natural Science Center for Basic Research and Development, Hiroshima University, Higashi-Hiroshima, Japan
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Li A, Piao H, Zhang J, Cheng Q, Piao F, Cao C, Yan Y, Li J, Jin B. Clinical Effect of Platelet-Rich Fibrin Combined with BIO-GENE Artificial Bone Meal in Bone Defects After Jaw Cyst Surgery. Int J Gen Med 2023; 16:5225-5234. [PMID: 38021056 PMCID: PMC10644843 DOI: 10.2147/ijgm.s431638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To compare the clinical repair effects of leaving the defect empty and using Platelet-Rich Fibrin (PRF) combined with BIO-GENE artificial bone powder in patients with bone defects 6 months after jaw cystectomy. Patients and Methods From June 2021 to June 2022, 70 patients who were admitted to the Department of Stomatology, Affiliated Hospital of Yanbian University, and were diagnosed with jaw cysts postoperatively were selected. All of the patients were divided into two groups according to random method, among which 35 patients who underwent cystectomy alone were recorded as group A, which served as blank control; 35 patients who underwent cystectomy and PRF combined with BIO-GENE artificial bone meal repaired bone defects during the same period were recorded as group B. 3D Slicer 5.0.3 software was used to reconstruct Cone Beam Computed Tomography (CBCT) after operation. In this study, the preoperative and postoperative CBCT data of the patients were analyzed using 3D Slicer 5.0.3 software in DICOM format to calculate the cleft volume before surgery and the newly formed bone volume after surgery. The osteogenesis rate was measured based on these calculations.The bone formation percentage in the bone defect area was recorded at 6 months, and the clinical curative effects of the two groups were compared. Results After 6 months of surgery, the patients showed varying degrees of restoration in the jaw cyst area.The osteogenesis rate at 6 months in group A was 76.06±13.38%, while group B had a rate of 92.87±5.72%.The CBCT values in group B were higher than those in group A at 6 months post-surgery (P<0.05), t=-6.84.Group A and Group B showed a statistically significant difference. Conclusion Compared with simple cystectomy, PRF combined with BIO-GENE artificial bone powder has a better effect on the speed of bone repair after cystectomy within 6 months and provides more favorable effects for the repair of postoperative dentition defects, and provides support to repair teeth after defects such as dental implants.
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Affiliation(s)
- An Li
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Huxiong Piao
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Jiamin Zhang
- Department of Periodontal Mucosal Disease, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Qingtao Cheng
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Fangyu Piao
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Chang Cao
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Yuqi Yan
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Jingxu Li
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
| | - Bin Jin
- Stomatology, Affiliated Hospital of Yanbian University, Yanji, People’s Republic of China
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Galagali DA, Bhatia A, Kumar P. A, Ajoy SM. Fresh Fractures: A New Indication for Use of Bone Allografts-A 10-Year Data Analysis. Indian J Orthop 2023; 57:1490-1496. [PMID: 37609015 PMCID: PMC10441971 DOI: 10.1007/s43465-023-00953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
Background Tissue banking includes the process starting from procurement to the distribution and usage of allograft tissues. The use of bone bank in orthopaedics is not widely seen. Our objective is to describe the 10-year allograft donor and recipient data from a fully functioning tissue bank in India, analyse the types of grafts used, indications and demand for various grafts. This will show the need for a tissue bank in a tertiary care orthopaedic setup. Methods Analysis of donor and recipient data for allografts of a tissue bank in an Indian tertiary care setup was done from 2012 to 2022. The number of grafts procured and used were analysed. The recipient and donor sites were also analysed. Results In 10 years, the tissue bank provided 2776 grafts and received 1962 donations. Slices procured after total knee replacements were the most commonly used allografts (28.03%). Acute fracture with bone loss or severe comminution (23.11%) being the most common indication of bone grafting was a major result of our study. Among these, proximal tibia (27.79%) was the most frequent recipient site. Tissue bank has also served patients in neurosurgery, ophthalmology, oromaxillofacial surgery, otorhinolaryngology, urology and wound care. Conclusion A tissue bank is a useful setup in tertiary care orthopaedic hospitals. Allografts were most widely used for acute trauma management. Allografts provide large graft quantity and reduce surgical time. Hence a tissue bank is not only an asset to the establishment but also to the surrounding hospitals, to which the grafts can be supplied.
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Affiliation(s)
- Dev Anand Galagali
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
| | - Aanchal Bhatia
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
| | - Ashok Kumar P.
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
| | - S. M. Ajoy
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
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Zhu Y, Jia G, Yang Y, Weng J, Liu S, Zhang M, Zhang G, Qin H, Chen Y, Yang Q, Yuan G, Yu F, Zeng H. Biomimetic Porous Magnesium Alloy Scaffolds Promote the Repair of Osteoporotic Bone Defects in Rats through Activating the Wnt/β-Catenin Signaling Pathway. ACS Biomater Sci Eng 2023. [PMID: 37200162 DOI: 10.1021/acsbiomaterials.2c01097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In this study, biomimetic porous magnesium alloy scaffolds were prepared to repair femoral bone defects in ovariectomized osteoporotic rats. The purpose of the study was to investigate the effect of biomimetic porous magnesium alloy scaffolds on repairing osteoporotic bone defects and possible mechanisms. The animal model of osteoporosis was established in female SD rats. Three months later, a bone defect of 3 mm in diameter and 3 mm in depth was created in the lateral condyle of the right femur. The rats were then randomly divided into two groups: an experimental group and a control group. Four weeks after surgery, gross specimens were observed and micro-CT scans were performed. The repair of osteoporotic femoral defects in rats was studied histologically using HE staining, Masson staining, and Goldner staining. The expression of Wnt5a, β-catenin, and BMP-2 was measured between groups by immunohistochemical staining. The bone defect was repaired better after the application of biomimetic porous magnesium alloy scaffolds. Immunohistochemical results showed significantly higher expression of Wnt5a, β-catenin, and BMP-2. To conclude, the biomimetic porous magnesium alloy scaffolds proposed in this paper might promote the repair of osteoporotic femoral bone defects in rats possibly through activating the Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Yuanchao Zhu
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Gaozhi Jia
- School of Intelligent Manufacturing and Equipment, Shenzhen Institute of Information Technology, Shenzhen 518172, China
| | - Yifei Yang
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Jian Weng
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Su Liu
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Mengwei Zhang
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Geng Zhang
- Zunyi Medical University, Zunyi 563000, China
| | - Haotian Qin
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Yixiao Chen
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Qi Yang
- Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Guangyin Yuan
- Shanghai Jiao Tong University, Shanghai 200240, China
| | - Fei Yu
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hui Zeng
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
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Gens L, Marchionatti E, Steiner A, Stoddart MJ, Thompson K, Mys K, Zeiter S, Constant C. Surgical technique and comparison of autologous cancellous bone grafts from various donor sites in rats. J Orthop Res 2023; 41:834-844. [PMID: 35953282 DOI: 10.1002/jor.25429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Autologous cancellous bone graft is the gold standard in large bone defect repair. However, studies using autologous bone grafting in rats are rare. To determine the feasibility of autologous cancellous bone graft harvest from different anatomical donor sites (humerus, ilium, femur, tibia, and tail vertebrae) in rats and compare their suitability as donor sites, a total of 13 freshly euthanized rats were used to describe the surgical technique, determine the cancellous bone volume and microstructure, and compare the cancellous bone collected quantitatively and qualitatively. It was feasible to harvest cancellous bone grafts from all five anatomical sites with the humerus and tail being more surgically challenging. The microstructural analysis using micro-computed tomography showed a significantly lower bone volume fraction, bone mineral density, and trabecular thickness of the humerus and iliac crest compared to the femur, tibia, and tail vertebrae. The harvested weight and volume did not differ between the donor sites. All donor sites apart from the femur yielded primary osteogenic cells confirmed by the presence of alkaline phosphatase and Alizarin Red S stain. Bone samples from the iliac crest showed the most consistent outgrowth of osteoprogenitor cells. In conclusion, the tibia and iliac crest may be the most favorable donor sites considering the surgical approach. However, due to the differences in microstructure of the cancellous bone and the consistency of outgrowth of osteoprogenitor cells, the donor sites may have different healing properties, that need further investigation in an in vivo study.
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Affiliation(s)
- Lena Gens
- AO Research Institute Davos, Davos, Switzerland
| | - Emma Marchionatti
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Adrian Steiner
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | | | - Karen Mys
- AO Research Institute Davos, Davos, Switzerland
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Idulhaq M, Mudigdo A, Utomo P, Wasita B, Warman FI. Platelet-rich fibrin as a tissue engineering material in accelerate bone healing in rat bone defects: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 84:104869. [PMID: 36504707 PMCID: PMC9732119 DOI: 10.1016/j.amsu.2022.104869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Various techniques for tissue engineering have been introduced to help regenerate damaged or lost bone tissue. This study aimed to see the potential implication of platelet-rich fibrin (PRF) to accelerate the bone healing process in rat bone defects. Methods A systematic literature search was conducted from several electronic databases on subjects looking at the use of PRF in rat bone defects and their results in bone regeneration. Specific results compared PRF vs. other methods, PRF vs. control, and PRV vs. combination PRF and other methods. Science Direct, PubMed, and Cochrane Library were the main information sources. The Cochrane Collaboration method is employed to assess the risk of bias. Results A total of 483 rats were used in the twelve studies, and this meta-analysis showed that the PRF vs. other methods pooled odds ratio (OR) obtained was 0.92 (95% CI 0.42-2.04; p = 0.29; I2 = 18%), PRF versus control OR obtained 9.45 (95% CI 4.68-19.08; P = 0.01; I2 = 0%), the combination of PRF compared to PRF alone OR obtained 0.12 (95% CI 0.03-0.41; p = 0.01; I2 = 0%). Discussion Platelet-rich fibrin accelerates the bone healing process in rat bone defects compared to physiologically. Platelet-rich fibrin combined with other methods can stimulate rat bone defects than utilization of platelet-rich fibrin only. The small number of articles assessed may cause limitations in sensitivity tests. This study was registered in the research registry (reviewregistry1341).
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Affiliation(s)
- Mujaddid Idulhaq
- Doctorate Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia,Department of Orthopedic & Traumatology Faculty of Medicine, Universitas Sebelas MaretRSUD Dr. Moewardi / RSO Prof Dr. R Soeharso, Surakarta, Indonesia,Corresponding author.Doctorate Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.
| | - Ambar Mudigdo
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Pamudji Utomo
- Department of Orthopedic & Traumatology Faculty of Medicine, Universitas Sebelas MaretRSUD Dr. Moewardi / RSO Prof Dr. R Soeharso, Surakarta, Indonesia
| | - Brian Wasita
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Fanny Indra Warman
- Department of Orthopedic & Traumatology Faculty of Medicine, Universitas Sebelas MaretRSUD Dr. Moewardi / RSO Prof Dr. R Soeharso, Surakarta, Indonesia
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Jeong CH, Kim J, Kim HS, Lim SY, Han D, Huser AJ, Lee SB, Gim Y, Ji JH, Kim D, Aldosari AM, Yun K, Kwak YH. Acceleration of bone formation by octacalcium phosphate composite in a rat tibia critical-sized defect. J Orthop Translat 2022; 37:100-112. [PMID: 36262961 PMCID: PMC9574596 DOI: 10.1016/j.jot.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background The osteogenic capabilities and biodegradability of octacalcium phosphate (OCP) composites make them unique. Despite the excellent characteristics of OCP, their use is limited due to handling difficulties. In this study, we aimed to evaluate and compare three types of OCPs (cemented OCP (C-OCP), C-OCP with collagen (OCP/Col), and synthetic OCP (S-OCP) with alginate (OCP/Alg)) versus commercially available β-tricalcium phosphate (β-TCP) regarding their potential to accelerate bone formation in defective rat tibias. Methods The specimens with OCP composite were manufactured into 5 mm cubes and inserted into the segmental defects of rat tibias fixed with an external fixator. In addition, 3 mm-hole defects in rat tibias were evaluated to compare the graft material properties in different clinical situations. Serial X-ray studies were evaluated weekly and the tibias were harvested at postoperative 6 weeks or 8 weeks for radiologic evaluation. Histological and histomorphometric analyses were performed to evaluate the acceleration of bone formation. Results In the critical-defect model, OCP/Alg showed bone bridges between segmentally resected bone ends that were comparable to those of β-TCP. However, differences were observed in the residual graft materials. Most β-TCP was maintained until 8 weeks postoperatively; however, OCP/Alg was more biodegradable. In addition calcification in the β-TCP occurred at the directly contacted area between graft particles and bony ingrowth was observed in the region adjacent resected surface of tibia. In contrast, no direct bony ingrowth was observed in OCP-based materials, but osteogenesis induced from resected surface of tibia was more active. In the hole-defect model, OCP/Col accelerated bone formation. β-TCP and OCP/Alg showed similar patterns with relatively higher biodegradability. In histology, among the OCP-based materials, directly contacted new bone was formed only in OCP/Alg group. The new bone formation in the periphery area of graft materials was much more active in the OCP-based materials, and the newly formed bone showed a thicker trabecular and more mature appearance than the β-TCP group. Conclusions In this study, OCP/Alg was equivalent to β-TCP in the acceleration of bone formation with better biodegradability appropriate for clinical situations in different circumstances. Our OCP/Col composite showed fast degradation, which makes it unsuitable for use in mechanical stress conditions in clinical orthopedic settings. The Translational Potential of this Article In our research, we compared our various manufactured OCP composites to commercially available β-TCP in critical-defect rat tibia model. OCP/Col showed acceleration in hole-defect model as previous studies in dental field but in our critical-sized defect model it resorbed fast without acceleration of bony union. OCP/Alg showed matched results compared to β-TCP and relatively fast resorption so we showed market value in special clinical indication depending on treatment strategy. This is the first OCP composite study in orthopaedics with animal critical-sized tibia bone study and further study should be considered for clinical application based on this study.
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Affiliation(s)
- Cheol-Hee Jeong
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jooseong Kim
- Department of Biomedical Engineering, Yeungnam University, Daegu, Republic of Korea.,HudensBio Co., Ltd., Gwangju, Republic of Korea
| | - Hyun Sil Kim
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Song-Yi Lim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Dawool Han
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Aaron J Huser
- Paley Advanced Limb Lengthening Institutute, St. Mary's Hospital, West Palm Beach, FL, USA
| | - Sang Bae Lee
- Center for Testing and Evaluation of Dental Biomaterials, Ministry of Food and Drug Safety Recognition Laboratory, Yonsei University College of Dentistry, Seoul, South Korea
| | - Yeonji Gim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Jeong Hyun Ji
- Department of Laboratory Animal Resources, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Dohun Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Amaal M Aldosari
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.,Department of Orthopedic Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Kyelim Yun
- HudensBio Co., Ltd., Gwangju, Republic of Korea
| | - Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
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ON Path: outpatient nonunion pathway for lower-extremity nonunions. OTA Int 2022; 5:e218. [PMID: 36569112 PMCID: PMC9782313 DOI: 10.1097/oi9.0000000000000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/03/2022] [Accepted: 07/06/2022] [Indexed: 11/05/2022]
Abstract
Objectives The purpose of this study was to assess the safety and efficacy of outpatient and short-stay surgical nonunion treatment by incorporating minimally invasive surgical techniques, multimodal pain control, and a modernized postoperative protocol. Design Retrospective case series. Setting Tertiary referral hospital and hospital outpatient department. Patients All consecutive nonunion surgeries performed by 1 surgeon between 2014 and 2019 were identified. Outpatient and short-stay surgeries for patients with nonunion of the tibia and femur were eligible (n = 50). Intervention Outpatient and short-stay surgical nonunion treatment by incorporating minimally invasive surgical techniques, multimodal pain control, and a modernized postoperative protocol. Main Outcome Measurements Length of stay, postoperative emergency department visits, all complications, reoperations, and time to union. Results Fifty patients were eligible, with 32 male patients (64%) and an average age of 46.5 years. The patient cohort consisted of 28 femur (56%) and 22 tibia (44%) nonunions. The average length of stay was 0.36 days. Seven patients (14%) required reoperation, 6 patients because of deep infection and 1 patient because of painful implant removal. Four patients (8%) presented to the emergency department within 1 week of surgery. One patient requiring amputation and patients lost to follow-up were excluded from the union rate calculation. For the remaining patients (46/50), 100% (46/46) united their nonunion. The average time to radiographic union was 7.82 months. Conclusions An outpatient pathway is safe and effective for medically appropriate patients undergoing nonunion surgery. Outpatient nonunion surgery is a reasonable alternative that achieves similar outcomes compared with inpatient nonunion studies in the published literature. Level of Evidence IV.
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Wickramasinghe ML, Dias GJ, Premadasa KMGP. A novel classification of bone graft materials. J Biomed Mater Res B Appl Biomater 2022; 110:1724-1749. [DOI: 10.1002/jbm.b.35029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Maduni L. Wickramasinghe
- Department of Biomedical Engineering General Sir John Kotelawala Defense University Ratmalana Sri Lanka
| | - George J. Dias
- Department of Anatomy, School of Medical Sciences University of Otago Dunedin New Zealand
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Ashukina N, Maltseva V, Vorontsov P, Danyshchuk Z, Nikolchenko O, Korzh M, Korzh M. Histological evaluation of the incorporation and remodeling of structural allografts in critical size metaphyseal femur defects in rats of different ages. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:349-356. [PMID: 36374140 PMCID: PMC9804061 DOI: 10.47162/rjme.63.2.06] [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] [Indexed: 11/18/2022]
Abstract
Insufficient bone regeneration is a common issue for patients with extensive bone damage, therefore the use of allografts is required. With increasing life expectancy, there is a higher risk of bone repair issues after fractures or orthopedic surgical intervention. We studied incorporation and remodeling of structural allografts in critical size metaphyseal femur defects in 52 rats aged 3-month-old and 12-month-old who underwent surgeries creating a bone defect, which was either filled with a structural allograft (3-month-old - 3moAllo; 12-month-old - 12moAllo) or left empty (3-month-old - 3moE; 12-month-old - 12moE). Histological analyses were performed 14, 28 and 90 days after the surgery. The percentage of bone and fibrous tissues, and allograft relative to the defect area was evaluated. The transmission electron microscopy was carried out 14 days after allograft implantation. When the defect was empty, slower bone regeneration was observed in 12moE rats versus 3moE, leading to sufficient irregularities in the anatomic structure of the femur 90 days after the surgery. When a structural allograft was used, the area of the fibrous tissue was larger in the defects of 12moAllo compared with 3moAllo rats 90 days after surgery. No age-related differences were found in the allograft remodeling and structures of the osteocytes, osteoblasts, and osteoclasts over the observation period. Evident issues with bone regeneration were found in critical size defects both of 12moE and 12moAllo rats. However, the allograft use allowed the bone maintaining anatomic structure 90 days after the surgery.
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Affiliation(s)
- Nataliya Ashukina
- Laboratory of Connective Tissue Morphology, Sytenko Institute of Spine and Joint Pathology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine;
| | - Valentyna Maltseva
- Laboratory of Connective Tissue Morphology, Sytenko
Institute of Spine and Joint Pathology, National Academy of Medical Sciences of
Ukraine, Kharkiv, Ukraine
| | - Petro Vorontsov
- Department of Transplantology and Experimental Modeling
with an Experimental Biological Clinic, Sytenko Institute of Spine and Joint
Pathology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Zinaida Danyshchuk
- Laboratory of Connective Tissue Morphology, Sytenko
Institute of Spine and Joint Pathology, National Academy of Medical Sciences of
Ukraine, Kharkiv, Ukraine
| | - Olga Nikolchenko
- Department of Transplantology and Experimental Modeling
with an Experimental Biological Clinic, Sytenko Institute of Spine and Joint
Pathology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Mykola Korzh
- Department of Emergency Traumatology and Reconstructive
Surgery, Sytenko Institute of Spine and Joint Pathology, National Academy of Medical
Sciences of Ukraine, Kharkiv, Ukraine
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Vascular Endothelial Growth Factor and Mesenchymal Stem Cells Revealed Similar Bone Formation to Allograft in a Sheep Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6676609. [PMID: 33763484 PMCID: PMC7946458 DOI: 10.1155/2021/6676609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/07/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
Introduction Mesenchymal stem cells (MSCs) and vascular endothelial growth factor (VEGF) are key factors in bone regeneration. Further stimulation should establish an enhanced cell environment optimal for vessel evolvement and hereby being able to attract bone-forming cells. The aim of this study was to generate new bone by using MSCs and VEGF, being able to stimulate growth equal to allograft. Methods Eight Texel/Gotland sheep had four titanium implants in a size of 10 × 12 mm inserted into bilateral distal femurs, containing a 2 mm gap. In the gap, autologous 3 × 106 MSCs seeded on hydroxyapatite (HA) granules in combination with 10 ng, 100 ng, and 500 ng VEGF release/day were added. After 12 weeks, the implant-bone blocks were harvested, embedded, and sectioned for histomorphometric analysis. Bone formation and mechanical fixation were evaluated. Blood samples were collected for the determination of bone-related biomarkers and VEGF in serum at weeks 0, 1, 4, 8, and 12. Results The combination of 3 × 106 MSCs with 10 ng, 100 ng, and 500 ng VEGF release/day exhibited similar amount of bone formation within the gap as allograft (P > 0.05). Moreover, no difference in mechanical fixation was observed between the groups (P > 0.05). Serum biomarkers showed no significant difference compared to baseline (all P > 0.05). Conclusion MSCs and VEGF exhibit significant bone regeneration, and their bone properties equal to allograft, with no systemic increase in osteogenic markers or VEGF with no visible side effects. This study indicates a possible new approach into solving the problem of insufficient allograft, in larger bone defects.
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