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Gelli R, Ridi F. An Overview of Magnesium-Phosphate-Based Cements as Bone Repair Materials. J Funct Biomater 2023; 14:424. [PMID: 37623668 PMCID: PMC10455751 DOI: 10.3390/jfb14080424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
In the search for effective biomaterials for bone repair, magnesium phosphate cements (MPCs) are nowadays gaining importance as bone void fillers thanks to their many attractive features that overcome some of the limitations of the well-investigated calcium-phosphate-based cements. The goal of this review was to highlight the main properties and applications of MPCs in the orthopedic field, focusing on the different types of formulations that have been described in the literature, their main features, and the in vivo and in vitro response towards them. The presented results will be useful to showcase the potential of MPCs in the orthopedic field and will suggest novel strategies to further boost their clinical application.
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Affiliation(s)
| | - Francesca Ridi
- Department of Chemistry “Ugo Schiff” and CSGI Consortium, University of Florence, Via della Lastruccia 3, 50019 Sesto Fiorentino, Italy;
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Bingol HB, Bender JC, Opsteen JA, Leeuwenburgh SC. Bone adhesive materials: From bench to bedside. Mater Today Bio 2023; 19:100599. [PMID: 37063249 PMCID: PMC10102013 DOI: 10.1016/j.mtbio.2023.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Biodegradable bone adhesives represent a highly sought-after type of biomaterial which would enable replacement of traditional metallic devices for fixation of bone. However, these biomaterials should fulfil an extremely large number of requirements. As a consequence, bone-adhesive biomaterials which meet all of these requirements are not yet commercially available. Therefore, this comprehensive review provides an extensive overview of the development of bone adhesives from a translational perspective. First, the definition, classification, and chemistry of various types of bone adhesives are highlighted to provide a detailed overview of this emerging class of biomaterials. In this review we particularly focused studies which describe the use of materials that are capable of gluing two pieces of bone together within a time frame of minutes to days. Second, this review critically reflects on i) the experimental conditions of commonly employed adhesion tests to assess bone adhesion and ii) the current state-of-the-art regarding their preclinical and clinical applicability.
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Affiliation(s)
- Hatice B. Bingol
- Department of Dentistry-Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- GATT Technologies BV, Nijmegen, the Netherlands
| | | | | | - Sander C.G. Leeuwenburgh
- Department of Dentistry-Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Corresponding author.
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Han Z, Wang B, Ren B, Liu Y, Zhang N, Wang Z, Liu J, Mao K. Characterization and Biomechanical Study of a Novel Magnesium Potassium Phosphate Cement. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070997. [PMID: 35888086 PMCID: PMC9320010 DOI: 10.3390/life12070997] [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: 06/09/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
Magnesium potassium phosphate cement (MKPC) has attracted considerable attention as a bone regeneration material. However, there are only a few reports on its biomechanical properties. To evaluate the biomechanical properties of MKPC, we compared the mechanical parameters of pedicle screws enhanced with either MKPC or polymethyl methacrylate (PMMA) bone cement. The results show that the maximum pull-out force of the pedicle screws was 417.86 ± 55.57 and 444.43 ± 19.89 N after MKPC cement setting for 30 min and 12 h, respectively, which was better than that of the PMMA cement. In fatigue tests, the maximum pull-out force of the MKPC cement group was 435.20 ± 7.96 N, whereas that of the PMMA cement in the control group was 346.80 ± 7.66 N. Furthermore, the structural characterization analysis of the MKPC cement revealed that its microstructure after solidification was an irregular tightly packed crystal, which improved the mechanical strength of the cement. The maximum exothermic temperature of the MKPC reaction was 45.55 ± 1.35 °C, the coagulation time was 7.89 ± 0.37 min, and the compressive strength was 48.29 ± 4.76 MPa, all of which meet the requirements of clinical application. In addition, the MKPC cement did not significantly inhibit cell proliferation or increase apoptosis, thus indicating good biocompatibility. In summary, MKPC exhibited good biomechanical properties, high initial strength, good biocompatibility, and low exothermic reaction temperature, demonstrating an excellent application potential in the field of orthopedics.
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Affiliation(s)
- Zhenchuan Han
- Chinese PLA Medical School, Beijing 100853, China; (Z.H.); (B.R.)
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing 100088, China;
| | - Bo Wang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China;
| | - Bowen Ren
- Chinese PLA Medical School, Beijing 100853, China; (Z.H.); (B.R.)
| | - Yihao Liu
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
| | - Nan Zhang
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing 100088, China;
| | - Zheng Wang
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
| | - Jianheng Liu
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Correspondence: (J.L.); (K.M.)
| | - Keya Mao
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Correspondence: (J.L.); (K.M.)
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Clinical parameters and radiographic resorption of a novel magnesium based bone void filler. Injury 2022; 53:947-952. [PMID: 34895713 DOI: 10.1016/j.injury.2021.11.057] [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: 05/31/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone voids can present challenging problems for the Orthopaedic surgeon, and are often treated with backfilling followed by structural stabilization. Recently, a magnesium based, and presumably resorbable, bone void filler (BVF) has been developed, but has limited longitudinal clinical data. Therefore, the purpose of this study was to investigate clinically relevant parameters and radiographic resorption characteristics of this novel magnesium based BVF (MgBVF) with long-term clinical data. METHODS All patients who underwent surgery by a single surgeon in which MgBVF was utilized from 2019 to 2020 were retrospectively reviewed. Clinical parameters including evidence of infection, wound breakdown, and wound drainage were reviewed. Radiographic resorption, evidence of joint extrusion of BVF, heterotopic ossification, and subsidence was assessed at each post-operative visit. Those with less than 6 month follow up were excluded from radiographic analysis of resorption. Postoperative images at two weeks were compared to each subsequent radiograph during follow up, and reviewed by each of the three authors in blinded fashion. Interval radiographs were assigned a grade of radiographic resorption which corresponded to estimated percent resorption: grade 1 (0-25%), grade 2 (25-50%), grade 3 (50-75%), or grade 4 (75-100%). After 2 weeks, this process was repeated, and both inter and intraobserver reliability scores were calculated. RESULTS Forty-two patients were identified for clinical review, and 18 for radiographic review. Average length of follow up was 209±113 days. Five patients experienced a postoperative complication: two wound infections, one delayed wound healing, one sterile serous drainage, and one catastrophic failure of the fixation construct. Four patients were noted to have postoperative joint subsidence of 2 mm or less. Average grade of resorption was found to be 1.5 ± 0.8, 1.7 ± 0.9, 2.9 ± 0.9, and 3.6 ± 0.6 at 6 weeks, 3 months, 6 months, and 1 year, respectively (p<0.001). Average kappa (intrarater reliability) was found to be 0.61, 0.41, 0.55, and 0.63 for each time interval, respectively. Interrater reliability increased form 0.19 at 6 weeks to 0.42 at 1 year. CONCLUSION This novel MgBVF demonstrates clinically relevant resorption, provides structural support in challenging bone voids, and does not appear to significantly increase risk of complications, setting it apart from previously described BVF's.
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Gelli R, Di Pompo G, Graziani G, Avnet S, Baldini N, Baglioni P, Ridi F. Unravelling the Effect of Citrate on the Features and Biocompatibility of Magnesium Phosphate-Based Bone Cements. ACS Biomater Sci Eng 2020; 6:5538-5548. [PMID: 33320576 PMCID: PMC8011797 DOI: 10.1021/acsbiomaterials.0c00983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
![]()
In
the framework of new materials for orthopedic applications,
Magnesium Phosphate-based Cements (MPCs) are currently the focus of
active research in biomedicine, given their promising features; in
this field, the loading of MPCs with active molecules to be released
in the proximity of newly forming bone could represent an innovative
approach to enhance the in vivo performances of the biomaterial. In
this work, we describe the preparation and characterization of MPCs
containing citrate, an ion naturally present in bone which presents
beneficial effects when released in the proximity of newly forming
bone tissue. The cements were characterized in terms of handling properties,
setting time, mechanical properties, crystallinity, and microstructure,
so as to unravel the effect of citrate concentration on the features
of the material. Upon incubation in aqueous media, we demonstrated
that citrate could be successfully released from the cements, while
contributing to the alkalinization of the surroundings. The cytotoxicity
of the materials toward human fibroblasts was also tested, revealing
the importance of a fine modulation of released citrate to guarantee
the biocompatibility of the material.
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Affiliation(s)
- Rita Gelli
- Department of Chemistry "Ugo Schiff" and CSGI, University of Florence, via della Lastruccia 3-13, 50019 Sesto Fiorentino, Italy
| | - Gemma Di Pompo
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gabriela Graziani
- Laboratory of Nanobiotechnology (NaBi), IRCSS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Sofia Avnet
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicola Baldini
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, 40127 Bologna, Italy
| | - Piero Baglioni
- Department of Chemistry "Ugo Schiff" and CSGI, University of Florence, via della Lastruccia 3-13, 50019 Sesto Fiorentino, Italy
| | - Francesca Ridi
- Department of Chemistry "Ugo Schiff" and CSGI, University of Florence, via della Lastruccia 3-13, 50019 Sesto Fiorentino, Italy
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Roller BL, Stoker AM, Cook JL. Elution properties of a resorbable magnesium phosphate cement. J Clin Orthop Trauma 2020; 11:S729-S734. [PMID: 32999547 PMCID: PMC7503075 DOI: 10.1016/j.jcot.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study tests the elution capabilities of a magnesium phosphate cement (MPC). Study objectives were to quantify the passive release of magnesium ions from MPC and to assess the effects of antibiotic-loaded MPC on bacterial growth and osteoblast viability. METHODS MPC constructs were created and incubated in fetal bovine serum (FBS). At 2, 4, and 17 weeks, a sample was collected for magnesium ion concentration analysis. Control and vancomycin-loaded (vanc) MPC beads were also created. Zone of inhibition was measured after incubating beads on Staphylococcus aureus agar plates for 24 h. Osteoblasts were seeded onto control and vanc beads and cultured for 9 days. Metabolic activity was measured via a resazurin assay. ANOVA with Tukey HSD post-hoc tests and t-tests were performed. RESULTS Magnesium ions were eluted at 2 and 4-week time points without significant difference, but demonstrated a significant spike at the 17-week time point. Zones of inhibition for the bacterial species was observed for Vanc-MPC beads, but not control beads. No cytotoxic effects on osteoblasts were noted. CONCLUSION MPC has potential to improve bone regeneration based on its ability to passively elute magnesium. Additionally, antibiotic-loaded MPC inhibits bacterial growth while avoiding osteoblast cytotoxicity.
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Affiliation(s)
- Brandon L. Roller
- Wake Forest School of Medicine, Department of Radiology, Winston-Salem, NC, USA,Corresponding author. Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157-1088, USA.
| | - Aaron M. Stoker
- University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L. Cook
- University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
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Magnesium-based bioceramics in orthopedic applications. Acta Biomater 2018; 66:23-43. [PMID: 29197578 DOI: 10.1016/j.actbio.2017.11.033] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 11/22/2022]
Abstract
Magnesium ions are directly involved in numerous biological mechanisms; for example, they play an important part in the regulation of ion channels, DNA stabilization, enzyme activation and stimulation of cell growth and proliferation. This alkaline earth metal has gained great popularity in orthopedic applications in recent years. Magnesium-based bioceramics include a large group of magnesium containing compounds such as oxides, phosphates and silicates, that are involved in orthopedic applications like bone cements, bone scaffolds or implant coatings. This article aims to give a comprehensive review on different magnesium-based bioceramics, e.g. magnesium phosphates (MgO-P2O5), calcium magnesium phosphates (CaO-MgO-P2O5), and magnesium glasses (SiO2-MgO) with a strong focus on the chemistry and properties of magnesium phosphate containing cements as the main application form. In addition, the processing of magnesium phosphate minerals into macroporous scaffolds for tissue engineering applications by either using traditional porogens or by additive manufacturing approaches are reflected. Finally, the biological in vitro and in vivo properties of magnesium phosphates for bone regeneration are summarized, which show promising results regarding the application as bone replacement material, but still lack in terms of testing in large animal models, load-bearing application sites and clinical data. STATEMENT OF SIGNIFICANCE Though bone substitutes from calcium phosphates have been investigated for a long time, a new trend is visible in the biomaterials sector: magnesium based bioceramics from magnesium phosphates and silicates due to the special biological significance of magnesium ions in enzymatic activation, cell growth and proliferation, etc. In contrast to pure magnesium implants, such formulations do not release hydrogen during degradation. As with calcium based bioceramics, magnesium based bioceramics are used for the development of diverse applications such as cements, macroporous scaffolds and coatings. From this perspective, we present a systematic overview on diverse kinds of magnesium based bioceramics, their processing regimes for different clinical purposes and their behavior both in vitro and in vivo.
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Liu C, Ren Z, Xu Y, Pang S, Zhao X, Zhao Y. Biodegradable Magnesium Alloys Developed as Bone Repair Materials: A Review. SCANNING 2018; 2018:9216314. [PMID: 29725492 PMCID: PMC5872617 DOI: 10.1155/2018/9216314] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/03/2017] [Accepted: 02/05/2018] [Indexed: 05/06/2023]
Abstract
Bone repair materials are rapidly becoming a hot topic in the field of biomedical materials due to being an important means of repairing human bony deficiencies and replacing hard tissue. Magnesium (Mg) alloys are potentially biocompatible, osteoconductive, and biodegradable metallic materials that can be used in bone repair due to their in situ degradation in the body, mechanical properties similar to those of bones, and ability to positively stimulate the formation of new bones. However, rapid degradation of these materials in physiological environments may lead to gas cavities, hemolysis, and osteolysis and thus, hinder their clinical orthopedic applications. This paper reviews recent work on the use of Mg alloy implants in bone repair. Research to date on alloy design, surface modification, and biological performance of Mg alloys is comprehensively summarized. Future challenges for and developments in biomedical Mg alloys for use in bone repair are also discussed.
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Affiliation(s)
- Chen Liu
- Department of Materials Science and Engineering, Zhejiang University, Hangzhou, China
- Ningbo Branch of China Academy of Ordnance Science, Ningbo, China
| | - Zheng Ren
- Ningbo Branch of China Academy of Ordnance Science, Ningbo, China
| | - Yongdong Xu
- Ningbo Branch of China Academy of Ordnance Science, Ningbo, China
| | - Song Pang
- Ningbo Branch of China Academy of Ordnance Science, Ningbo, China
| | - Xinbing Zhao
- Department of Materials Science and Engineering, Zhejiang University, Hangzhou, China
| | - Ying Zhao
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Pearce DJ, Brown JA. Extraction of 22 equine cheek teeth with displaced sagittal fractures using polymethylmethacrylate stabilisation (2011–2016). EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D. J. Pearce
- Marion duPont Scott Equine Medical Center Virginia‐Maryland Regional College of Veterinary Medicine Virginia Polytechnic and State University Leesburg Virginia USA
| | - J. A. Brown
- Marion duPont Scott Equine Medical Center Virginia‐Maryland Regional College of Veterinary Medicine Virginia Polytechnic and State University Leesburg Virginia USA
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Ostrowski N, Roy A, Kumta PN. Magnesium Phosphate Cement Systems for Hard Tissue Applications: A Review. ACS Biomater Sci Eng 2016; 2:1067-1083. [PMID: 33445235 DOI: 10.1021/acsbiomaterials.6b00056] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the search for more ideal bone graft materials for clinical application, the investigation into ceramic bone cements or bone void filler is ongoing. Calcium phosphate-based materials have been widely explored and implemented for medical use in bone defect repair. Such materials are an excellent choice because the implant mimics the natural chemistry of mineralized bone matrix and in injectable cement form, can be implemented with relative ease. However, of the available calcium phosphate cements, none fully meet the ideal standard, displaying low strengths and acidic setting reactions or slow setting times, and are often very slow to resorb in vivo. The study of magnesium phosphates for bone cements is a relatively new field compared to traditional calcium phosphate bone cements. Although reports are more limited, preliminary studies have shown that magnesium phosphate cements (MPC) may be a strong alternative to calcium phosphates for certain applications. The goal of the present publication is to review the history and achievements of magnesium phosphate-based cements or bone void fillers to date, assess how these cements compare with calcium phosphate competitors and to analyze the future directions and outlook for the research, development, and clinical implementation of these cements.
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Affiliation(s)
- Nicole Ostrowski
- Swanson School of Engineering, University of Pittsburgh, 815C Benedum Hall, 3700 O'Hara Street, Pittsburgh, Pennsylvania 15261, United States
| | - Abhijit Roy
- Swanson School of Engineering, University of Pittsburgh, 815C Benedum Hall, 3700 O'Hara Street, Pittsburgh, Pennsylvania 15261, United States
| | - Prashant N Kumta
- Swanson School of Engineering, University of Pittsburgh, 815C Benedum Hall, 3700 O'Hara Street, Pittsburgh, Pennsylvania 15261, United States
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