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Gatti SD, Gaddi D, Turati M, Leone G, Arts JJ, Pessina F, Carminati M, Zatti G, De Rosa L, Bigoni M. Clinical outcomes and complications of S53P4 bioactive glass in chronic osteomyelitis and septic non-unions: a retrospective single-center study. Eur J Clin Microbiol Infect Dis 2024; 43:489-499. [PMID: 38195783 DOI: 10.1007/s10096-023-04737-z] [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: 02/10/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dead space management following debridement surgery in chronic osteomyelitis or septic non-unions is one of the most crucial and discussed steps for the success of the surgical treatment of these conditions. In this retrospective clinical study, we described the efficacy and safety profile of surgical debridement and local application of S53P4 bioactive glass (S53P4 BAG) in the treatment of bone infections. METHODS A consecutive single-center series of 38 patients with chronic osteomyelitis (24) and septic non-unions (14), treated with bioactive glass S53P4 as dead space management following surgical debridement between May 2015 and November 2020, were identified and evaluated retrospectively. RESULTS Infection eradication was reached in 22 out of 24 patients (91.7%) with chronic osteomyelitis. Eleven out of 14 patients (78.6%) with septic non-union achieved both fracture healing and infection healing in 9.1 ± 4.9 months. Three patients (7.9%) developed prolonged serous discharge with wound dehiscence but healed within 2 months with no further surgical intervention. Average patient follow-up time was 19.8 months ± 7.6 months. CONCLUSION S53P4 bioactive glass is an effective and safe therapeutic option in the treatment of chronic osteomyelitis and septic non-unions because of its unique antibacterial properties, but also for its ability to generate a growth response in the remaining healthy bone at the bone-glass interface.
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Affiliation(s)
| | - Diego Gaddi
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Marco Turati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy.
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France.
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France.
| | - Giulio Leone
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Jacobus J Arts
- Department Orthopaedic Biomechanics, Faculty Biomedical Engineering, Eindhoven University of Technology TU/e, Eindhoven, Netherlands
- Department Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Fabio Pessina
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Mattia Carminati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Laura De Rosa
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
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Gaddi D, Gatti SD, Piatti M, Poli A, De Rosa L, Riganti A, Zatti G, Bigoni M, Turati M. Non-Union Scoring System (NUSS): Is It Enough in Clinical Practice? Indian J Orthop 2022; 57:137-145. [PMID: 36655209 PMCID: PMC9789216 DOI: 10.1007/s43465-022-00767-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Bone consolidation defects represent a real orthopedic challenge because of the absence of validated treatment guidelines that can assist the surgeon in his choices. The aim of this study is to evaluate the appropriateness of the Non-Union Scoring System NUSS treatment protocol in the management of long bone non-unions by comparing it to the experience-based therapeutic approach carried out in our facility. MATERIALS AND METHODS We conducted a comparative outcome study of a retrospective series of 89 patients surgically treated for long bone non-union in our facility vs. clinical results reported by Calori et al. obtained following the NUSS treatment protocol. RESULTS Radiographic healing was reached in 13/13 non-unions (100%) in group NUSS 1, in 58/62 (93.5%) in group NUSS 2, and in 13/14 (92.9%) in group NUSS 3. The mean time to radiographic healing was 5.69 ± 2.09 months in group 1, 7.38 ± 3.81 months in group 2 and 9.23 ± 2.31 months in group 3. 91% of patients in group I, 69% in group II and 48% in group III received what would be considered by the NUSS treatment protocol an "overtreatment", especially from a biological stand point. The comparative outcome analysis shows that our case series achieved significantly higher global healing rates (p value = 0.017) and shorter radiological healing times in groups NUSS 1 and 2 (p value < 0.001). CONCLUSION From the results obtained, we can assume that the NUSS treatment protocol might underestimate the necessary therapies, particularly from a biological point of view.
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Affiliation(s)
- Diego Gaddi
- Department of Orthopedic Surgery, Policlinico San Pietro, Strada Statale 18, 23826 IT Mandello del Lario, LC Italy
| | - Simone D. Gatti
- School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy
| | - Massimiliano Piatti
- Department of Orthopedic Surgery, Policlinico San Pietro, Strada Statale 18, 23826 IT Mandello del Lario, LC Italy
| | - Andrea Poli
- Orthopedic Department, Carate Brianza Hospital, Via Don Luigi Monza 14/B Carate B.Za, 23900 IT Lecco, LC Italy
| | - Laura De Rosa
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy ,School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy
| | - Andrea Riganti
- Department of Economics, Management and Quantitative Methods, University of Milano Statale, Via Speri Della Chiesa 28, 21100 IT Milan, VA Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy ,School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Via Rismondo 62, Seregno, 20831 IT Monza, MB Italy ,Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Hospital Couple Enfant, Via Marcona 15, 20100 IT Grenoble, MI France ,Department of Orthopedic Surgery, Policlinico San Pietro, Strada Statale 18, 23826 IT Mandello del Lario, LC Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy ,Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Via Filzi 34, Giussano, 20833 IT Grenoble, MB France ,School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
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Cannio M, Bellucci D, Roether JA, Boccaccini DN, Cannillo V. Bioactive Glass Applications: A Literature Review of Human Clinical Trials. MATERIALS (BASEL, SWITZERLAND) 2021; 14:5440. [PMID: 34576662 PMCID: PMC8470635 DOI: 10.3390/ma14185440] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022]
Abstract
The use of bioactive glasses in dentistry, reconstructive surgery, and in the treatment of infections can be considered broadly beneficial based on the emerging literature about the potential bioactivity and biocompatibility of these materials, particularly with reference to Bioglass® 45S5, BonAlive® and 19-93B3 bioactive glasses. Several investigations have been performed (i) to obtain bioactive glasses in different forms, such as bulk materials, powders, composites, and porous scaffolds and (ii) to investigate their possible applications in the biomedical field. Although in vivo studies in animals provide us with an initial insight into the biological performance of these systems and represent an unavoidable phase to be performed before clinical trials, only clinical studies can demonstrate the behavior of these materials in the complex physiological human environment. This paper aims to carefully review the main published investigations dealing with clinical trials in order to better understand the performance of bioactive glasses, evaluate challenges, and provide an essential source of information for the tailoring of their design in future applications. Finally, the paper highlights the need for further research and for specific studies intended to assess the effect of some specific dissolution products from bioactive glasses, focusing on their osteogenic and angiogenic potential.
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Affiliation(s)
- Maria Cannio
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, Via P. Vivarelli 10, 41125 Modena, Italy; (M.C.); (D.B.)
| | - Devis Bellucci
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, Via P. Vivarelli 10, 41125 Modena, Italy; (M.C.); (D.B.)
| | - Judith A. Roether
- Department of Materials Science and Engineering, Institute for Polymer Materials, University of Erlangen-Nuremberg, 91058 Erlangen, Germany;
| | | | - Valeria Cannillo
- Dipartimento di Ingegneria Enzo Ferrari, Università degli Studi di Modena e Reggio Emilia, Via P. Vivarelli 10, 41125 Modena, Italy; (M.C.); (D.B.)
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Vallittu PK, Posti JP, Piitulainen JM, Serlo W, Määttä JA, Heino TJ, Pagliari S, Syrjänen SM, Forte G. Biomaterial and implant induced ossification: in vitro and in vivo findings. J Tissue Eng Regen Med 2020; 14:1157-1168. [PMID: 32415757 PMCID: PMC7496445 DOI: 10.1002/term.3056] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
Material-induced ossification is suggested as a suitable approach to heal large bone defects. Fiber-reinforced composite-bioactive glasses (FRC-BGs) display properties that could enhance the ossification of calvarial defects. Here, we analyzed the healing processes of a FRC-BG implant in vivo from the perspective of material-induced ossification. Histological analysis of the implant, which was removed 5 months after insertion, showed the formation of viable, noninflammatory mesenchymal tissue with newly-formed mineralized woven bone, as well as nonmineralized connective tissue with capillaries and larger blood vessels. The presence of osteocytes was detected within the newly generated bone matrix. To expand our understanding on the osteogenic properties of FRC-BG, we cultured human adipose tissue-derived mesenchymal stromal cells (AD-MSCs) in the presence of two different BGs (45S5 and S53P4) and Al2 O3 control. AD-MSCs grew and proliferated on all the scaffolds tested, as well as secreted abundant extracellular matrix, when osteogenic differentiation was appropriately stimulated. 45S5 and S53P4 induced enhanced expression of COL2A1, COL10A1, COL5A1 collagen subunits, and pro-osteogenic genes BMP2 and BMP4. The concomitant downregulation of BMP3 was also detected. Our findings show that FRC-BG can support the vascularization of the implant and the formation of abundant connective tissue in vivo. Specifically, BG 45S5 and BG S53P4 are suited to evoke the osteogenic potential of host mesenchymal stromal cells. In conclusion, FRC-BG implant demonstrated material-induced ossification both in vitro and in vivo.
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Affiliation(s)
- Pekka K. Vallittu
- Department of Biomaterials ScienceInstitute of Dentistry, University of Turku and City of Turku, Welfare DivisionTurkuFinland
| | - Jussi P. Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury CentreTurku University Hospital and University of TurkuTurkuFinland
| | - Jaakko M. Piitulainen
- Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology ‐ Head and Neck Surgery, Turku University HospitalTurku Finland and University of TurkuTurkuFinland
| | - Willy Serlo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland and Department of Children and AdolescentsOulu University HospitalOuluFinland
| | | | | | - Stefania Pagliari
- International Clinical Research Center of St. Anne's University Hospital BrnoBrnoCzech Republic
| | - Stina M. Syrjänen
- Department of Oral Pathology and Radiology, Institute of DentistryUniversity of TurkuTurkuFinland
| | - Giancarlo Forte
- International Clinical Research Center of St. Anne's University Hospital BrnoBrnoCzech Republic
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黄 勇, 李 理, 石 展, 崔 旭, 潘 浩, 李 兵. [Application and research status of bioactive glass in bone repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:660-666. [PMID: 32410437 PMCID: PMC8171856 DOI: 10.7507/1002-1892.201908093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/30/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research status of bioactive glass (BAG) in bone repair. METHODS The recently published literature concerning BAG in bone repair at home and abroad was reviewed and summarized. RESULTS BAG has been widely used in clinical bone repair with a favorable effectiveness. In the experimental aspect, to meet different clinical application needs, BAG has been prepared in different forms, such as particles, prosthetic coating, drug and biological factor delivery system, bone cement, and scaffold. And the significant progress has been made. CONCLUSION BAG has been well studied in the field of bone repair due to its excellent bone repair performance, and it is expected to become a new generation of bone repair material.
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Affiliation(s)
- 勇华 黄
- 广西医科大学第四附属医院 柳州市工人医院骨科(广西柳州 545005)Department of Orthopedics, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker’s Hospital, Liuzhou Guangxi, 545005, P.R.China
| | - 理 李
- 广西医科大学第四附属医院 柳州市工人医院骨科(广西柳州 545005)Department of Orthopedics, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker’s Hospital, Liuzhou Guangxi, 545005, P.R.China
| | - 展英 石
- 广西医科大学第四附属医院 柳州市工人医院骨科(广西柳州 545005)Department of Orthopedics, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker’s Hospital, Liuzhou Guangxi, 545005, P.R.China
| | - 旭 崔
- 广西医科大学第四附属医院 柳州市工人医院骨科(广西柳州 545005)Department of Orthopedics, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker’s Hospital, Liuzhou Guangxi, 545005, P.R.China
| | - 浩波 潘
- 广西医科大学第四附属医院 柳州市工人医院骨科(广西柳州 545005)Department of Orthopedics, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker’s Hospital, Liuzhou Guangxi, 545005, P.R.China
| | - 兵 李
- 广西医科大学第四附属医院 柳州市工人医院骨科(广西柳州 545005)Department of Orthopedics, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Worker’s Hospital, Liuzhou Guangxi, 545005, P.R.China
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