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Colding-Rasmussen T, Horstmann PF, Jørgensen PH, Hettwer W, Hansen BH, Tierp-Wong CNE, Petersen MM. Does the use of polymethyl-methacrylate cement after intralesional curettage of giant cell tumors of appendicular bone guarantee reduced local recurrence rates? A retrospective analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231202155. [PMID: 37688488 DOI: 10.1177/10225536231202155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Polymethyl-methacrylate cement (PMMA) is often used as bone defect reconstruction material after surgical removal of giant cell tumors. The purpose of this study was to investigate if the application of PMMA improves the local recurrence rates for giant cell tumors (GCT) of appendicular bone treated with intralesional curettage. METHODS A retrospective analysis of all appendicular GTCs treated at two major Danish sarcoma centres between the 1st of January 1998 and December 31st 2013; minimum follow-up of 3.0 years (median: 8.9; 1.3-18.7 years). Kaplan-Meier survival model, log-rank and multivariate Cox regression were used to calculate and compare local recurrence rates. p-values <0.05 were considered statistically significant. RESULTS 102 patients (M59/F43), median age 31Y (11-84) were included in this study. The overall 3-years local recurrence-rate was 19.9% (95%CI: 11.9-27.9%); 91% had occurred within 3 years. In patients treated with intralesional curettage (n = 64), the 3-years recurrence-rate was 30.6% (95%CI: 18.8-42.4%), compared to 2.6% (95%CI: 0.0-7.8%) in patients treated with wide resection or amputation (n = 38), p < .001. The 3-years recurrence-rate for patients treated with intralesional curettage and reconstruction using PMMA was 29.0% (95%CI: 12.6-45.4%) and without PMMA: 31.8% (95%CI: 15.2-48.4%), p = .83. CONCLUSION We found that the use of PMMA for bone defect reconstruction after intralesional curettage of GTCs in the appendicular skeleton did not ensure a reduced risk of local recurrence.
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Affiliation(s)
| | - Peter F Horstmann
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter H Jørgensen
- Sarcoma Center, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Werner Hettwer
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne H Hansen
- Sarcoma Center, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael M Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Hamrouni N, Højvig JH, Petersen MM, Hettwer W, Jensen LT, Bonde CT. Total calcaneal reconstruction using a massive bone allograft and a distally pedicled osteocutaneous fibula flap: A novel technique to prevent amputation after calcaneal malignancy. J Plast Reconstr Aesthet Surg 2023; 76:44-48. [PMID: 36516510 DOI: 10.1016/j.bjps.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/23/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
In patients with primary calcaneal malignancies, such as Ewing's sarcoma, radical treatment with amputation of the foot can result in serious functional impairment and chronic pain. Total calcanectomy followed by the reconstruction of the calcaneal defect offers an alternative treatment to amputation. Capanna et al. described a technique for successfully reconstructing long limb segmental bone defects using a free fibula flap placed within the intramedullary canal of an allograft. We present both a review of the literature on calcaneal reconstruction and describe how the principles of Capanna can be adapted to reconstruct the calcaneus. Total calcanectomy due to Ewing's sarcoma and the subsequent application of this novel reconstructive technique was performed in two young patients aged 5 and 16 years. The reconstruction was achieved by inserting a distally pedicled osteocutaneous fibula flap within the reamed canal of an allograft and placing the composite in the calcaneal defect. Reconstruction was successful with complete bone union between the allograft and the adjacent bone. There were no fractures or infections and both flaps survived. Functional outcome was assessed with a physiotherapist at a follow-up period of 2 years postoperatively, showing near-normal ambulance. This novel technique proved excellent as a limb salvage procedure, avoiding amputation, and offering a satisfactory oncological and functional outcome.
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Affiliation(s)
- Nizar Hamrouni
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Inge Lehmannsvej 6, 2100 Copenhagen, Denmark.
| | - Jens Hjermind Højvig
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Inge Lehmannsvej 6, 2100 Copenhagen, Denmark
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Inge Lehmannsvej 6, 2100 Copenhagen, Denmark
| | - Werner Hettwer
- Department of Orthopedic Surgery, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Inge Lehmannsvej 6, 2100 Copenhagen, Denmark
| | - Lisa Toft Jensen
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Inge Lehmannsvej 6, 2100 Copenhagen, Denmark
| | - Christian Torsten Bonde
- Department of Plastic Surgery and Burns Treatment, Center of Head, Neck and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Inge Lehmannsvej 6, 2100 Copenhagen, Denmark
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Hettwer W, Horstmann PF, Bischoff S, Güllmar D, Reichenbach JR, Poh PSP, van Griensven M, Gras F, Diefenbeck M. Establishment and effects of allograft and synthetic bone graft substitute treatment of a critical size metaphyseal bone defect model in the sheep femur. APMIS 2019; 127:53-63. [PMID: 30698307 PMCID: PMC6850422 DOI: 10.1111/apm.12918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/10/2018] [Indexed: 01/17/2023]
Abstract
Assessment of bone graft material efficacy is difficult in humans, since invasive methods like staged CT scans or biopsies are ethically unjustifiable. Therefore, we developed a novel large animal model for the verification of a potential transformation of synthetic bone graft substitutes into vital bone. The model combines multiple imaging methods with corresponding histology in standardized critical sized cancellous bone defect. Cylindrical bone voids (10 ml) were created in the medial femoral condyles of both hind legs (first surgery at right hind leg, second surgery 3 months later at left hind leg) in three merino‐wool sheep and either (i) left empty, filled with (ii) cancellous allograft bone or (iii) a synthetic, gentamicin eluting bone graft substitute. All samples were analysed with radiographs, MRI, μCT, DEXA and histology after sacrifice at 6 months. Unfilled defects only showed ingrowth of fibrous tissue, whereas good integration of the cancellous graft was seen in the allograft group. The bone graft substitute showed centripetal biodegradation and new trabecular bone formation in the periphery of the void as early as 3 months. μCT gave excellent insight into the structural changes within the defects, particularly progressive allograft incorporation and the bone graft substitute biodegradation process. MRI completed the picture by clearly visualizing soft tissue ingrowth into unfilled bone voids and presence of fluid collections. Histology was essential for verification of trabecular bone and osteoid formation. Conventional radiographs and DEXA could not differentiate details of the ongoing transformation process. This model appears well suited for detailed in vivo and ex vivo evaluation of bone graft substitute behaviour within large bone defects.
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Affiliation(s)
- Werner Hettwer
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter F Horstmann
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sabine Bischoff
- Central Experimental Animal Facility, University Hospital Jena, Jena, Germany
| | - Daniel Güllmar
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Patrina S P Poh
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martijn van Griensven
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Gras
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Michael Diefenbeck
- BONESUPPORT AB, Lund, Sweden.,Scientific Consulting in Orthopaedic Surgery and Traumatology, Hamburg, Germany
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Colding-Rasmussen T, Horstmann P, Petersen MM, Hettwer W. Antibiotic Elution Characteristics and Pharmacokinetics of Gentamicin and Vancomycin from a Mineral Antibiotic Carrier: An in vivo Evaluation of 32 Clinical Cases. J Bone Jt Infect 2018; 3:234-240. [PMID: 30416950 PMCID: PMC6215984 DOI: 10.7150/jbji.26301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/18/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction: Locally implanted antibiotic-eluting carriers may be a valuable adjuvant to the management of prosthetic joint infections. Aim: to assess local and plasma antibiotic concentrations as well as cumulative antibiotic urine excretion associated with clinical use of a gentamicin - or vancomycin-loaded mineral composite antibiotic carrier. Methods: 32 patients (male/female=19/13, mean age=56; 21-82 years) were prospectively followed after implantation of gentamicin (n=11), vancomycin (n=15), or a combination (n=7), using an antibiotic carrier (CERAMENT™|G or CERAMENT™|V, mean amount 11 (3-20) mL) during resection arthroplasty of the hip/knee. We measured antibiotic concentrations in plasma (1h, 3h, 24h, 48h and 72h post-implantation), urine (24h, 48h and 72h post-implantation) and in drain (n=15). Results: We observed low antibiotic concentrations in plasma (Gentamicin: 0.33 mg/L (95%-CI: 0.25-0.44) and vancomycin: 1.33 mg/L (95%-CI: 1.02-1.66)) and high concentrations in drain (Gentamicin: mean 57.8 mg/L (95%-CI: 45.8-69.7) and vancomycin: mean 234.4 mg/L (95%-CI: 198.9-269.7)). Use of a drain was associated with a statistically significant reduction in vancomycin urine excretion (55.6% (95% CI: 36.45-74.92) to 28.71% (95% CI: 13.07-44.35), p=0.042). A similar trend was observed for gentamicin (34.17% (95% CI: 24.62-43.72) to 16.22% (95% CI: 0-33.86), p=0.078). Conclusions: CERAMENT™G/V was associated with safe plasma concentrations and high local concentrations above minimum inhibitory concentration. Installation of a surgical drain results in removal of a substantial amount of antibiotics and reduces antibiotic urine excretion.
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Affiliation(s)
- Thomas Colding-Rasmussen
- Department of Orthopaedic Surgery, the Musculoskeletal Tumour Section, Rigshospitalet, University of Copenhagen
| | - Peter Horstmann
- Department of Orthopaedic Surgery, the Musculoskeletal Tumour Section, Rigshospitalet, University of Copenhagen
| | - Michael Mørk Petersen
- Department of Orthopaedic Surgery, the Musculoskeletal Tumour Section, Rigshospitalet, University of Copenhagen
| | - Werner Hettwer
- Department of Orthopaedic Surgery, the Musculoskeletal Tumour Section, Rigshospitalet, University of Copenhagen
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Horstmann PF, Raina DB, Isaksson H, Hettwer W, Lidgren L, Petersen MM, Tägil M. Composite Biomaterial as a Carrier for Bone-Active Substances for Metaphyseal Tibial Bone Defect Reconstruction in Rats. Tissue Eng Part A 2017; 23:1403-1412. [DOI: 10.1089/ten.tea.2017.0040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Peter Frederik Horstmann
- Department of Orthopedics, Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Deepak Bushan Raina
- Department of Orthopedics, Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden
| | - Hanna Isaksson
- Department of Orthopedics, Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Werner Hettwer
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Lidgren
- Department of Orthopedics, Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden
| | - Michael Mørk Petersen
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Magnus Tägil
- Department of Orthopedics, Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden
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Rendon JS, Swinton M, Bernthal N, Boffano M, Damron T, Evaniew N, Ferguson P, Galli Serra M, Hettwer W, McKay P, Miller B, Nystrom L, Parizzia W, Schneider P, Spiguel A, Vélez R, Weiss K, Zumárraga JP, Ghert M. Barriers and facilitators experienced in collaborative prospective research in orthopaedic oncology: A qualitative study. Bone Joint Res 2017; 6:307-314. [PMID: 28515060 PMCID: PMC5457637 DOI: 10.1302/2046-3758.65.bjr-2016-0192.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives As tumours of bone and soft tissue are rare, multicentre prospective collaboration is essential for meaningful research and evidence-based advances in patient care. The aim of this study was to identify barriers and facilitators encountered in large-scale collaborative research by orthopaedic oncological surgeons involved or interested in prospective multicentre collaboration. Methods All surgeons who were involved, or had expressed an interest, in the ongoing Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial were invited to participate in a focus group to discuss their experiences with collaborative research in this area. The discussion was digitally recorded, transcribed and anonymised. The transcript was analysed qualitatively, using an analytic approach which aims to organise the data in the language of the participants with little theoretical interpretation. Results The 13 surgeons who participated in the discussion represented orthopaedic oncology practices from seven countries (Argentina, Brazil, Italy, Spain, Denmark, United States and Canada). Four categories and associated themes emerged from the discussion: the need for collaboration in the field of orthopaedic oncology due to the rarity of the tumours and the need for high level evidence to guide treatment; motivational factors for participating in collaborative research including establishing proof of principle, learning opportunity, answering a relevant research question and being part of a collaborative research community; barriers to participation including funding, personal barriers, institutional barriers, trial barriers, and administrative barriers and facilitators for participation including institutional facilitators, leadership, authorship, trial set-up, and the support of centralised study coordination. Conclusions Orthopaedic surgeons involved in an ongoing international randomised controlled trial (RCT) were motivated by many factors to participate. There were a number of barriers to and facilitators for their participation. There was a collective sense of fatigue experienced in overcoming these barriers, which was mirrored by a strong collective sense of the importance of, and need for, collaborative research in this field. The experiences were described as essential educational first steps to advance collaborative studies in this area. Knowledge gained from this study will inform the development of future large-scale collaborative research projects in orthopaedic oncology. Cite this article: J. S. Rendon, M. Swinton, N. Bernthal, M. Boffano, T. Damron, N. Evaniew, P. Ferguson, M. Galli Serra, W. Hettwer, P. McKay, B. Miller, L. Nystrom, W. Parizzia, P. Schneider, A. Spiguel, R. Vélez, K. Weiss, J. P. Zumárraga, M. Ghert. Barriers and facilitators experienced in collaborative prospective research in orthopaedic oncology: A qualitative study. Bone Joint Res 2017;6:–314. DOI: 10.1302/2046-3758.65.BJR-2016-0192.R1.
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Affiliation(s)
- J S Rendon
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada
| | - M Swinton
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada
| | - N Bernthal
- Department of Orthopaedic Surgery, University of California Los Angeles, 1250 16 Street, Suite 3142, Santa Monica, Los Angeles, CA, 90404, USA
| | - M Boffano
- Department of Orthopaedics, AO Città della Salute e della Scienza di Torino, Via Zuretti 29, Torino, 10126 Italy
| | - T Damron
- State University of New York (SUNY) Upstate Medical University, 6620 Fly Road, Suite 100, East Syracuse, NY, 13057, USA
| | - N Evaniew
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada
| | - P Ferguson
- Division Chair, Division of Orthopaedic Surgery, University of Toronto, 600 University Avenue, Suite 476G, Toronto, ON, Canada
| | - M Galli Serra
- Universidad Austral, Av. Juan Domingo Péron 1500, 4to. Piso, Derqui B1629ODT Pilar, Buenos Aires, Argentina
| | - W Hettwer
- Department of Orthopaedic Surgery, University of Copenhagen, Copenhagen, 2100, Denmark
| | - P McKay
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada
| | - B Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, USA
| | - L Nystrom
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - W Parizzia
- Universidad Austral, Av. Juan Domingo Péron 1500, 4to. Piso, Derqui B1629ODT Pilar, Buenos Aires, Argentina
| | - P Schneider
- McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON, Canada
| | - A Spiguel
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA
| | - R Vélez
- Department of Orthopaedic Surgery and Traumatology, Hospital Vall d'Hebron, Pg. Vall d'Hebron 119-129, 2a planta, Barcelona, Spain
| | - K Weiss
- Department of Orthopaedic Surgery, University of Pittsburgh, 5200 Centre Avenue, Shadyside Medical Building, Suite 415, Pittsburgh, PA, USA
| | - J P Zumárraga
- Department of Orthopaedics and Traumatology, Universidade de São Paulo, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, Brazil
| | - M Ghert
- Department of Surgery, McMaster University, 711 Concession Street, Surgical Offices B3 169A
- Hamilton, ON, Canada
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Raina DB, Gupta A, Petersen MM, Hettwer W, McNally M, Tägil M, Zheng MH, Kumar A, Lidgren L. Muscle as an osteoinductive niche for local bone formation with the use of a biphasic calcium sulphate/hydroxyapatite biomaterial. Bone Joint Res 2016; 5:500-511. [PMID: 27784668 PMCID: PMC5108354 DOI: 10.1302/2046-3758.510.bjr-2016-0133.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells. Materials and Methods We seeded mouse skeletal muscle cells C2C12 on the hydroxyapatite/calcium sulphate biomaterial and the phenotype of the cells was analysed. To mimic surgical conditions with leakage of extra cellular matrix (ECM) proteins and growth factors, we cultured rat bone cells ROS 17/2.8 in a bioreactor and harvested the secreted proteins. The secretome was added to rat muscle cells L6. The phenotype of the muscle cells after treatment with the media was assessed using immunostaining and light microscopy. Results C2C12 cells differentiated into osteoblast-like cells expressing prominent bone markers after seeding on the biomaterial. The conditioned media of the ROS 17/2.8 contained bone morphogenetic protein-2 (BMP-2 8.4 ng/mg, standard deviation (sd) 0.8) and BMP-7 (50.6 ng/mg, sd 2.2). In vitro, this secretome induced differentiation of skeletal muscle cells L6 towards an osteogenic lineage. Conclusion Extra cellular matrix proteins and growth factors leaking from a bone cavity, along with a ceramic biomaterial, can synergistically enhance the process of ectopic ossification. The overlaying muscle acts as an osteoinductive niche, and provides the required cells for bone formation. Cite this article: D. B. Raina, A. Gupta, M. M. Petersen, W. Hettwer, M. McNally, M. Tägil, M-H. Zheng, A. Kumar, L. Lidgren. Muscle as an osteoinductive niche for local bone formation with the use of a biphasic calcium sulphate/hydroxyapatite biomaterial. Bone Joint Res 2016;5:500–511. DOI: 10.1302/2046-3758.510.BJR-2016-0133.R1.
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Affiliation(s)
- D B Raina
- Department of Orthopaedics, Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India
| | - A Gupta
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India
| | - M M Petersen
- Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, 2100, Denmark
| | - W Hettwer
- Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, 2100, Denmark
| | - M McNally
- Oxford University Hospital, NHS Trust, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7LD, UK
| | - M Tägil
- Department of Orthopedics, Clinical Sciences, University of Western Australia, Crawley, Australia
| | - M-H Zheng
- Centre for Orthopaedic Translational Research, School of Surgery, University of Western Australia, Crawley, Australia
| | - A Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, 208016, UP, India
| | - L Lidgren
- Department of Orthopedics, Clinical Sciences, Lund University, Lund, 221 85, Sweden
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Stravinskas M, Horstmann P, Ferguson J, Hettwer W, Nilsson M, Tarasevicius S, Petersen MM, McNally MA, Lidgren L. Pharmacokinetics of gentamicin eluted from a regenerating bone graft substitute: In vitro and clinical release studies. Bone Joint Res 2016; 5:427-35. [PMID: 27678329 PMCID: PMC5047051 DOI: 10.1302/2046-3758.59.bjr-2016-0108.r1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/02/2016] [Indexed: 12/18/2022] Open
Abstract
Objectives Deep bone and joint infections (DBJI) are directly intertwined with health, demographic change towards an elderly population, and wellbeing. The elderly human population is more prone to acquire infections, and the consequences such as pain, reduced quality of life, morbidity, absence from work and premature retirement due to disability place significant burdens on already strained healthcare systems and societal budgets. DBJIs are less responsive to systemic antibiotics because of poor vascular perfusion in necrotic bone, large bone defects and persistent biofilm-based infection. Emerging bacterial resistance poses a major threat and new innovative treatment modalities are urgently needed to curb its current trajectory. Materials and Methods We present a new biphasic ceramic bone substitute consisting of hydroxyapatite and calcium sulphate for local antibiotic delivery in combination with bone regeneration. Gentamicin release was measured in four setups: 1) in vitro elution in Ringer’s solution; 2) local elution in patients treated for trochanteric hip fractures or uncemented hip revisions; 3) local elution in patients treated with a bone tumour resection; and 4) local elution in patients treated surgically for chronic corticomedullary osteomyelitis. Results The release pattern in vitro was comparable with the obtained release in the patient studies. No recurrence was detected in the osteomyelitis group at latest follow-up (minimum 1.5 years). Conclusions This new biphasic bone substitute containing antibiotics provides safe prevention of bone infections in a range of clinical situations. The in vitro test method predicts the in vivo performance and makes it a reliable tool in the development of future antibiotic-eluting bone-regenerating materials. Cite this article: M. Stravinskas, P. Horstmann, J. Ferguson, W. Hettwer, M. Nilsson, S. Tarasevicius, M. M. Petersen, M. A. McNally, L. Lidgren. Pharmacokinetics of gentamicin eluted from a regenerating bone graft substitute: In vitro and clinical release studies. Bone Joint Res 2016;5:427–435. DOI: 10.1302/2046-3758.59.BJR-2016-0108.R1.
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Affiliation(s)
- M Stravinskas
- Orthopaedic Surgeon, Lithuanian University of Health, Eivenių str. 2, LT-50009 Kaunas, Lithuania
| | - P Horstmann
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - J Ferguson
- The Bone Infection Unit, Nuffield Orthopedic Centre, Oxford University Hospitals, Windmill Road, Headington, Oxford OX3 7HE, UK
| | - W Hettwer
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - M Nilsson
- Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden
| | - S Tarasevicius
- Orthopaedic Surgeon, Lithuanian University of Health, Eivenių str. 2, LT-50009 Kaunas, Lithuania
| | - M M Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - M A McNally
- The Bone Infection Unit, Nuffield Orthopedic Centre, Oxford University Hospitals, Windmill Road, Headington, Oxford OX3 7HE, UK
| | - L Lidgren
- Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden
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Magee W, Hettwer W, Badra M, Bay B, Hart R. Biomechanical comparison of a fully threaded, variable pitch screw and a partially threaded lag screw for internal fixation of Type II dens fractures. Spine (Phila Pa 1976) 2007; 32:E475-9. [PMID: 17762280 DOI: 10.1097/brs.0b013e31811ec2bb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Stiffness and load to failure were studied in a human cadaver model of Type II odontoid fractures stabilized with either a single partially threaded lag screw and washer or a headless fully threaded variable pitch screw. OBJECTIVE To determine whether a headless fully threaded variable pitch screw provides biomechanically superior fixation of Type II odontoid fractures in comparison with a partially threaded, cannulated lag screw and washer. SUMMARY OF BACKGROUND DATA Surgical treatment of Anderson and D'Alonzo Type II odontoid fractures is often performed using a partially threaded cannulated screw and washer. Reported clinical failure rates of this construct are as high as 20%. This technique requires perforation of the cortex of the tip of the dens, placing the brainstem and vertebrobasilar circulation at risk. A headless fully threaded variable pitch screw has not been described for this application. METHODS A transverse osteotomy was created at the base of the dens in 16 human cadaver C2 specimens and stabilized using either a headless fully threaded variable pitch screw or a partially threaded cannulated lag screw and washer. Specimens were loaded to failure under a static, posteriorly directed force applied to the surface of the dens. Stiffness and load to failure were measured and the mode of failure for each specimen was determined. RESULTS Stiffness and load to failure were greater for the headless, fully threaded variable pitch screw compared with the partially threaded lag screw and washer. The mode of failure for all specimens was via anterior screw cut-out at the C2 vertebral body. CONCLUSION A headless, fully threaded variable pitch screw was biomechanically favorable in comparison with a partially threaded lag screw and washer in this cadaver model of Type II dens fractures. The mode of failure at the C2 vertebral body may have important implications for further improvements in construct strength.
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Affiliation(s)
- William Magee
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR 97239-3098, USA
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Abstract
STUDY DESIGN A biomechanical study in porcine spines of the construct stiffness effects of segmental pedicle screws. Stiffness effects of supplementation of nonsegmental screw constructs with cross-links was also evaluated. OBJECTIVE To assess the biomechanical differences between constructs using segmental versus nonsegmental pedicle screw-based instrumentation as well as the effect of cross-links. SUMMARY OF BACKGROUND DATA An in vitro biomechanical comparison of segmental versus nonsegmental pedicle screw constructs with and without cross-links using porcine lumbar vertebrae was performed. Mechanical trade-offs of reducing the number of pedicle screws in a given construct and substituting a cross-link for a pair of screws are not well understood. METHODS Three, 4, and 5-vertebral segments from 18 porcine spines were instrumented with segmental and nonsegmental pedicle screw constructs, and with nonsegmental screws augmented with cross-links. Unconstrained biomechanical testing in flexion, extension, and axial rotation with 6 degree-of-freedom motion tracking was performed. Statistical comparisons of stiffness data were conducted using 2-tailed paired t tests. RESULTS There was a statistically significant increase in stiffness between models with segmental pedicle screws compared to nonsegmental pedicle screws in 6 of the 9 mechanical tests. The remaining 3 tests approached but did not reach statistical significance (P = 0.087, 0.062, and 0.078). When cross-links were added to the nonsegmental models, differences in stiffness compared to segmental pedicle screws were largely eliminated, decreasing well below statistical significance in 8 of 9 tests. The highest difference in nonsegmental models with cross-links and segmental pedicle screw models was observed for the 5-vertebrae fusion models, for which axial rotation testing maintained statistically significant differences (P = 0.006), and flexion testing approached significance (P = 0.062). CONCLUSIONS Segmental pedicle screw constructs increased mechanical stiffness compared to nonsegmental constructs in our fusion models. Placement of a single cross-link with nonsegmental screws eliminated statistical differences for 3 and 4-vertebral level constructs, and may be a satisfactory alternative in this clinical setting. Caution in applying these results inlonger constructs is recommended, given persistent increased stiffness found for the segmental 5-vertebral level models.
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Affiliation(s)
- Robert Hart
- Oregon Health & Science University, Department of Orthopaedics and Rehabilitation, Portland, OR 97239, USA.
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Fischer J, Hettwer W, Mansfeld HW, Wahl G, Schellenberger A. Polystyrolgebundene Glucoamylase: Kinetisches Verhalten des Enzyms aus Endomycopsis bispora gegenüber technischen Substratlösungen. STARCH-STARKE 1982. [DOI: 10.1002/star.19820340408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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