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PubMed1998

A-W glass ceramic as a bone substitute in cemented hip arthroplasty: 15 hips followed 2-10 years.

We retrospectively reviewed hip arthroplasties in 13 patients (15 hips), in whom we had used apatite-wollastonite (A-W) glass ceramic together with auto- or allograft for augmentation of severe bone deficiency. 11 cemented sockets and 4 stem revisions were included and followed for 2-9.6 years. There were no radiolucent lines between A-W glass ceramic and surrounding bone, and remodeling of the bone graft containing A-W glass ceramic was observed. No migration of cemented sockets was seen except in 1 case, which was revised. In this case, direct bonding between bone and A-W glass ceramic granules was present histologically. In 4 stem revisions, 5 mm subsidence occurred in 1 case. However, the stem became stable and remodeling of the grafted bone occurred. An artificial bone material, such as A-W glass ceramic, can be used under high-load conditions, because of its good mechanical properties.

Adult↗
PubMed1993

Four calcium phosphate ceramics as bone substitutes for non-weight-bearing.

Calcium phosphate ceramics, beta-calcium pyrophosphate (Ca2P2O7), beta-tricalcium phosphate (Ca3(PO4)2), hydroxyapatite (Ca10(PO4)6(OH)2) and tetracalcium phosphate (Ca4(PO4)2O), were prepared. The calcium:phosphorus ratios and microporosities were 1 (31.6%), 1.5 (1.6%), 1.66 (1%) and 2 (34.6%) respectively. Samples (15 mm x 10 mm x 2 mm), abraded with No. 2000 alumina powder, were implanted into the tibial metaphysis of mature male rabbits. Failure load, when an implant detached from the bone or the bone itself broke, was measured. At 10 wk after implantation, the failure loads in beta-calcium pyrophosphate, beta-tricalcium phosphate, hydroxyapatite and tetracalcium phosphate were 31.65 +/- 9.90 N, 72.81 +/- 19.01 N, 49.49 +/- 17.25 N and 43.22 +/- 14.99 N respectively. At 25 wk after implantation, the values were 47.04 +/- 14.90 N, 71.34 +/- 19.50 N, 69.09 +/- 16.17 N and 62.03 +/- 18.62 N respectively. Histologically, bone bonding behaviour of calcium phosphate ceramics did not vary with the calcium:phosphorus ratio, as observed by contact microradiogram, Giemsa surface staining and scanning electron micrograph-electron probe micro analysis. There was no intervening soft tissue at the interface of bone and ceramics. Hydroxyapatite or tricalcium phosphate are used as bone substitutes. However, their mechanical strength is insufficient for weight-bearing and they are used as bone filler. This study showed that the apparent insignificance of strict calcium:phosphorus ratio with respect to the biological results greatly simplifies processing of calcium phosphate ceramics for clinical application. In clinical application, calcium phosphate ceramics with different Ca:P can be used as bone fillers for bone defects or bone cavities under non-weight-bearing conditions.

Animals↗
PubMed1997

[Radiological evaluation of integration of bone grafts and bone substitutes after implantation to replace acetabular substance losses in reoperation of total hip prosthesis].

Plain radiograms are insufficient to evaluate the integrity of a graft used to replace acetabular tissue loss in reoperations for total hip replacement. The aim of this work was to compare radiographic, computed tomographic and magnetic resonance imaging findings. Two groups of patients including 12 hip joints in each were evaluated 5 years after undergoing reoperation for annular support. Allografts (5 cases) or xenografts (7 cases) were used in one group. Plain radiograms. CT-scan and MRI were performed in each patient. The graft-receiver bone borders were visible on the CT-scans but were not distinguishable on the radiograms. Bone and graft density and structure in contact with the implant could be determined on the CT-scan. MRI was difficult to interpret in most cases due to implant-induced artefacts and is not recommended in this type of reconstruction.

Adult↗
PubMed2004

Bone morphogenetic protein 2 accelerates osteointegration and remodelling of solvent-dehydrated bone substitutes.

INTRODUCTION: lt was the purpose of this study to investigate how bone morphogenetic protein 2 (BMP-2) influences remodelling and the biomechanics of solvent-dehydrated bone in the long run. Furthermore, the early influence of this growth factor on the substitute was investigated. MATERIALS AND METHODS: Using a weight-bearing animal model, solvent-dehydrated bone was implanted in the tibial head of merino sheep ( n=12) after being loaded with BMP-2 (100 microg/100 microl). At 4 weeks ( n=6) and 9 months ( n=6) after surgery, histomorphological, histomorphometrical and biomechanical investigations were performed. RESULTS: At 9 months after implantation of BMP-2-loaded specimens, the bone per tissue volume was high, with levels above those of physiological cancellous bone. The amount of remaining solvent-dehydrated bone was markedly decreased, and in contrast, the amount of newly formed bone was extremely high. The specimen degradation had already occurred within the first 4 weeks after implantation, showing no further impact throughout the 9-month period. Biomechanical investigations at 9 months after implantation demonstrated a yield strength which achieved levels at least equivalent to physiological cancellous bone. BMP-2 showed no significant impact on the biomechanical properties after 4 weeks, compared to specimens prior to implantation. CONCLUSION: BMP-2 predominantly has an impact on the early implant degradation as well as bone formation, which leads to an almost completed bone remodelling of the solvent-dehydrated specimen within the study period of 9 months.

Animals↗
PubMed2002

Porous calcium polyphosphate scaffolds for bone substitute applications in vivo studies.

Porous rods (6 mm in length and 4 mm in diameter) of calcium polyphosphate (CPP) made by gravity sintering of particles in the size ranges of 45-105, 105-150. and 150-250 microm and with initial volume percent porosity in the range of 35-45% were implanted in the distal femur of New Zealand white rabbits. In an initial experiment, four rabbits implanted with rods made from coarse particles (150-250 microm) were sacrificed at each of the following time points: 2 days, 2 weeks, 6 weeks and 12 weeks. In a subsequent experiment, 10 rabbits were implanted with rods made by sintering 45-105 microm particles and another 10 were made by using particles of 105-150 microm. These rabbits were sacrificed at 6 weeks (five rabbits) and 1 year (five rabbits). No adverse reaction was found histologically at any time point in either experiment. These experiments show that CPP macroporous rods can support bone ingrowth and that between 12 weeks and 1 year, the amount of bones formed is equivalent to the natural bone volume found at similar sites. The degradation of the CPP material is inversely proportional to the original particle size and is rapid initially (within the first 6 weeks) and slows down thereafter. In conclusion, this material seems to promote rapid bone ingrowth and can be tailored to degrade at a given rate in vivo to some degree through appropriate selection of the starting particle size.

Animals↗
PubMed2006

A prospective randomized study of posterolateral lumbar fusion using osteogenic protein-1 (OP-1) versus local autograft with ceramic bone substitute: emphasis of surgical exploration and histologic assessment.

STUDY DESIGN: A prospective, randomized and controlled study. OBJECTIVES: To evaluate the osteoinductive property of Osteogenic Protein-1 (OP-1 or BMP-7) and fusion rate in human instrumented posterolateral lumbar fusion through radiographic examination, surgical exploration, and histologic assessment. SUMMARY OF BACKGROUND DATA: The use of osteoinductive agents is a current topic in spinal fusion. Numerous preclinical investigations have demonstrated efficacy of osteoinductive proteins in spinal fusion, but few human clinical studies have been reported. METHODS: Nineteen patients with L3-L4 or L4-L5 degenerative spondylolisthesis underwent posterolateral lumbar fusion using pedicle screw instrumentation. The patients were randomized to receive either OP-1 Putty (3.5 mg OP-1/g of collagen matrix per side) alone (n = 9), or local autograft with HA-TCP granules (n = 10). Fusion status was evaluated using plain radiography and CT scan. Radiographic fusion criteria included less than 5 degrees of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area in which the graft materials were placed following decortication. After a minimum 1-year follow-up, the patients who showed radiographic evidence of fusion underwent instrumentation removal and surgical exploration of the fusion site. Biopsy specimens were taken from the fusion mass and evaluated histologically. RESULTS: Radiographic fusion rate was 7 of 9 OP-1 patients and 9 of 10 control patients. Based on surgical exploration of these 16 patients, new bone formation was macroscopically observed in the posterolateral lumbar region in all cases; however, solid fusion was observed in 4 of 7OP-1 and 7 of 9 HA-TCP/autograft patients. Histologic assessment demonstrated viable bone in 6 of 7 OP-1 patients. All the control (HA-TCP/autograft) specimens contained viable bone and fibrous tissue surrounding ceramic granules, suggesting slow incorporation of the graft material. CONCLUSIONS: In a human posterolateral lumbar spine trial, OP-1 reliably induced viable amounts of new bone formation, but the fusion success rate evaluated by surgical exploration was only 4 of 7.

Aged↗
PubMed2000

[Determining the size of the specific surface of bone substitutes with gas adsorption].

The surface area and the microporosity of bone regeneration materials influence their chemical and biological properties. Therefore, the size of the specific surface area and the distribution of the pore diameters (pores < 1 micron) of bone regeneration materials were analyzed within this study. The analyzed hydroxyapatites were of synthetic, bovine, and phytotroph origin. The tricalcium phosphates and the bioglasses included only synthetic materials. The gas adsorption of each specimen was analyzed using a volumetric N2/Kr system (ASAP 2010, Micromeritics). Additionally, for materials with a specific surface area (> 2 m2/g) the pore size distribution was evaluated by the BJH-method. Two of the materials evaluated astonishingly large dimensions of the specific surface area (BioOss 79.7 m2/g, Algipore new 14.6 m2/g). A medium surface area was found for Algipore old (4.9 m2/g) and Interpore200 (2.64 m2/g). All other included materials showed only small sizes of the specific surface area (Ceros80 1.8 m2/g, Ceros82 1.31 m2/g, Cerasorb 1.2 m2/g, Biobase 0.7 m2/g, Endobone 0.7 m2/g, Perioglas 0.6 m2/g, Allotropat50 0.23 m2/g, Biogran 0.2 m2/g). The materials with large and medium sizes of the specific surface area evaluated the following pore diameters: BioOss 2-50 nm, Algipore new 2-100 nm, Algipore old 5-50 nm, Interpore200 2-100 nm. Pore sizes less than 2 nm were not found in relevant numbers. The materials BioOss, old and new Algipore, and Interpore200 contain a large interconnecting mesopore system (diameter < 1 micron). For the materials Biobase, Endobone, Perioglas, Allotropat 50, and Biogran this cannot be assumed. The materials Ceros80, Ceros82, and Cerasorb evaluated a specific surface area between those and might include only a small part of these interconnecting pores. An influence of the interconnecting porosity and the different sizes of the specific surface areas on the biological behavior of the bone regeneration materials can be suggested.

Adsorption↗
PubMed1996

[Biocoral--an alternative bone substitute].

Biocoral is a biomaterial derived from natural corals, and it has surgical applications. Since 1992 the author has been using this material as a bone graft substitute in maxillofacial surgery. Seventy-seven clinical implantations were done for different indications. The results suggest that coral grafts are well tolerated and become partially ossified when the calcified skeleton is resorbed. This material has been demonstrated to be successful.

Adult↗
PubMed1997

A zinc based self setting ceramic bone substitute for local delivery of testosterone.

Testosterone has been shown to stimulate bone healing. However, large doses of testosterone are associated with liver damage and prostate enlargement. Continuous release of testosterone at the traumatized bone site could enhance healing without inducing systemic side effects. In this investigation a self-setting zinc sulfate calcium phosphate (ZSCAP) ceramic with and without testosterone was used to fill experimentally induced bone defects in rats. Each treatment group consisted of six albino, Holtzman rats. Groups I and II consisted of non-operated and sham-operated animals. Rats in Group III, IV, V, and VI were implanted with ZSCAP particulate ceramic powders (63-75 microns) containing 0.0, 0.5, 1.0, or 1.5 mg testosterone in a 2.3 mm defect in the femur of each rat. Radiographic and morphologic examination of the implant site at four, eight, and twelve weeks post surgery showed integration of the implant in the femur of each rat. Serum testosterone of all rats was assayed at four, eight, and twelve weeks post surgery. Differences in the serum testosterone levels of rats in the six groups were not significant. Results of this study suggest that a ZSCAP-testosterone composite can be used to repair traumatized bone without increasing the levels of testosterone in the systemic circulation.

Animals↗
PubMed1999

[Roentgen spectrometry comparison of currently available bone substitutes].

INTRODUCTION: The crystalline structure of hydroxyapatite (HA) and tricalciumphosphate (TCP) used as bone regeneration materials affects their physical and probably also their biological properties. Varying velocities of the HA solution process seem to be correlated to different results in powder diffraction analysis (RDX) [1], a validated, routine procedure in minerology [2, 6] to analyse crystallized materials. As far we know there are no comparative RDX analyses for the TCP materials in clinical use. GOALS: The dimension and quality of the crystallization of several bone regeneration materials are analysed by RDX. MATERIAL AND METHODS: The materials analysed were divided in different groups: hydroxyapatite, tricalciumphosphate and bioglass. The materials are characterized by the specific intensity curve measurements. RESULTS: The HA products, with the exception of Algipore, seem to be monophasic. Ceros80 and Endobone were the only ones which seem to be totally crystallized. The TCP products Biobase and Cerasorb are nearly monophasic, whereas Ceros82 seems to contain a mixture of 30% HA and 70% beta-TCP. All TCPs show a high crystallization. The bioglasses did--as suspected--not show crystalline structures. DISCUSSION: There are many possible causes for inhomogeneous crystallization of the investigated materials, as they are composites of different foreign ions, extremely small crystals or abnormal (deficient) apatites. How this affects the biological behaviour is not known. SUMMARY: We found differences between the examined materials; how this affects the biological behaviour is unknown. Further investigations are necessary to correlate the characteristics of the materials to the clinical outcome.

Bone Substitutes↗
PubMed2000

Spinal fusions: bone and bone substitutes.

Vertebral arthrodesis is one of the most commonly performed, yet incompletely understood, procedures in spinal surgery. Despite major progress in internal fixation techniques, the high rate of nonunions indicates that physiologic, biologic and molecular events that are crucial to this process are not well known. This article will analyze the general biology of bone regeneration, and particularly discuss the properties and use of various bone graft materials and graft substitutes.

Bone Regeneration↗
PubMed1997

Role of exchanged ions in the integration of ionomeric (glass polyalkenoate) bone substitutes.

Ionomeric (glass polyalkenoate) implants are synthetic materials which can be used for repairing bone defects. It has been suggested that ions are leached from these implants during healing and that they influence cellular activity in the surrounding tissues. Morphological, immunohistochemical and microanalytical techniques were used to compare the osteogenic capacity of implants which eluted aluminium ions with implants which did not elute aluminium ions. The extracellular matrix molecules fibronectin and tenascin were located upon the surface of both implanted materials. Thick seams of lamellar bone were apposed to implants containing labile aluminium ions, but the bone was poorly mineralized. At the same time, transient increases were apparent in osteoblast activity on periosteal and endosteal surfaces and in chondrocyte activity in the growth plate and articular cartilages. In contrast, small amounts of mineralized lamellar bone were apposed to substituted implants (without aluminium) and the growth plate and articular cartilages remained normal in thickness and morphology. These results suggest that exchanged ions can influence the amount and quality of bone apposed to the implant. They also suggest that the effect of the ions depends upon their concentration and the state of differentiation of osteogenic cells.

Aluminum↗
PubMed2002

Polymer--calcium phosphate cement composites for bone substitutes.

The use of self-setting calcium phosphate cements (CPCs) as bioresorbable bone-replacement implant materials presently is limited to non-load-bearing applications because of their low compressive strength relative to natural bone. The present study investigated the possibility of strengthening a commercially available CPC, alpha-BSM, by incorporating various water-soluble polymers into the cement paste during setting. Several polyelectrolytes, poly(ethylene oxide), and the protein bovine serum albumin (BSA) were added in solution to the cement paste to create calcium phosphate-polymer composites. Composites formulated with the polycations poly(ethylenimine) and poly(allylamine hydrochloride) exhibited compressive strengths up to six times greater than that of pure alpha-BSM material, with a maximum value reached at intermediate polymer content and for the highest molecular weight studied. Composites containing BSA developed compressive strengths twice that of the original cement at protein concentrations of 13-25% by weight. In each case, XRD studies correlate the improvement in compressive strength with reduced crystallite dimensions, as evidenced by a broadening of the (0,0,2) reflection. This suggests that polycation or BSA adsorption inhibits crystal growth and possibly leads to a larger crystal aspect ratio. SEM results indicate a denser, more interdigitated microstructure. The increased strength was attributed to the polymer's capacity to bridge between multiple crystallites (thus forming a more cohesive composite) and to absorb energy through plastic flow.

Animals↗
PubMed2005

Bone substitutes: an update.

Autograft is considered ideal for grafting procedures, providing osteoinductive growth factors, osteogenic cells, and an osteoconductive scaffold. Limitations, however, exist regarding donor site morbidity and graft availability. Allograft on the other hand, posses the risk of disease transmission. Synthetic graft substitutes lack osteoinductive or osteogenic properties. Composite grafts combine scaffolding properties with biological elements to stimulate cell proliferation and differentiation and eventually osteogenesis. We present here an overview of bone grafts and graft substitutes available for clinical applications.

Bone Cements↗
PubMed2005

Fabrication and evaluation of a new composite composed of tricalcium phosphate, gelatin, and Chinese medicine as a bone substitute.

This study investigates the biological effects of traditional Chinese medicines on the activities of bone cells using rat bone cells. Then, a mixture of a GGT composite, that is, a novel biodegradable composite containing genipin crosslinked gelatin and tricalcium phosphate, and traditional Chinese medicine (TCM) was prepared as a GGT-TCM composite. A cultured neonatal rat calvarias organ was used to measure the potential of GGT-TCM composite for use in promoting the regeneration of defective bone tissue. The mitochondria activity of the bone cells following exposure to various concentrations of crude extracts of five herbal Chinese medicines was measured by colorimetric assay. Biochemical markers, such as alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP) titers were analyzed to evaluate the activities of bone cells. Finally, we examined the organ culture units, which were maintained in cultured medium for 5 weeks. Morphology of tissue was observed, and the quantitative evaluation of the regenerated bone was determined. In a bone cells culture experiment, adding Cuscuta chinensis Lam. (TCM-5) to the bone cells culture clearly promoted the proliferation and differentiation of the osteoblasts from their precursor cells; but the reduced amount of TRAP indicated that the medicine significantly inhibited the osteoclasts activities. Opposite bone cell responses were observed when Loranthus parasiticus Merr. (TCM-3) and Achyranthes bidentata Bl. (TCM-4) were added to the bone cells culture. Eucommia ulmoides Oliv. (TCM-1) and Dipsacus asper Wall. (TCM-2) potentially influence the proliferation and differentiation of the osteoblasts from their precursor cells, but they did not affect the osteoclasts activities. The finding from the organ culture indicated that Chinese medicine effectively increased the rate of tissue regeneration of damaged bones.

Acid Phosphatase↗
PubMedDate not supplied

Raman investigation of calcium carbonate bone substitutes and related biomaterials.

The interaction between biomaterials used in surgical procedures and the host bone is not yet perfectly understood. It appears that these problems may have been encountered because of insufficient characterisation of the basic component used in the synthesis of such biomaterials. Calcium carbonate (CaCO3) is interesting for bone filling or regeneration procedures because of its resorbability. The aim of this work is to compare different CaCO3 biomaterials and their basic source with the help of microRaman spectroscopy. Bionacre and Biocoral are analysed. The main bands of carbonate internal modes are observed around 1084-86 and 704-12 cm-1. In the lattice modes region, for both Biocoral and synthetic aragonite, two bands at 206 and 155 cm-1 are observed. The eggshell, oyster shell and synthetic calcite samples exhibit bands at 281 and 155 cm-1. Three bands are present at 280, 206 and 155 cm-1 on the Bionacre sample. The 206 and the 280 cm-1 bands are due to aragonite and calcite forms respectively. Therefore it appears to be a mixture of aragonite and calcite whereas Biocoral is pure aragonite. Additional Raman investigations should be of great interest in evaluating the structural modifications and their influence on the biological behaviour of these biomaterials. Lity index, the percentage of prematurity and of low birth weight are the indices of national health status.

Animals↗