Bone-Graft Resorption Reduced by the Induced Membrane Technique and Factors Affecting Volumetric Changes

Abstract

Background: Little is known about the volumetric changes of grafted bone over time when using the induced membrane technique. This study investigates the volumetric changes of bone graft using serial computed tomographic (CT) scans following the induced membrane technique. Methods: Patients with critical-sized bone defects had serial CT scans after undergoing bone-grafting using the induced membrane technique. CT scans to evaluate the volume of bone graft were obtained immediately postoperatively and at 6 and 12 months. The change in the volume of bone graft was determined at 6 and 12 months postoperatively. Patient demographic characteristics, the location and composition of the bone graft, and the type of fixation construct were analyzed. Results: Forty patients met inclusion criteria. There were 27 tibiae and 13 femora with a mean size defect of 8.6 cm (range, 2.5 to 20.6 cm). Of these patients, 21 received autograft with cancellous bone graft and 19 received mixed autogenous bone with demineralized bone matrix (DBM) at a mean time of 17 weeks after the membrane formation. For the first 6 months, there was an overall osseous resorption of −9.9%. The overall graft volume from 6 to 12 months demonstrated an increase of osseous volume by +1.6%. For the entire 12-month period, there was a mean graft volume resorption of −8.3%. A correlation was found between the early volumetric changes of grafted bone and the percentage of DBM in the graft mixture. A correlation was also found between the late volumetric changes and the location of defect or the type of fixation. Conclusions: At 1 year after use of the induced membrane technique for the treatment of a critical-sized bone defect, resorption of the grafted bone averaged −8.3%. The volumetric changes were influenced by the property of the grafted bone, the fixation construct, and the location of the defect. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Stress fracture after implant removal from the tibia reconstructed by the induced membrane technique: A case report

“…Second, uneven bone grafting placement in the membrane may cause resorption of the grafted bone. As a previous study has demonstrated, defects filled with a combination of autograft and demineralized bone matrix (DBM) have a higher incidence of bony resorption than those filled with purely autograft alone [9] . Thus, notching could theoretically occur at defect sites filled with DBM and autograft.…”

Effect of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) with Hydroxyapatite Carrier in Induced Membrane Technique: A Retrospective Propensity Score-Matched Study

“…2). 7 Changes in density of the regenerated bone (1 year after CT) from grafted bone (immediate postoperative CT) were measured by mean Hounsfield unit (HU), which represents attenuation of CT image and correlates with T-score 37 (see Figure, Supplemental Digital Content 1, http://links.lww. com/JOT/B610, which illustrates density measurement of grafted bone and regenerated bone).…”

“…Two orthopaedic trauma surgeons used 1 surgical protocol on 143 patients from January 2017 to May 2019 for the management of CSBD due to osteomyelitis, noninfected nonunion, and open fracture. Our surgical protocol was previously described, 7,35,36 and the staged IMT was performed with or without rhBMP-2/HA augmentation (Novosis, CGBIO, Gyeonggi, South Korea) (Fig. 1).…”

“…As a result, IM can prevent resorption of grafted bone and stimulate osteoinduction and osteogenesis. 6,7 However, there remain issues that surgeons struggle with while performing the IMT. The recurrence of infection and incomplete consolidation are the most common current problems in IMT.…”

“…3,19 However, a higher ratio of volume expander is correlated with a higher volumetric resorption rate of the grafted bone. 7 To solve these 3 issues within IMT, we focused on recombinant human bone morphogenetic protein (rhBMP), which is a well-known osteoinductive protein that directs uncommitted mesenchymal cells to differentiate into osteoblasts and chondroblasts. Among rhBMP family, rhBMP-7 and rhBMP-2 are currently available for clinical applications and had promising results on bone regeneration in previous studies.…”