Chronology of the Radiographic Appearances of the Calcium Sulfate-Calcium Phosphate Synthetic Bone Graft Composite following Resection of Bone Tumors: A Follow-up Study of Postoperative Appearances

Tan, V.; Evaniew, Nathan; Finlay, Karen; Jurriaans, Erik; Ghert, Michelle; Deheshi, Benjamin; Parasu, Naveen

doi:10.1016/j.carj.2014.11.004

Cited by 15 publications

(10 citation statements)

References 11 publications

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“…Kotnis, et al described chronological radiographic appearance of a calcium sulphate-calcium phosphate matrix mixed with beta-tricalcium phosphate granules following bone tumour resection in 11 patients 41. Their findings showed some similarities to our own: resorption commenced peripherally with gradual inward progression; complete resorption of the BGS was seen at six months 41,42. Since the radiographic appearance of BGS are variable and can lead to confusion with recurrent or residual disease 43, it is important to understand the time-dependant changes which are seen during follow-up.…”

Section: Discussionsupporting

confidence: 70%

Radiographic and Histological Analysis of a Synthetic Bone Graft Substitute Eluting Gentamicin in the Treatment of Chronic Osteomyelitis

Ferguson

Athanasou

Diefenbeck

et al. 2019

J. Bone Joint Infect.

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Abstract. Introduction: Managing chronic osteomyelitis can be challenging and attention to the osseous dead-space left following resection is an important part of successful treatment. We assess radiographic bone healing following implantation of a gentamicin-eluting synthetic bone graft substitute (gBGS) used at chronic osteomyelitis (cOM) resection. We also describe histological carrier changes from biopsies in nine cases at various time points.Methods:This was a retrospective review of a prospectively collected consecutive series of 163 patients with Cierny-Mader Type III or IV cOM who underwent single-stage excision, insertion of gBGS and definitive soft-tissue closure or coverage. Bone defect filling was assessed radiographically using serial radiographs. Nine patients had subsequent surgery, not related to infection recurrence, allowing opportunistic biopsy between 19 days and two years after implantation.Results: Infection was eradicated in 95.7% with a single procedure. 138 patients had adequate radiographs for assessment with minimum one-year follow-up (mean 1.7 years, range 1.0-4.7 years). Mean void-filling at final follow-up was 73.8%. There was significantly higher void-filling in metaphyseal compared to diaphyseal voids (mean 79.0% versus 65.6%; p=0.017) and in cases with good initial interdigitation of the carrier (mean 77.3% versus 68.7%; p=0.021). Bone formation continued for more than two years in almost two-thirds of patients studied (24/38; 63.2%).Histology revealed active biomaterial remodelling. It was osteoconductive with osteoblast recruitment, leading to the formation of osteoid, then woven and lamellar bone on the substrate's surface. Immunohistochemistry demonstrated osteocyte specific markers, dentine matrix protein-1 and podoplanin within the newly formed bone.Conclusion: This antibiotic-loaded biomaterial is effective in managing dead-space in surgically treated cOM with a low infection recurrence rate (4.3%) and good mean bone void-filling (73.8%). The radiographic resolution of the bone defect is associated with bone formation, as supported by histological analysis.

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Section: Discussionsupporting

confidence: 70%

Radiographic and Histological Analysis of a Synthetic Bone Graft Substitute Eluting Gentamicin in the Treatment of Chronic Osteomyelitis

Ferguson

Athanasou

Diefenbeck

et al. 2019

J. Bone Joint Infect.

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“…Furthermore, due to the introduction of CP, the mechanical strength of the composite is superior to CS and autogenous cancellous bone (17). Both animal studies and clinical studies have demonstrated the satisfactory osteogenesis and antibiotic loading effect of CS/CP composites (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Induced membrane technique combined with antibiotic-loaded calcium sulfate–calcium phosphate composite as bone graft expander for the treatment of large infected bone defects: preliminary results of 12 cases

Zhi¹,

Wang²,

Zhang³

et al. 2020

Ann Transl Med

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Background: Management of large infected bone defects is a major clinical and socioeconomic problem.The induced membrane technique has been widely used as a solution. However, it has apparent disadvantages such as limited autologous bone graft supply and lack of continuous infection control. Meanwhile, calcium sulfate/calcium phosphate composites have efficacious osteogenesis and antibiotic delivery capacity. For the first time, we analyzed the efficiency of calcium sulfate/calcium phosphate composites as a bone graft expander in the induced membrane technique to treat large infected bone defects. Methods:We retrospectively analyzed the clinical data of 12 patients with large infected bone defects of 6.1-17.2 cm treated with the induced membrane technique from November 2016 to July 2019. In the second reconstruction stage, the bone defect was filled with a mixture of the autogenous iliac bone and vancomycinimpregnated calcium sulfate/calcium phosphate composites at a ratio of 3:1. We assessed the bony union by Samantha X-ray score and recorded infection recurrence and complications. Paley scale and SF-36 score were used to evaluate the function of adjacent joint and quality of life pre and postoperatively. Pearson's correlation coefficients were calculated for union time and other clinical scores.Results: The mean follow-up was 69 weeks (ranging from 30 to 142) after the second stage of the operation. The mean Samantha X-ray score was 5.1 [3-6], preoperative and postoperative SF-36 scores showed that there were statistical differences in all the nine aspects, and the excellent rate of adjacent joint function was 75% (Paley). All cases were radiologically healed, and none of the 12 patients had infection recurrence or failure of fixation at the last follow-up. Two cases had delayed wound healing and were cured after dress changing. There was a significant correlation between union time and Samantha X-ray score (r =-0.887; P=0.000), while there was no correlation between filling dose, size of the defect, and other outcomes.Conclusions: This study provided evidence supporting calcium sulfate/calcium phosphate composites as an effective and safe bone graft expander in the induced membrane technique to treat large infected bone defect. This technique may help decrease the use of autologous bone graft and enhance the anti-infection effect of the induced membrane technique.

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“…The aim of this pilot study was to develop a large animal model that would replicate a common clinical bone defect scenario as closely as possible and would also allow detailed analysis of the bone healing response to bone defect filling with a BGS in comparison to cancellous allograft or no filling at all. Since the resorption patterns of ceramic BGS are challenging to interpret and its transformation into bone are difficult to substantiate in clinical practice , we anticipated that the analysis of multiple different imaging modalities in correlation and accordance with histological findings would help to replicate, clarify and better understand clinical observations in humans.…”

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confidence: 99%

Establishment and effects of allograft and synthetic bone graft substitute treatment of a critical size metaphyseal bone defect model in the sheep femur

Hettwer

Horstmann

Bischoff

et al. 2019

APMIS

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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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Chronology of the Radiographic Appearances of the Calcium Sulfate-Calcium Phosphate Synthetic Bone Graft Composite following Resection of Bone Tumors: A Follow-up Study of Postoperative Appearances

Abstract: Our study suggests a characteristic time and volume related radiographic pattern of resorption and new bone ingrowth with the CaSO4/CaPO4 synthetic graft. Findings that deviate from this pattern may represent complication and warrant additional follow-up.

Cited by 15 publications

References 11 publications

Radiographic and Histological Analysis of a Synthetic Bone Graft Substitute Eluting Gentamicin in the Treatment of Chronic Osteomyelitis

Radiographic and Histological Analysis of a Synthetic Bone Graft Substitute Eluting Gentamicin in the Treatment of Chronic Osteomyelitis

Induced membrane technique combined with antibiotic-loaded calcium sulfate–calcium phosphate composite as bone graft expander for the treatment of large infected bone defects: preliminary results of 12 cases

Establishment and effects of allograft and synthetic bone graft substitute treatment of a critical size metaphyseal bone defect model in the sheep femur

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