Clinical and radiological assessment of the induced membrane technique using beta-tricalcium phosphate in reconstructive surgery for lower extremity long bone defects

Abstract

Aims To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. Methods A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using β-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. Results There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. Conclusion IMT using β-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456–461.

Effect of Tricalcium Phosphate on Healing of Non-Unions: An Observational Study of over 400 Non-Unions

“…In contrast, Sasaki et al conclude that there is no significant influence of defect size on healing rates. 23 However, the collective in this study is significantly smaller and consolidation is evaluated in a less reliable way than in our study: Here, healing was assumed in the presence of callus formation.…”

“…Sasaki et al show callus formation of 88.6% in lower extremity non-unions in 35 patients. 23 Previous results are often limited by very small study populations and short follow-up.…”

Induced membrane technique using beta-tricalcium phosphate for reconstruction of clavicle bone defect after fracture related infection - A case report

“…Generally, the granule-type β-TCP is used. However, osteogenesis was only observed in the dorsal aspect of the femoral diaphysis after transplanting the autogenous cancellous bone mixed with the granule-type β-TCP into a defect in the femoral shaft [ 10 ]. In bones covered with muscles and other mobile tissues, due to gravity, the β-TCP and cancellous bone can move within the gap between the bone defects during daily life activities.…”

Induced membrane technique using an equal portion of autologous cancellous bone and β-tricalcium phosphate provided a successful outcome for osteomyelitis in large part of the femoral diaphysis - Case report

“…The critical concern for applying the IMT for large bone defects has been the limited amount of autograft harvested from the iliac crest, which may be insufficient to fill the defect due to adequate debridement of the infected bone. To address this problem, we introduced the application of β-TCP, which can be used as an extender by mixing it with autograft in approximately equal proportions [7] , [8] . In the present case, plain radiographs indicated successfully callus formation in three out of four cortices.…”