Optimizing the grain size distribution of allografts in bone impaction grafting

Putzer, David; Coraça‐Huber, Débora C.; Wurm, Alexander; Schmoelz, Werner; Nogler, Michaël

doi:10.1002/jor.22635

Cited by 14 publications

(15 citation statements)

References 25 publications

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“…Depending on the packing density nutrients, cells and blood vessels are able to immigrate into the defect (Coathup et al, ). On the other hand, higher mechanical stability can be achieved with tighter packing (Putzer, Coraça‐Huber, Wurm, Schmoelz, & Nogler, ). Furthermore, the granule size has important impact on material dissolution and resorption characteristics (Klüppel et al, ).…”

Section: Introductionmentioning

confidence: 99%

Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur

et al. 2019

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The Masquelet technique for the treatment of large bone defects is a two‐stage procedure based on an induced membrane. The size of a scaffold is reported to be a critical factor for bone healing response. We therefore aimed to investigate the influence of the granule size of a bone graft substitute on bone marrow derived mononuclear cells (BMC) supported bone healing in combination with the induced membrane. We compared three different sizes of Herafill® granules (Heraeus Medical GmbH, Wehrheim) with or without BMC in vivo in a rat femoral critical size defect. A 10 mm defect was made in 126 rats and a membrane induced by a PMMA‐spacer. After 3 weeks, the spacer was taken out and membrane filled with different granule sizes. After 8 weeks femurs were taken for radiological, biomechanical, histological, and immunohistochemical analysis. Further, whole blood of the rat was incubated with granules and expression of 29 peptide mediators was assessed. Smallest granules showed significantly improved bone healing compared to larger granules, which however did not lead to an increased biomechanical stability in the defect zone. Small granules lead to an increased accumulation of macrophages in situ which could be assigned to the inflammatory subtype M1 by majority. Increased release of chemotactic respectively proangiogenic active factors in vitro compared to syngenic bone and beta‐TCP was observed. Granule size of the bone graft substitute Herafill® has significant impact on bone healing of a critical size defect in combination with Masquelet's technique in terms of bone formation and inflammatory potential.

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Section: Introductionmentioning

confidence: 99%

Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur

et al. 2019

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“…Allograft samples were assembled according to their grain size in proportions specified in Table 1 after being separated using sieves ranging from 0.063 to 16 mm in correspondence to ASTM C 125 standard (Application time 1 h, Amplitude 10 mm, Haver und Böcker, Ölde, Germany) (Putzer et al 2014b). Samples with a mean weight of 8 ± 0.01 g were obtained and divided into four groups each containing 20 samples.…”

Section: Methodsmentioning

confidence: 99%

“…Previously published data by the authors were used as control groups were native allografts (NA) (Putzer et al 2014a) and allografts with optimized grain size distribution (OG) were evaluated (Putzer et al 2014b).…”

Section: Methodsmentioning

confidence: 99%

Platelet concentrate as an additive to bone allografts: a laboratory study using an uniaxial compression test

et al. 2018

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Chemical cleaning procedures of allografts are destroying viable bone cells and denaturing osteoconductive and osteoinductive proteins present in the graft. The aim of the study was to investigate the mechanical differences of chemical cleaned allografts by adding blood, clotted blood; platelet concentrate and platelet gel using a uniaxial compression test. The allografts were chemically cleaned, dried and standardized according to their grain size distribution. Uniaxial compression test was carried out for the four groups before and after compacting the allografts. No statistically significant difference was found between native allografts, allografts mixed with blood, clotted blood, platelet concentrate and platelet concentrate gel regarding their yield limit after compaction. The authors recommend to chemical clean allografts for large defects, optimize their grain size distribution and add platelet concentrate or platelet rich plasma for enhancing as well primary stability as well bone ingrowth.

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“…The donated material was fresh‐frozen at −80 °C and stored at −20 °C. Cortical and cartilage tissues were removed and the femoral heads were reduced to fragments smaller than 10 mm in diameter using a bone mill (Noviomagus, coarse milling drum, Spierings Medische Techniek BV, Nijmegen, The Netherlands) under sterile conditions . Allografts were washed chemically, dried for 4 days at 37 °C and carefully mixed to minimize any patient‐specific bone characteristics .…”

Section: Methodsmentioning

confidence: 99%

“…Allografts are compacted to prevent early massive subsidence of an implant . The initial stability of the allografts also depends on the distribution of grain sizes, as well as on the specific preparation method . Different materials have been studied as bone graft extenders to overcome shortages of material from human donors …”

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confidence: 99%

BAG‐S53P4 as an additive to bone allografts: A laboratory study using an uniaxial compression test

Putzer

Fuchs

Coraça‐Huber

et al. 2015

Journal Orthopaedic Research

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We want to address the clinical issue of too sparse supply of allograft in total hip replacement and ambitions of controlling the grain size distribution. Bioglass BAG-S53P4 was evaluated as a bone graft additive to chemically treated allografts with controlled grain size distribution. Allografts were chemically cleaned (CG) and mixed with BAG-S53P4 additive (BG) for comparison. All samples were compacted with a dropped weight apparatus and then underwent a uniaxial compression test. The yield limit was determined by a uniaxial compression test and density was recorded while flowability was calculated. There was no difference between the yield stress limit of BG and CG after compaction (p ¼ 0.432). Adding BAG-S53P4 reduced flowability and could indicate better interlocking mechanism between particles. Adding BAG-S53P4 seems to have no impact on the yield stress limit. The extended allografts withstand the compaction equally good which makes it a valid bone substitute in total hip replacement. An in vivo loaded study is needed before clinical use can be recommended. Keywords: BAG-S53P4; bioglass; additive to bone allografts; bone impaction grafting; bone graft extender Compacted bone allografts are used to fill and reconstruct bone defects in orthopaedic and trauma surgery with good clinical long term results. [1][2][3] Allografts are compacted to prevent early massive subsidence of an implant. 4,5 The initial stability of the allografts also depends on the distribution of grain sizes, 3,5,6 as well as on the specific preparation method. 7-9 Different materials have been studied as bone graft extenders to overcome shortages of material from human donors. [10][11][12][13][14] One such artificial substitute is bioglass. 15 Bioactive glasses are composed of SiO 2 , Na 2 O, CaO, and P 2 O 5 , all of which naturally occur in the human body. [16][17][18] The main advantage of bioglass is its bioactivity, while its disadvantages include its mechanical weakness and low fracture resistance. Bioglass S53P4 (BAG-S53P4) bonds firmly to bone and promotes new bone formation while naturally inhibiting bacterial growth. 19 The Young's modulus of BAG-S53P4 is very close to that of cortical bone. 20,21 Lindfors et al. proved clinically that the long-term performance is equivalent to that of autogenic bone. 19 It can be also used as a carrier material for antibiotics. 22 BAG-S53P4 has similar mechanical properties as cortical bone tissue and could, therefore, be used as a bone graft extender in case only limited bone material is available.The aim of this study was to evaluate the mechanical effects of adding BAG-S53P4 to chemically treated allografts with controlled grain size distribution. METHODSFemoral heads were donated by patients who underwent total hip replacement surgery and gave their consent previously. The donated material was fresh-frozen at À80˚C and stored at À20˚C. Cortical and cartilage tissues were removed and the femoral heads were reduced to fragments smaller than 10 mm in diameter using a bone mill (No...

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Optimizing the grain size distribution of allografts in bone impaction grafting

Cited by 14 publications

References 25 publications

Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur

Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur

Platelet concentrate as an additive to bone allografts: a laboratory study using an uniaxial compression test

BAG‐S53P4 as an additive to bone allografts: A laboratory study using an uniaxial compression test

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