ß-TCP bone substitutes in tibial plateau depression fractures

Rolvien, Tim; Barvencik, Florian; Busse, Björn; Hahn, Michael; Rueger, Johannes M.; Rupprecht, Martin

doi:10.1016/j.knee.2017.06.010

Cited by 16 publications

(17 citation statements)

References 29 publications

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“…However, the allograft bone center remained acellular, which is in accordance with previous findings 22 . We previously found that synthetic bone materials (beta-tricalcium-phosphate bone substitutes) are also not completely remodeled and incorporated over time, although the clinical outcomes were good 23 .…”

Section: Discussionmentioning

confidence: 99%

Incorporation and Remodeling of Structural Allografts in Acetabular Reconstruction

Butscheidt

Moritz

Gehrke

et al. 2018

The Journal of Bone and Joint Surgery

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Background:Total hip arthroplasty (THA) is frequently accompanied by acetabular bone loss, which constitutes a major challenge in revision procedures. Structural allografts can be implanted to restore a stable osseous foundation for the acetabular prosthesis. As previous studies were limited to clinical data or included very few cases, the extent to which the graft bone is incorporated over time has remained unclear.Methods:Thirteen acetabula were retrieved post mortem, and the incorporation properties of the bone allografts were analyzed using a hierarchical approach of imaging techniques including contact radiography, high-resolution peripheral quantitative computed tomography (HR-pQCT), histological analysis of undecalcified specimens, and quantitative backscattered electron imaging (qBEI). The distance between the current allograft bone and host bone borders (i.e., current overlap) as well as the distance between the original allograft bone and host bone borders (i.e., total ingrowth) were assessed.Results:In 10 of 13 cases, the complete interface (100%) was characterized by direct contact and additional overlap of the allograft bone and host bone, while the remaining 3 cases demonstrated direct contact along 25% to 80% of the interface. The allograft bone showed an intact trabecular structure and significantly higher mineralization compared with the host bone. The mean current overlap (and standard deviation) was 2.3 ± 1.0 mm, with a maximum of 5.3 ± 2.4 mm. Importantly, the total ingrowth reached much further, to a mean of 7.2 ± 2.3 mm (maximum, 10.5 ± 4.0 mm). Neither the time that the allograft was in situ nor the degree of contact between the host and allograft bone correlated with the current overlap and the time in situ did not correlate with total ingrowth.Conclusions:This study showed bone remodeling with subsequent interconnection of the host and allograft bone along the majority of the interface, leading to adequate incorporation of the allograft. The lack of complete incorporation of the graft did not lead to graft collapse up to 22 years after revision surgery.Clinical Relevance:Our study provides the first systematic multiscale evaluation of successfully implanted structural allografts and forms the scientific basis for their clinical use in revision THA.

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Section: Discussionmentioning

confidence: 99%

Incorporation and Remodeling of Structural Allografts in Acetabular Reconstruction

Butscheidt

Moritz

Gehrke

et al. 2018

The Journal of Bone and Joint Surgery

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“…Therefore, despite the very good clinical outcome of these allografts, as well as the impression of a completely remodeled graft in conventional imaging [ 49 , 50 , 51 , 52 ], there are indications that the incorporation might be less pronounced than previously expected (at least in humans) [ 9 ]. Also, synthetic materials showed incomplete remodeling with detectable remnants in human studies [ 1 ], although various animal studies indicated a complete remodeling [ 53 ].…”

Section: Limits and Failure Of Bone Substitutes And Implantsmentioning

confidence: 99%

“…Since bone defects are common problems in complex fractures, revision arthroplasty procedures or tumor reconstructions, bone substitute materials (bone grafts) are required to fill these bone defects and to ensure a tight junction between the implant and the host bone. For example, the surgical treatment of intra-articular fractures often involves bone grafts to ensure the anatomic reduction of the depressed joint fragments and to preserve the joint surface [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, research studies require a closer examination, e.g., by microscopic preparations. Several histological and micro-morphological studies from retrieved specimens have proven the successful incorporation of bone substitutes such as allografts or synthetic grafts [ 1 , 7 , 8 ]. For allografts, bone remodeling with the subsequent interconnection of the host bone and the graft bone was found in the majority of the interface, leading to the progressive incorporation of the bone graft [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…For allografts, bone remodeling with the subsequent interconnection of the host bone and the graft bone was found in the majority of the interface, leading to the progressive incorporation of the bone graft [ 9 ]. Furthermore, synthetic materials such as beta-tricalcium phosphate (β-TCP) were also found to induce bone formation and promote bone repair [ 1 ]. While the restoration of bone defects is often successful, there are also certain materials and conditions which are associated with a failure of the bone healing process, for example in terms of impaired integration and induction of immunologic responses [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Cellular Mechanisms Responsible for Success and Failure of Bone Substitute Materials

Rolvien

Barbeck

Wenisch

et al. 2018

IJMS

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Bone grafts, i.e., autologous, allogeneic or synthetic bone substitute materials play an increasing role in reconstructive orthopedic surgery. While the indications and materials differ, it is important to understand the cellular mechanisms regarding their integration and remodeling, which are discussed in this review article. Osteoconductivity describes the new bone growth on the graft, while osteoinductivity represents the differentiation of undifferentiated cells into bone forming osteoblasts. The best case is that both mechanisms are accompanied by osteogenesis, i.e., bone modeling and remodeling of the graft material. Graft incorporation is mediated by a number of molecular pathways that signal the differentiation and activity of osteoblasts and osteoclasts (e.g., parathyroid hormone (PTH) and receptor activator of nuclear factor κβ ligand (RANKL), respectively). Direct contact of the graft and host bone as well as the presence of a mechanical load are a prerequisite for the successful function of bone grafts. Interestingly, while bone substitutes show good to excellent clinical outcomes, their histological incorporation has certain limits that are not yet completely understood. For instance, clinical studies have shown contrasting results regarding the complete or incomplete resorption and remodeling of allografts and synthetic grafts. In this context, a foreign body response can lead to complete material degradation via phagocytosis, however it may also cause a fibrotic reaction to the bone substitute. Finally, the success of bone graft incorporation is also limited by other factors, including the bone remodeling capacities of the host, the material itself (e.g., inadequate resorption, toxicity) and the surgical technique or preparation of the graft.

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Posttraumatic Bone Defects Around the Knee

Griensven¹

2021

Knee Fractures

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ß-TCP bone substitutes in tibial plateau depression fractures

Cited by 16 publications

References 29 publications

Incorporation and Remodeling of Structural Allografts in Acetabular Reconstruction

Incorporation and Remodeling of Structural Allografts in Acetabular Reconstruction

Cellular Mechanisms Responsible for Success and Failure of Bone Substitute Materials

Posttraumatic Bone Defects Around the Knee

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