Unfocused shockwaves for osteoinduction in bone substitutes in rat cortical bone defects

Abstract

Bone substitutes are frequently used in clinical practice but often exhibit limited osteoinductivity. We hypothesized that unfocused shockwaves enhance the osteoinductivity of bone substitutes and improve osteointegration and angiogenesis. Three different bone substitutes, namely porous tricalcium phosphate, porous hydroxyapatite and porous titanium alloy, were implanted in a critical size (i.e. 6-mm) femoral defect in rats. The femora were treated twice with 1500 shockwaves at 2 and 4 weeks after surgery and compared with non-treated controls. The net volume of de novo bone in the defect was measured by microCT-scanning during 11-weeks follow-up. Bone ingrowth and angiogenesis in the bone substitutes was examined at 5 and 11 weeks using histology. It was shown that hydroxyapatite and titanium both had an increase of bone ingrowth with more bone in the shockwave group compared to the control group, whereas resorption was seen in tricalcium phosphate bone substitutes over time and this was insensitive to shockwave treatment. In conclusion, hydroxyapatite and titanium bone substitutes favour from shockwave treatment, whereas tricalcium phosphate does not. This study shows that osteoinduction and osteointegration of bone substitutes can be influenced with unfocused shockwave therapy, but among other factors depend on the type of bone substitute, likely reflecting its mechanical and biological properties.

Coupling between Osseointegration and Mechanotransduction to Maintain Foreign Body Equilibrium in the Long-Term: A Comprehensive Overview

“…Recent research shows that this anabolic bone response through ESWT can also be generated in relation to titanium devices in bone, which could have great therapeutic potential, especially in patients with bone disease. Koolen et al demonstrated at the histological level that in bone defects reconstructed with a titanium scaffold as a bone substitute show the de novo bone formation after ESWT in rats [93]. In this same line of investigation, Koolen et al [91] hypothesized that peri-operative shock wave treatment can improve screw fixation and the osteointegration of cortical and cancellous orthopedic screws, especially in osteoporotic patients.…”

“…This is why the fact that ESWT can act as an effective bioactivator on HBMMSC, increasing its rate of growth, proliferation, migration and reducing apoptosis of these cells, suggests that ESWT could be an adequate tool to express all the potential therapeutic effects of HBMMSC [98]. This evidence suggests that the findings described in relation to ESWT and titanium [91,93,94] are probably a product of the local immunomodulatory effect of HBMMSC [14].…”

Effects of ultrasound, radial extracorporeal shock waves, and electrical stimulation on rat bone defect healing

“…To our current knowledge, no in vivo studies have investigated the biological effects of different physical agents on fracture healing. Furthermore, although it has been generally accepted that postmenopausal estrogen deficiency affects the fracture healing process, 9–11 most in vivo studies of physical agents have focused on a single stimulation intensity or animal model 12–22 . We hypothesized that physical agents accelerate fracture healing and that the responses to the physical agents can differ by its type and stimulation intensity.…”

Designing Precise Ossicular Chain Reconstruction with Finite Element Modelling

“…While TCP has not yet been utilized for ossicular reconstruction, to the best of our knowledge, it is suggested to consider this material in OCR to see how it functions in reality. This biomaterial is regarded as a well-known bone substitute with appropriate levels of biocompatibility, biodegradability, and osteoconductivity in clinical settings(Koolen et al 2018; Van der Stok et al 2011). Regarding the other two materials, HA and titanium, consistent with our results, there is some evidence that HA and titanium perform similarly with no statistically signi cant difference(Gelfand and Chang 2011;Ocak et al 2015;Truy et al 2007).…”