Bone Grafts and Bone Graft Substitutes in Orthopaedic Trauma Surgery

Long, William G.; Einhorn, Thomas A.; Koval, Kenneth J.; McKee, Michael D.; Smith, Wade R.; Sanders, Roy; Watson, Tracy

doi:10.2106/jbjs.f.00465

Cited by 476 publications

(283 citation statements)

References 48 publications

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“…However, with the aging and growing population, the number of surgical intervention to regenerate bone defects are increasing. The limited supply and patient site morbidity is a well-known disadvantage and problem [1][2]. Allografts are an option.…”

Section: Introductionmentioning

confidence: 99%

Crystallization and sintering of borosilicate bioactive glasses for application in tissue engineering

et al. 2017

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Typical silicate bioactive glasses are known to crystallize readily during the processing of porous scaffolds. While such crystallization does not fully suppress the bioactivity, the presence of significantly large amounts of crystals leads to a decrease in the rate of reaction of the glass and an uncontrolled release of ions. Furthermore, due to the non-congruent dissolution of silicate glasses, these materials have been shown to remain within the surgical site even 14 years postoperation. Therefore, a need for bioactive materials that can dissolve with higher conversion rates and more effectively are required. Within this work, boron was introduced, in the FDA approved S53P4 glass, at the expense of SiO2. The crystallization and sintering-ability of the newly developed glasses were investigated by differential thermal analysis. All the glasses were found to crystallize primarily from the surface, and the crystal phase precipitating was dependent upon the quantity of B2O3 incorporated. The rate of crystallization was found to be lower for the glasses were 25, 50 and 75 % of the SiO2 was replaced with B2O3. These glasses were further sintered into porous scaffolds using simple heat sintering. The impact of glass particles size and heat treatment temperature on the scaffolds porosity and average pore size was investigated. Scaffolds with porosity ranging from 10 to 60 % with compressive strength ranging from 1 to 35 MPa, were produced. The scaffolds remained amorphous during processing and their ability to rapidly precipitate hydroxycarbonated apatite was maintained. This is of particular interest in the field of tissue engineering as the scaffolds degradation and reaction was generally faster and offers higher controllability as opposed to current partially/fully crystallized scaffolds obtained from the FDA approved bioactive glasses. IntroductionAs of today, autografts are still the gold standard for the repair of large bone defects. However, with the aging and growing population, the number of surgical intervention to regenerate bone defects are increasing. The limited supply and patient site morbidity is a well-known disadvantage and problem [1][2]. Allografts are an option. However, the limited tissue bank as well as the higher risk for infection and cellular and humoral immune reactions limits their usage [3]. The quest for synthetic biomaterials to replace the autografts is more than two decades old. However, as of today no materials have shown as promising a result as autografts. Q. Chen et al. have reported the optimum characteristic that the synthetic materials should have to find great potential as bone grafts [4]. The bone graft should be a 3D construct (3D scaffold) not only biocompatible, but ultimately biodegradable and osteoconductive with highly interconnected porosity. Pore size should be no less than 100 µm to allow cell and fluid penetration as well as angiogenesis. In general, interconnected pores of at least 100 µm and an open porosity of over 50% is considered the minimum requirement for ti...

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Section: Introductionmentioning

confidence: 99%

Crystallization and sintering of borosilicate bioactive glasses for application in tissue engineering

et al. 2017

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“…[ 1 ] Currently, the "golden standard" clinical treatment of large bone defects include autografts or allografts. [ 2 ] Despite presenting successful healing, however, they carry drawbacks such as donor site morbidity, disease transmission, and immune rejections. [ 2 ] Synthetic polyesters have been used in the biomedical fi eld and for producing scaffolds for BTE for decades.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 ] Despite presenting successful healing, however, they carry drawbacks such as donor site morbidity, disease transmission, and immune rejections. [ 2 ] Synthetic polyesters have been used in the biomedical fi eld and for producing scaffolds for BTE for decades. [ 3 ] Degradable copolymers such as poly[( L -lactide)-co-(ε-caprolactone)] (PLCL) produced by copolymerization have been recently exploited for BTE scaffolds due to their in vitro cytocompatibility, [ 4 ] osteogenic conductivity [ 5 ] in addition to tuneable mechanical and degradable properties.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Host Response and Degradation of Copolymer Scaffolds Functionalized with Nanodiamonds and Bone Morphogenetic Protein 2

Suliman

Sun

Pedersen

et al. 2016

Adv Healthcare Materials

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The aim is to evaluate the effect of modifying poly[( L -lactide)-co-(ε-caprolactone)] scaffolds (PLCL) with nanodiamonds (nDP) or with nDP+physisorbed BMP-2 (nDP+BMP-2) on in vivo host tissue response and degradation. The scaffolds are implanted subcutaneously in Balb/c mice and retrieved after 1, 8, and 27 weeks. Molecular weight analysis shows that modifi ed scaffolds degrade faster than the unmodifi ed. Gene analysis at week 1 shows highest expression of proinfl ammatory markers around nDP scaffolds; although the presence of infl ammatory cells and foreign body giant cells is more prominent around the PLCL. Tissue regeneration markers are highly expressed in the nDP+BMP-2 scaffolds at week 8. A fi brous capsule is detectable by week 8, thinnest around nDP scaffolds and at week 27 thickest around PLCL scaffolds. mRNA levels of ALP, COL1α2, and ANGPT1 are signifi cantly upregulating in the nDP+BMP-2 scaffolds at week 1 with ectopic bone seen at week 8. Even when almost 90% of the scaffold is degraded at week 27, nDP are observable at implantation areas without adverse effects. In conclusion, modifying PLCL scaffolds with nDP does not aggravate the host response and physisorbed BMP-2 delivery attenuates infl ammation while lowering the dose of BMP-2 to a relatively safe and economical level.

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“…Unfortunately, all these techniques are associated with the limited availability of autologous material [7,8] and considerable morbidity at the donor site, such as additional blood loss, which might reach significance in patients with co-morbidities, chronic pain, iliac wing fractures or infections [9,10,11,12,13]. Allo- or xenografts are available, but despite the development of screening methods for contamination and a production procedure following good manufacturing practices, concerns about pathogen transmission and immunogenicity of such grafts still remain [14]. Synthetic and natural polymeric scaffolds can potentially avoid such risks but they lack most of the actual osteoinductive or osteogenic properties of autologous bone chips [15].…”

Section: Introductionmentioning

confidence: 99%

Perspective on the Evolution of Cell-Based Bone Tissue Engineering Strategies

et al. 2012

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Despite the compelling clinical needs in enhancing bone regeneration and the potential offered by the field of tissue engineering, the adoption of cell-based bone graft substitutes in clinical practice is limited to date. In fact, no study has yet convincingly demonstrated reproducible clinical performance of tissue-engineered implants and at least equivalent cost-effectiveness compared to the current treatment standards. Here, we propose and discuss how tissue engineering strategies could be evolved towards more efficient solutions, depicting three different experimental paradigms: (i) bioreactor-based production; (ii) intraoperative manufacturing, and (iii) developmental engineering. The described approaches reflect the need to streamline graft manufacturing processes while maintaining the potency of osteoprogenitors and recapitulating the sequence of biological steps occurring during bone development, including vascularization. The need to combine the assessment of efficacy of the different strategies with the understanding of their mechanisms of action in the target regenerative processes is highlighted. This will be crucial to identify the necessary and sufficient set of signals that need to be delivered at the injury or defect site and should thus form the basis to define release criteria for reproducibly effective engineered bone graft substitutes.

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Bone Grafts and Bone Graft Substitutes in Orthopaedic Trauma Surgery

Cited by 476 publications

References 48 publications

Crystallization and sintering of borosilicate bioactive glasses for application in tissue engineering

Crystallization and sintering of borosilicate bioactive glasses for application in tissue engineering

In Vivo Host Response and Degradation of Copolymer Scaffolds Functionalized with Nanodiamonds and Bone Morphogenetic Protein 2

Perspective on the Evolution of Cell-Based Bone Tissue Engineering Strategies

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