Reconstruction of infected long bone defects: Issues and Challenges

Papakostidis, Costas; Giannoudis, Peter V.

doi:10.1016/j.injury.2023.01.052

Cited by 4 publications

(4 citation statements)

References 37 publications

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“…Although various long bone defect treatment methods are advocated, all current techniques are associated with major obstacles that include inadequate limb function, lack of patient compliance, serial surgical procedures, and/or the need for specialized equipment and skills [124]. It should be noted that there is no "one treatment fits all" solution in this difficult, challenging patient population, and that the patient's profile, expectations, clinical history, and conditions of the local bone defect environment require an individualized treatment approach [269]. Notably, common treatment methods are also being refined, such as a modification of the classic distraction osteogenesis technique with a novel method of bone transport via an intramedullary nail using an intramedullary cable transport system [270,271], novel plate-assisted bone segment transport procedure [272][273][274], or the combination of bone transport with the Masquelet technique [275,276].…”

Section: Discussionmentioning

confidence: 99%

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

Laubach

Hildebrand

Suresh

et al. 2023

JFB

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The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient’s age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon’s preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.

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Section: Discussionmentioning

confidence: 99%

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

Laubach

Hildebrand

Suresh

et al. 2023

JFB

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“…Residual surgical site infection has been established as the main cause of failure of the Mq technique and, therefore, a thorough and meticulous surgical debridement is recommended during both stages of the Mq procedure [ 13 ]. As a result, the number of procedural stages may be more than two depending on infection status and the requirement of infection elimination for bone graft insertion [ 3 , 12 ]. Multiple debridements must also be repeated during the final stage of spacer replacement by bone graft and definitive fixation of the NU, as this stage presents the final opportunity to remove avascular and thus potentially contaminated bone [ 3 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, the number of procedural stages may be more than two depending on infection status and the requirement of infection elimination for bone graft insertion [ 3 , 12 ]. Multiple debridements must also be repeated during the final stage of spacer replacement by bone graft and definitive fixation of the NU, as this stage presents the final opportunity to remove avascular and thus potentially contaminated bone [ 3 , 12 , 13 ]. Failure to understand the value of achieving a local sterile environment before embarking on the final stage of definitive bone grafting and stabilisation of the defect site is perhaps, the main reason for producing suboptimal outcomes with the IMT in several clinical series.…”

Section: Discussionmentioning

confidence: 99%

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Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Wakefield,

Papakostidis,

Giannoudis

et al. 2023

Eur J Trauma Emerg Surg

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Introduction Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. As there is a paucity of data directly comparing the outcomes of these techniques, there is no universal agreement on which strategy a surgeon should choose to use. Aims This systematic review and meta-analysis aimed to summarize the outcomes of both DO and IMT, in terms of primary outcomes (bone union and infection elimination), and secondary outcomes (complication rates and functional outcomes). Methods A PRISMA strategy was used. Medline, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated using OCEBM and GRADE systems. Results Thirty-two studies with 1136 subjects met the inclusion criteria. With respect to the primary outcomes of interest, union was observed in 94.6% (DO method) and 88.0% (IMT method); this difference, however, was not significant between the two techniques (p = 0.45). In addition, infection elimination rates were also higher in the Ilizarov DO group when compared to Masquelet (Mq) IMT (93.0% vs 80.4% respectively). Again, no significant difference was observed (p = 0.06). For all secondary outcomes assessed (unplanned re-operations, re-fracture rates amputation rate), no statistically significant differences were documented between the treatment options. Conclusion This study demonstrated that there is no clinical difference in outcomes for patients treated with Ilizarov DO versus Mq IMT techniques. The evidence base at present is relatively sparse and, therefore, we would recommend for further Level I studies to be conducted, to make more meaningful conclusions.

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Vancomycin-encapsulated hydrogel loaded microarc-oxidized 3D-printed porous Ti6Al4V implant for infected bone defects: Reconstruction, anti-infection, and osseointegration

Zhang,

Zhou,

Yang

et al. 2024

Bioactive Materials

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Reconstruction of infected long bone defects: Issues and Challenges

Cited by 4 publications

References 37 publications

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies

Vancomycin-encapsulated hydrogel loaded microarc-oxidized 3D-printed porous Ti6Al4V implant for infected bone defects: Reconstruction, anti-infection, and osseointegration

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