The Biology of Bone Grafting

Chung

Clinical Orthopaedics &Amp; Related Research

et al. 2015

Background Calcaneal lengthening with allograft is frequently used for the treatment of patients with symptomatic planovalgus deformity; however, the behavior of allograft bone after calcaneal lengthening and the risk factors for graft failure are not well documented. Questions/purposes (1) What proportion of the patients treated with allograft bone had radiographic evidence of graft failure and what further procedures were performed? (2) What are the risk factors for radiographic graft failure after calcaneal lengthening? (3) What patient factors are associated with the magnitude of correction achieved after calcaneal lengthening? Methods Between May 2003 and January 2014, we performed 341 calcaneal lengthenings on 202 patients for planovalgus deformity, the etiology of which included idiopathic, cerebral palsy, and other neuromuscular disease. Of these, 176 patients (87%) had adequate followup for graft evaluation, defined as lateral radiographs taken before and at least 6 months after the index procedure (mean, 18 months; range, 6-100 months) and 117 patients (58%) had adequate followup for the assessment of the extent of correction, defined as weightbearing anteroposterior and lateral radiographs taken before and at least 1 year after the index procedure (mean, 24 months; range, 12-96 months). These patients' results were evaluated retrospectively. The Goldberg scoring system was chosen for demonstration of allograft behavior. A score lower than 6 at 6 months after surgery was defined as radiographic graft failure; the highest possible score was 7 points, and this represented graft incorporation with excellent reorganization of the graft and no loss of height. The patient age, sex, diagnosis, graft material, ambulatory status, and use of antiseizure medication were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. Additionally, six radiographic indices were analyzed for their effects on the extent of correction. Results The mean estimated Goldberg score was 6 (SD, 1.14) at 6 months after calcaneal lengthening with 11 feet (4%) classified as radiographic graft failure (Goldberg score \ 6). Of these, four feet (1%) underwent reoperation using an iliac autograft bone resulting from pain and loss of correction. Multivariate analysis showed that the tricortical iliac crest allograft was superior to the patellar allograft (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.1-9.8; p = 0.038) and the possibility of radiographic graft failure was found to increase along with age (OR, 1.2; 95% CI, 1.0-1.3; p = 0.006). Radiographically, the extent of correction was found to decrease with patient age, as

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

Chung

Clinical Orthopaedics &Amp; Related Research

et al. 2015

“…Our treatment approach was based on current evidence that autograft contains osteoprogenitor cells and osteoinductive factors and also provides some osteoconductive scaffolding properties [17,31] and on the hypothesis that BMP-7 may enhance the osteoinductive capacity of the ABG [9,23,27,38]. In patients with bone defects, the concept was to use BMP-7 as a powerful osteoinductive agent and the ABG as a graft expander.…”

Section: Discussionmentioning

confidence: 99%

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

Giannoudis

Kanakaris

Dimitriou

et al. 2009

Clin Orthop Relat Res

118

Combining autologous bone graft and recombinant human bone morphogenetic protein-7 (BMP-7) to treat long-bone fracture aseptic atrophic nonunions theoretically could promote bone healing at higher rates than each of these grafting agents separately. We retrospectively reviewed prospectively collected data on patient general characteristics, clinical outcomes, and complications over 3 years to determine the healing rates and the incidence of complications and adverse events of this ''graft expansion rationale.'' There were 45 patients (32 male) with a median age of 43 years (range, 19-76 years). Minimum followup was 12 months (mean, 24.5 months; range, 12-65 months). There were seven humeral, 19 femoral, and 19 tibial nonunions. The median number of prior operations was two (range, 1-7). All fractures united. Clinical and radiographic union occurred within a median of 5 months (range, 3-14 months) and 6 months (range, 4-16 months), respectively. Thirty-nine (87%) patients returned to their preinjury occupation at a mean of 4.2 months (range, 3-6 months). The median visual analog scale pain score was 0.9 (range, 0-2.8; maximum 10), and the median functional score was 86 (range, 67-95; maximum 100) at the final followup. BMP-7 as a bone-stimulating agent combined with conventional autograft resulted in a nonunion healing rate of 100% in these 45 patients.

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

“…[8][9][10][11][12][13][14][15][16][17] Although the literature contains many reports describing the use of a myriad of bone substitutes, including allografts, xenografts, and alloplasts, autologous bone graft has been shown to be the only "material" to possess the three fundamental properties ("regenerative triad") of an ideal graft: osteogenesis, osteoinduction, and osteoconduction. [18][19][20][21] For this reason, autologous bone graft remains the gold standard for biologic management of alveolar ridge augmentation despite the risk of donor site morbidity and graft resorbtion. [18][19][20][21] Since its first applications to alveolar bone at the end of the 1980s and beginning of the 1990s, Bio-Oss (Geistlich Pharma AG, Wolhusen, Switzerland), a deproteinized bovine bone substitute, is, by far, the most commonly used xenograft.…”

mentioning

confidence: 99%

“…[18][19][20][21] For this reason, autologous bone graft remains the gold standard for biologic management of alveolar ridge augmentation despite the risk of donor site morbidity and graft resorbtion. [18][19][20][21] Since its first applications to alveolar bone at the end of the 1980s and beginning of the 1990s, Bio-Oss (Geistlich Pharma AG, Wolhusen, Switzerland), a deproteinized bovine bone substitute, is, by far, the most commonly used xenograft. It may be used alone or mixed with cancellous autogenous bone for the reconstruction of limited horizontal alveolar ridge defects, for subantral bone augmentation as part of sinus lift procedures, for periodontal regeneration, and for the healing of extraction sockets.…”

mentioning

confidence: 99%

Association between maxillary sinus fungus ball and sinus bone grafting with deproteinized bovine bone substitutes: a case-control study

Scolozzi

Perez

Verdeja

et al. 2016

Objective. To evaluate the association between sinus bone graft and the development of fungus ball (FB) of the maxillary sinus. Study Design. The charts of all patients seen for surgical treatment of maxillary sinus FB following sinus bone grafting between 2006 and 2014 were reviewed. The charts of 49 participants were selected from our internal registry for comparison as controls. The association between FB and age, gender, smoking habits, associated co-morbidities, and bone grafting material was evaluated. FB of the maxillary sinus was estimated by using an odds ratio with a Yates' correction. P values were computed using Fisher's exact test, and the statistical significance was set at a P value < .05. Results. All 13 cases (100%) with FB of the maxillary sinus had received anorganic bovine bone as the bone substitute (P ¼ .0001). There were significantly more women in the case group than in the control group (84.6% in the cases vs 40.8% in the controls; P ¼ .01).Conclusions. This study demonstrated a significant association between a specific deproteinized bovine bone substitute use as sinus bone graft material and subsequent development of FB of the maxillary sinus. (Oral Surg Oral Med Oral Pathol Oral Radiol 2016;121:e143-e147) Fungus ball (FB) represents the most common form of noninvasive extramucosal fungal infection involving the paranasal sinuses and is encountered in almost 28.5% of patients suffering from chronic maxillary sinusitis. 1-3 Aspergillus fumigatus is, by far, the most frequent causative agent found in Europe, and the root canal overfilling with the passage of zinc oxide endodontic sealers into the maxillary sinus is the most commonly recognized risk factor for the development of FB in up to 84% of patients. [1][2][3][4][5][6] Although this form of sinusitis typically affects healthy adults and has a striking female predominance, several pathologic conditions, such as diabetes, immunodeficiency diseases, and immunosuppressive and chronic corticosteroid and antibiotic treatments have been pointed out as potential predisposing factors favoring the colonization and subsequent overgrowth of the fungal hyphae. [1][2][3] Since its first report in 1980 by Boyne and James, grafting of the maxillary sinus floor has rapidly become the most common surgical procedure used to increase the subantral alveolar bone height of the posterior maxilla for subsequent dental implant placement. 7 Although reported as a predictable and reliable procedure, sinus bone graft has, nevertheless, been associated with several intra-and postoperative complications, such as sinus membrane perforation, maxillary sinusitis, wound dehiscence with graft exposure, and graft infection. In most cases, complications resolve with no need for further surgery and with no substantial impact on implant survival; however, in some cases, complications may lead to complete loss of the graft material, thus compromising the subsequent implant-supported dental restoration. [8][9][10][11][12][13][14][15][16][17] Although the literature co...