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MUSCULOSKELETAL SURGERY

, Volume 93, Issue 2, pp 89–96 | Cite as

Major bone defect treatment with an osteoconductive bone substitute

  • Stefania Paderni
  • S. Terzi
  • L. Amendola
Case Report

Abstract

A bone defect can be provoked by several pathological conditions (e.g. bone tumours, infections, major trauma with bone stock loss) or by surgical procedures, required for the appropriate treatment. Surgical techniques currently used for treating bone defects may count on different alternatives, including autologous vascularized bone grafts, homologous bone graft provided by musculoskeletal tissue bank, heterologous bone graft (xenograft), or prostheses, each one of them dealing with both specific advantages and complications and drawbacks. The main concerns related to these techniques respectively are: donor site morbidity and limited available amount; possible immune response and viral transmission; possible animal-derived pathogen transmission and risk of immunogenic rejection; high invasiveness and surgery-related systemic risks, long post-operative. physical recovery and prostheses revision need. Nowadays, an ideal alternative is the use of osteoconductive synthetic bone substitutes. Many synthetic substitutes are available, used either alone or in combination with other bone graft. Synthetic bone graft materials available as alternatives to autogeneous bone include calcium sulphates, special glass ceramics (bioactive glasses) and calcium phosphates (calcium hydroxyapatite, HA; tricalcium phosphate, TCP; and biphasic calcium phosphate, BCP). These materials differ in composition and physical properties fro each other and from bone (De Groot in Bioceramics of calcium phosphate, pp 100–114, 1983; Hench in J Am Ceram Soc 74:1487–1510, 1994; Jarcho in Clin Orthop 157:259–278, 1981; Daculsi et al. in Int Rev Cytol 172:129–191, 1996). Both stoichiometric and non-stoichiometric HA-based substitutes represent the current first choice in orthopedic surgery, in that they provide an osteoconductive scaffold to which chemotactic, circulating proteins and cells (e.g. mesenchymal stem cells, osteoinductive growth factors) can migrate and adhere, and within which progenitor cells can differentiate into functioning osteoblasts (Szpalski and Gunzburg in Orthopedics 25S:601–609, 2002). Indeed, HA may be extemporarily combined either with whole autologous bone marrow or PRP (platelet rich plasma) gel inside surgical theatre in order to favour and accelerate bone regeneration. A case of bifocal ulnar bone defect treated with stoichiometric HA-based bone substitute combined with PRP is reported in here, with a 12-month-radiographic follow-up.

Keywords

Bone defect Hydroxyapatite Bone substitute Open fracture 

Notes

Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.

References

  1. 1.
    De Groot K (1983) Ceramics of calcium phosphates: preparation and properties. In: De Groot K (ed) Bioceramics of calcium phosphate. CRC Press, Boca Raton, FL, pp 100–114Google Scholar
  2. 2.
    Hench LL (1994) Bioceramics: from concept to clinic. J Am Ceram Soc 74:1487–1510CrossRefGoogle Scholar
  3. 3.
    Jarcho M (1981) Calcium phosphate ceramics as hard tissue prosthetics. Clin Orthop 157:259–278PubMedGoogle Scholar
  4. 4.
    Daculsi G, Bouler JM, Legeros RZ (1996) Adaptive crystal formation: in normal and pathological calcification, in synthetic calcium phosphate and related biomaterials. Int Rev Cytol 172:129–191CrossRefGoogle Scholar
  5. 5.
    Szpalski M, Gunzburg R (2002) Bone void fillers in trauma surgery. Orthopedics 25S:601–609Google Scholar
  6. 6.
    Eijkelkamp MF, Hayen J, Veldhuizen AG, van Horn JR, Verkerke GJ (2002) Improving the fixation of an artificial intervertebral disc. Int J Artif Organs 25:327–333PubMedGoogle Scholar
  7. 7.
    Taylor GI (1983) The current status of free vascularized bone grafts. Clin Plast Surg 10:185–209PubMedGoogle Scholar
  8. 8.
    Vail TP, Urbaniak JR (1996) Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am 78(2):204–211PubMedGoogle Scholar
  9. 9.
    Marcacci M (2004) Impiego della bioingegneria per la rigenerazione del tessuto osseo e cartilagineo. Minerva Ortop Traumatol 55(5):209–226Google Scholar
  10. 10.
    Martinetti R, Belpassi A, Nataloni A, Biasimi V, Martignani G (1999) Porous hydroxyapatite as synthetic bone graft: physico-chemical characterisation. Atti Biomateriali, RomaGoogle Scholar
  11. 11.
    Donati D, Giacobini S, Gozzi E, Di Bella C, Mercuri M (2003) The results of the surgical treatment of bone tumors using massive homoplastic grafts. Chir Organi Mov 88(2):115–122PubMedGoogle Scholar
  12. 12.
    Nizard R, Bizot P, Kerboull L, Sedel L (1996) Biomatériaux orthopédiques. Encyclopédie Médico Chirurgicale 44-003:1–15Google Scholar
  13. 13.
    Martinetti R, Belpassi A, Nataloni A, Piconi C (2001) Porous hydroxyapatite cell carrier for tissue engineering. Key Engineering Materials 192–195:507–510CrossRefGoogle Scholar
  14. 14.
    Martinetti R, Dolcini L, Belassi A, Quarto R, Mastrogiacomo M, Cancedda R, Labanti M (2004) Inspired porousity for cells and tissues. Key Engineering Materials 254–256(109):5–1098Google Scholar
  15. 15.
    Mastrogiacomo M, Muraglia A, Komlev V, Peyrin F, Rustichelli F, Crovace A, Cancedda R (2005) Tissue engineering of bone: search for a better scaffold. Orthod Craniofac Res 8:277–284PubMedCrossRefGoogle Scholar
  16. 16.
    Cazalbou S, Bastiè C, Chatainier G, Theilgaard N, Svendsen N, Martinetti R, Dolcini L, Hamblin J, Stewart G, Di Silvio L, Gurav N, Quarto R, Overgaard S, Zippor B, Lemure A, Combes C, Reyi C (2004) Processing of Ca–P ceramics, surface characteristics and biological performance. Key Engineering Materials 254–256(83):3–836Google Scholar
  17. 17.
    Boyde A, Corsi A, Quarto R, Cancedda R, Bianco P (1999) Osteoconduction in large macroporous hydroxyapatite ceramic implants: evidence for a complementary integration and disintegration mechanism. Bone 24(6):579–589PubMedCrossRefGoogle Scholar
  18. 18.
    Casabona F, Martin I, Muraglia A, Berrino P, Santi P, Cancedda R, Quarto R (1998) Prefabricated engineered bone flaps: an experimental model of tissue reconstruction in plastic surgery. Plast Reconstr Surg 101(3):577–581PubMedCrossRefGoogle Scholar
  19. 19.
    Mastrogiacomo M, Cedola A, Komlev VS, Peyrin F, Burghammer M, Giannoni P, Cancedda R, Rustichelli F, Lagomarsino S (2004) Advanced X-ray micro-analysis of bone regenerated by bone marrow stromal cells. In: Proceeding 9th meeting ceramics, cells and tissuesGoogle Scholar
  20. 20.
    Kon E, Muraglia A, Corsi A, Bianco P, Marcacci M, Martin I, Boyde A, Ruspantini I, Chistolini P, Rocca M, Giardino R, Cancedda R, Quarto R (2000) Autologous bone marrow stromal cells loaded onto porous hydroxyapatite ceramic accelerate bone repair in critical-size defects of sheep long bone. J Biomed Mater Res 49:328–337PubMedCrossRefGoogle Scholar
  21. 21.
    Martin I, Muraglia A, Campanile G, Cancedda R, Quarto R (1997) Fibroblast growth factor-2 supports ex vivo expansion and maintenance of osteogenic precursor from human bone marrow. Endocrinology 138(10):4456–4462PubMedCrossRefGoogle Scholar
  22. 22.
    Fabbri M, Nataloni A, Celotti GC, Ravaglioli A (1995) Production and characterization of hydroxyapatite-based porous bodies for medical applications. Fourth Euro Ceramics 810:9–116Google Scholar
  23. 23.
    Ferraz MP, Mateus AY, Sousa JC, Monteiro FJ (2007) Nanohydroxyapatite microspheres delivery system for antibiotics: release kinetics, antimicrobial activity, and interaction with osteoblasts. J Biomed Mater Res A 81(4):994–1004PubMedGoogle Scholar
  24. 24.
    Carey LE, Xu HH, Simon CG Jr, Takagi S, Chow LC (2005) Premixed rapid-setting calcium phosphate composites for bone repair. Biomaterials 26(24):5002–5014PubMedCrossRefGoogle Scholar
  25. 25.
    Staffa G, Servadei F, Nataloni A, Martinetti R (2003) Design of custom-made porous hydroxyapatite devices for the reconstruction of the skull: 6 years multicentric experience. J Appl Biomater Biomech 1:214Google Scholar
  26. 26.
    Staffa G, Nataloni A, Compagnone C, Servadei F (2007) Custom made cranioplasty prostheses in porous hydroxy-apatite using 3D design techniques: 7 years experience in 25 patients. Acta Neurochir 149:161–170CrossRefGoogle Scholar
  27. 27.
    Van Havenbergh T, Berghmans D, De Smedt K, Arcangeli E, Nataloni A (2007) One step neuronavigated cranial vault tumor resection and porous hydroxyapatite custom made prosthesis reconstruction: a case report. In: Proceeding 11th meeting ceramics, cells and tissuesGoogle Scholar
  28. 28.
    Marcacci M, Kon E, Quarto R, Kutepov SM, Mukhacev V, Lavroukov A, Cancedda R (2001) Repair of large bone defects by autologous human bone marrow stromal cells. Key Engineering Materials 192–195(105):3–1056Google Scholar
  29. 29.
    Marcacci M, Kon E, Mukhacev V, Lavroukov A, Kutepov S, Quarto R, Mastrogiacomo M, Cancedda R (2007) Stem cells associated with macroporous bioceramics for long bone repair: 6- to 7-year outcome of a pilot clinical study. Tissue Eng 13(5):947–955PubMedCrossRefGoogle Scholar
  30. 30.
    Huber FX, McArthur N, Hillmeier J, Kock HJ, Baier M, Diwo M, Berger I, Meeder PJ (2006) Void filling of tibia compression fracture zones using a novel resorbable nanocrystalline hydroxyapatite paste in combination with a hydroxyapatite ceramic core: first clinical results. Arch Orthop Trauma Surg 126(8):533–540PubMedCrossRefGoogle Scholar
  31. 31.
    Helbert MU, Ulrich C (2000) Metaphyseal defect substitute: hydroxylapatite ceramic. Results of a 3 to 4 year follow up. Unfallchirurg 103(9):749–753CrossRefGoogle Scholar
  32. 32.
    Baer W, Schaller P, Carl HD (2002) Spongy hydroxyapatite in hand surgery—a five year follow-up. J Hand Surg (Br) 27(1):101–103Google Scholar
  33. 33.
    Yamamoto T, Onga T, Marui T, Mizuno K (2000) Use of hydroxyapatite to fill cavities after excision of benign bone tumours. Clinical results. J Bone Joint Surg Br 82(8):1117–1120PubMedCrossRefGoogle Scholar
  34. 34.
    Fujishiro T, Nishikawa T, Niikura T, Takikawa S, Nishiyama T, Mizuno K, Yoshiya S, Kurosaka M (2005) Impaction bone grafting with hydroxyapatite: increased femoral component stability in experiments using Sawbones. Acta Orthop 76(4):550–554PubMedCrossRefGoogle Scholar
  35. 35.
    Nich C, Sedel L (2006) Bone substitution in revision hip replacement. Int Orthop 30(6):525–531PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.UO Ortopedia e Traumatologia Ospedale MaggioreBolognaItaly

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