Skip to main content

Advertisement

SpringerLink
Log in

The use of interconnected β-tricalcium phosphate as bone substitute after curettage of benign bone tumours

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to analyse the clinical and radiological outcome in patients after implantation of β-tricalcium phosphate as a bone graft substitute to fill the defects after curettage of benign bone tumours and tumour-like lesions.

Method

A total of 21 male and 26 female patients underwent the process of curettage of the tumour and filling of the bone defect with interconnected β-tricalcium phosphate in granule form. In 39 patients, β-tricalcium phosphate was exclusively used; in contrast, in 8 patients, it was combined with a cancellous autografts. The mass of implanted β-tricalcium phosphate ranged from 1.5 to 66 g (mean = 12.5 g). The clinical examination and radiographs were performed 24–96 months (50 months on average) after curettage of the tumour and implantation of the bioactive ceramics.

Results

No patient complained of local pain, and all patients were satisfied with their limb function. Periodic radiographic assessments revealed that the material was incorporated in the surrounding bone without significant difference between implantation of β-tricalcium phosphate only and implantation of β-tricalcium phosphate mixed with autografts. Gradual resorption has started on the periphery and progressed centrally in both groups. Signs of the implanted β-tricalcium phosphate still remained radiographically in all 8 cases after implantation of synthetic material mixed with bone grafts and 27 of 39 cases after implantation of synthetic material only. The resorption was dependent on the mass of implanted β-tricalcium phosphate. In small defects with the mass of implanted material ≤3.5 g, we observed complete resorption of the material. The larger lesions with the mass of implanted material ≥5.5 g have healed more slowly, and β-tricalcium phosphate granules have been gradually resorbed but still remained radiographically distinct.

Conclusion

According to our study, interconnected β-tricalcium phosphate is a safe and successful bone graft substitute for the treatment of benign bone tumours and tumour-like lesions because of its biocompatibility and bioresorbability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Uchida A, Araki N, Shinto Y, Yoshikawa H, Kurisaki E, Ono K (1990) The use of calcium hydroxyapatite ceramic in bone tumour surgery. J Bone Joint Surg 72-B:298–302

    Google Scholar 

  2. Hibi A, Ishikawa T, Asano M, Ohsawa S, Tsuge K, Iyoda K (1994) A study of failed implantation of hydroxyapatite for benign bone tumor. Orthoped Surg (Sekiekgeka) 45:1423–1428

    Google Scholar 

  3. Itokazu M, Matsunaga T, Ishii M, Kusakabe H, Wyni Y (1996) Use of arthroscopy and interporous hydroxyapatite as a bone graft substitute in tibial plateau fractures. Arch Orthop Trauma Surg 115:45–48

    Article  PubMed  CAS  Google Scholar 

  4. Matsumine A, Myoui A, Kusazaki K, Araki N, Seto M, Yoshikawa H, Uchida A (2004) Calcium hydroxyapatite ceramic implants in bone tumour surgery: a long-term follow-up study. J Bone Joint Surg 86-B:719–725

    Article  Google Scholar 

  5. Ito M, Abumi K, Moridaira H, Shono Y, Kotani Y, Minami A, Kaneda K (2005) Iliac crest reconstruction with a bioactive ceramic spacer. Eur Spine J 14:99–102

    Article  PubMed  Google Scholar 

  6. Sponer P, Urban K, Urbanova E, Karpas K, Mathew PG (2010) Behavior of bioactive glass-ceramic implanted into long bone defects: a scintigraphic study. J Pediatr Orthop B 19:102–107

    Article  PubMed  Google Scholar 

  7. Merten HA, Wiltfang J, Grohmann U, Hoenig JF (2001) Intraindividual comparative animal study of α-and β-tricalcium phosphate degradation in conjunction with simultaneous insertion of dental implants. J Craniofacial Surg 12:59–67

    Article  CAS  Google Scholar 

  8. Wiltfang J, Merten HA, Schlegel KA, Schultze-Mosgau S, Kloss FR, Rupprecht S, Kessler P (2002) Degradation characteristics of α and β tri-calcium-phosphate (TCP) in minipigs. J Biomed Mater Res (Appl Biomater) 63:115–121

    Article  CAS  Google Scholar 

  9. Galois L, Mainard D, Delagoutte JP (2002) Beta-tricalcium phosphate ceramic as a bone substitute in orthopaedic surgery. Inter Orthop 26:109–115

    Article  CAS  Google Scholar 

  10. Ogose A, Hotta T, Kawashima H, Kondo N, Gu W, Kamura T, Endo N (2005) Comparison of hydroxyapatite and beta tricalcium phosphate as bone substitutes after excision of bone tumors. J Biomed Mater Res Part B: Appl Biomater 72B:94–101

    Article  CAS  Google Scholar 

  11. Hirata M, Murata H, Takeshita H, Sakabe T, Tsuji Y, Kubo T (2006) Use of purified beta-tricalcium phosphate for filling defects after curettage of benign bone tumours. Inter Orthop 30:510–513

    Article  CAS  Google Scholar 

  12. Brunner TJ, Grass RN, Bohner M, Stark WJ (2007) Effect of particle size, crystal phase and crystallinity on the reactivity of tricalcium phosphate cements for bone reconstruction. J Mater Chem 17:4072–4078

    Article  CAS  Google Scholar 

  13. Walsh WR, Vizesi F, Michael D, Auld J, Langdown A, Oliver R, Yu Y, Irie H, Bruce W (2008) β-TCP bone graft substitutes in a bilateral rabbit tibial defect model. Biomaterials 29:266–271

    Article  PubMed  CAS  Google Scholar 

  14. Gál P, Ondruš Š, Škvařil J, Straka M, Jochymek J, Plánka L (2009) Synthetic biocompatible degradable material for juvenilie bone cyst treatment. Acta Chir Orthop Traumatol Cech 76:495–500

    PubMed  Google Scholar 

  15. Stubbs D, Deakin M, Chapman-Sheath P, Bruce W, Debes J, Gillies RM et al (2004) In vivo evaluation of resorbable bone graft substitutes in a rabbit tibial defect model. Biomaterials 25:5037–5044

    Article  PubMed  CAS  Google Scholar 

  16. von Doernberg MC, von Rechenberg B, Bohner M, Grunenfelder S, van Lenthe GH, Muller R et al (2006) In vivo behavior of calcium phosphate scaffolds with four different pore sizes. Biomaterials 27:5186–5198

    Article  Google Scholar 

  17. Urban K, Strnad Z, Povysil C, Sponer P (1996) Tricalcium phosphate as a bone tissue substitute (testing of biological properties in animal experiments). Acta Chir Orthop Traumatol Cech. 63:16–20

    PubMed  CAS  Google Scholar 

  18. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Rel Res 286:241–246

    Google Scholar 

  19. Botez P, Sirbu P, Simion L, Munteanu F, Antonia I (2009) Application of a biphasic macroporous synthetic bone substitutes CERAFORM®: clinical and histological results. Eur J Orthop Surg Traumatol 19:387–395

    Article  Google Scholar 

  20. Mano JF, Sousa RA, Boesel LF, Neves NM, Reis RL (2004) Bioinert, biodegradable and injectable polymeric matrix composites for hard tissue replacement: state of the art and recent developments. Compos Sci Technol 64:789–817

    Article  CAS  Google Scholar 

  21. Naito K, Obayashi O, Mogami A, Itoi A, Kaneko K (2008) Fracture of the calcium phosphate bone cement which used to enchondroma of the hand: a case report. Eur J Orthop Surg Traumatol 18:405–408

    Article  Google Scholar 

  22. Dorozhkin SV (2009) Calcium orthophosphate-based biocomposites and hybrid biomaterials. J Mater Sci 44:2343–2387

    Article  CAS  Google Scholar 

  23. Lu JX, Flautre B, Anselme K, Hardouin P, Gallur A, Descamps M et al (1999) Role of interconnections in porous bioceramics on bone recolonization in vitro and in vivo. J Mater Sci Mater Med 10:111–120

    Article  PubMed  CAS  Google Scholar 

  24. Bohner M, Baumgart F (2004) Effects of geometrical factors on the resorption of calcium phosphate bone substitutes. Biomaterials 25:3569–3582

    Article  PubMed  CAS  Google Scholar 

  25. Daculsi G, Passuti N (1990) Effect of macroporosity for osseous substitution of calcium phosphate ceramics. Biomaterials 11:86–87

    PubMed  CAS  Google Scholar 

  26. Eggli PS, Muller W, Schenk RK (1988) Porous hydroxyapatite and tricalcium phosphate cylinders with two different macropore size ranges implanted in the cancellous bone of rabbits. Clin Orthop 232:127–138

    PubMed  CAS  Google Scholar 

  27. Galois L, Mainard D (2004) Bone ingrowth into two porous ceramics with different pore sizes: an experimental study. Acta Orthop Belg 70:598–603

    PubMed  Google Scholar 

  28. Karageorgiou V, Kaplan D (2005) Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials 26:5474–5491

    Article  PubMed  CAS  Google Scholar 

  29. Yuan H, Kurashina K, de Bruijn JD, Li Y, de Groot K, Zhang X (1999) A preliminary study on osteoinduction of two kinds of calcium phosphate ceramics. Biomaterials 20:1799–1806

    Article  PubMed  CAS  Google Scholar 

  30. Oonishi H, Hench LL, Wilson J, Sugihara F, Tsuji E, Kushitani S, Iwaki H (1999) Comparative bone growth behavior in granules of bioceramic materials of various sizes. J Biomed Mater Res 44:31–43

    Article  PubMed  CAS  Google Scholar 

  31. Nicholas RW, Lange TA (1994) Granular tricalcium phosphate grafting of cavitary lesions in human bone. Clin Orthop Rel Res 306:197–203

    Google Scholar 

Download references

Acknowledgment

The authors declare that they have no conflict of interest. No financial support was provided for this report.

Conflict of interest

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, 500 05, Hradec Kralove, Czech Republic

    Pavel Šponer, Karel Urban & Tomáš Kučera

  2. Department of Pathology, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, 500 05, Hradec Kralove, Czech Republic

    Aleš Kohout

  3. Department of Diagnostic Radiology, University Hospital in Hradec Kralove, 500 05, Hradec Kralove, Czech Republic

    Jindra Brtková

  4. Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University in Prague, 500 05, Hradec Kralove, Czech Republic

    Jiří Knížek

Authors
  1. Pavel Šponer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karel Urban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomáš Kučera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aleš Kohout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jindra Brtková
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiří Knížek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pavel Šponer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Šponer, P., Urban, K., Kučera, T. et al. The use of interconnected β-tricalcium phosphate as bone substitute after curettage of benign bone tumours. Eur J Orthop Surg Traumatol 21, 235–241 (2011). https://doi.org/10.1007/s00590-010-0701-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-010-0701-x

Keywords

Search

Navigation