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The Effect of Soaking Allograft in Bisphosphonate: A Pilot Dose-response Study

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Long-term survival of uncemented total joint replacements relies on osseointegration. With reduced bone stock impacted morselized allograft enhances early implant fixation but is subject to resorption.

Purpose

We therefore asked whether soaking morselized allograft in different concentrations of bisphosphonate before impaction would enhance fixation.

Methods

In each of 10 dogs, we implanted four unloaded titanium implants surrounded by a 2.5-mm gap into the proximal humerus, two implants in each humerus. The gap was filled with impacted morselized allograft soaked in saline or a low-, middle-, or high-dose bisphosphonate solution (0.005, 0.05, or 0.5 mg zoledronate/mL). At 4 weeks, the implants were evaluated by histomorphometric analysis and mechanical pushout test.

Results

The low dose of zoledronate increased new bone formation in the allograft but the high dose decreased new bone formation. The high dose of zoledronate resulted in the greatest inhibition of allograft resorption, whereas the low dose of zoledronate resulted in the lowest inhibition of allograft resorption. Implants surrounded allograft soaked in the low dose of zoledronate or saline had better fixation for all three mechanical parameters compared with implants surrounded by allograft soaked in the middle or high dose of zoledronate.

Conclusions

These data suggest bisphosphonate may enhance osseointegration of allografted implants and emphasize the need for preclinical testing of antiresorptive therapies.

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Acknowledgments

We thank Jane Pauli and Anette Milton, Orthopaedic Research Laboratory, Aarhus University Hospital, for technical expertise.

Author information

Authors and Affiliations

  1. Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus C, Denmark

    Thomas Jakobsen MD, PhD, Jørgen Baas MD, PhD, Brian Elmengaard MD, PhD & Kjeld Søballe MD, DMSc

  2. Orthopaedic Biomechanics Laboratory, Midwest Research Foundation, Minneapolis, MN, USA

    Joan E. Bechtold PhD

Authors
  1. Thomas Jakobsen MD, PhD
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  2. Jørgen Baas MD, PhD
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  3. Joan E. Bechtold PhD
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  4. Brian Elmengaard MD, PhD
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  5. Kjeld Søballe MD, DMSc
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Corresponding author

Correspondence to Thomas Jakobsen MD, PhD.

Additional information

One or more of the authors (TJ) have received funding from The Danish Rheumatism Association, Denmark. Biomet Inc coated the implants.

Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark (specimen preparation, testing, and analysis), and Orthopaedic Biomechanics Laboratory, Midwest Research Foundation, Minneapolis, MN, USA (surgery).

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Jakobsen, T., Baas, J., Bechtold, J.E. et al. The Effect of Soaking Allograft in Bisphosphonate: A Pilot Dose-response Study. Clin Orthop Relat Res 468, 867–874 (2010). https://doi.org/10.1007/s11999-009-1099-9

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  • DOI: https://doi.org/10.1007/s11999-009-1099-9

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