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BioMed Research International 2015Bone grafts are medical devices that are in high demand in clinical practice for substitution of bone defects and recovery of atrophic bone regions. Based on the... (Review)
Review
Bone grafts are medical devices that are in high demand in clinical practice for substitution of bone defects and recovery of atrophic bone regions. Based on the analysis of the modern groups of bone grafts, the particularities of their composition, the mechanisms of their biological effects, and their therapeutic indications, applicable classification was proposed that separates the bone substitutes into "ordinary" and "activated." The main differential criterion is the presence of biologically active components in the material that are standardized by qualitative and quantitative parameters: growth factors, cells, or gene constructions encoding growth factors. The pronounced osteoinductive and (or) osteogenic properties of activated osteoplastic materials allow drawing upon their efficacy in the substitution of large bone defects.
Topics: Bone Regeneration; Bone Substitutes; Bone Transplantation; Humans
PubMed: 26649300
DOI: 10.1155/2015/365050 -
Scandinavian Journal of Surgery : SJS :... Mar 2024Biomaterials are routinely used in orthopedic surgery to fill bone defects, improve bone healing, and as degradable fixation material. A wide range of materials are... (Review)
Review
BACKGROUND
Biomaterials are routinely used in orthopedic surgery to fill bone defects, improve bone healing, and as degradable fixation material. A wide range of materials are currently in use, and the materials are chosen according to their bioactive properties. Osteoinductive materials stimulate bone healing by promoting osteogenesis. Osteoconductive materials facilitate bone growth on the surface of the material. Despite the many materials in use and an increasing number of published studies, randomized controlled trials on the subject are scarce.
METHODS
This review aims to summarize the history of biodegradable biomaterials and also the published level I evidence currently available on orthopedic biomaterials.
RESULTS
Most of the studies have been superiority trials with non-significant differences compared to conventional treatment options, confirming that several biomaterials are suitable treatment options for multiple indications including bone and/or tendon fixation, filling bone defects, and spinal fusion. Biomaterials help to avoid donor site complications associated with autogenous bone grafts and often eliminate the need for implant removal. However, the surgical technique may in some cases be more demanding than with conventional methods. Careful consideration of the pros and cons is therefore recommended in clinical practice.
CONCLUSION
Biodegradable biomaterials complement the range of available treatment options in several fields of orthopedic surgery. However, some biomaterials performed worse than expected and were not recommended for clinical use, emphasizing the need for high-quality randomized trials. It is also noteworthy that several trials included only a limited number of patients, rendering the interpretation of the results of these underpowered studies challenging.
Topics: Humans; Biocompatible Materials; Bone Substitutes; Bone Regeneration; Osteogenesis; Bone Transplantation
PubMed: 37817459
DOI: 10.1177/14574969231200650 -
The Bone & Joint Journal Nov 2013The increasing need for total hip replacement (THR) in an ageing population will inevitably generate a larger number of revision procedures. The difficulties encountered... (Review)
Review
The increasing need for total hip replacement (THR) in an ageing population will inevitably generate a larger number of revision procedures. The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. The failed acetabular component requires reconstruction to restore the hip centre and improve joint biomechanics. Impaction bone grafting is successful in achieving acetabular reconstruction using both cemented and cementless techniques. Bone graft incorporation restores bone stock whilst providing good component stability. We provide a summary of the evidence and current literature regarding impaction bone grafting using both cemented and cementless techniques in revision THR.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Bone Transplantation; Cementation; Hip Prosthesis; Humans; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 24187364
DOI: 10.1302/0301-620X.95B11.32834 -
The Bone & Joint Journal Nov 2014A common situation presenting to the orthopaedic surgeon today is a worn acetabular liner with substantial acetabular and pelvic osteolysis. The surgeon has many options... (Review)
Review
A common situation presenting to the orthopaedic surgeon today is a worn acetabular liner with substantial acetabular and pelvic osteolysis. The surgeon has many options for dealing with osteolytic defects. These include allograft, calcium based substitutes, demineralised bone matrix, or combinations of these options with or without addition of platelet rich plasma. To date there are no clinical studies to determine the efficacy of using bone-stimulating materials in osteolytic defects at the time of revision surgery and there are surprisingly few studies demonstrating the clinical efficacy of these treatment options. Even when radiographs appear to demonstrate incorporation of graft material CT studies have shown that incorporation is incomplete. The surgeon, in choosing a graft material for a surgical procedure must take into account the efficacy, safety, cost and convenience of that material.
Topics: Acetabulum; Allografts; Arthroplasty, Replacement, Hip; Bone Substitutes; Bone Transplantation; Hip Joint; Humans; Osteolysis; Treatment Outcome
PubMed: 25381412
DOI: 10.1302/0301-620X.96B11.34452 -
Journal of Orthopaedic Science :... May 2023Several procedures of biological reconstruction for massive bone defect are available following tumor resection. Since the 1980s, allografting has been advanced mainly...
BACKGROUND
Several procedures of biological reconstruction for massive bone defect are available following tumor resection. Since the 1980s, allografting has been advanced mainly in the United States. However, allogeneic bone grafting has not been sufficiently developed in Japan for socioreligious reasons, and many other biological reconstructive methods have been developed.
STATUS OF BIOLOGICAL RECONSTRUCTION
Bone lengthening, recycled and vascularized bone grafting have yielded favorable outcomes. Once bone union is achieved, reoperation is scarcely performed, with lower rate of infection than that observed with a prosthesis. However, there are disadvantages, such as complicated surgical procedures and relatively common postoperative complications. However, if sufficient donors are available, allogeneic bone grafting can be a good alternative.
PROSPECTS OF THE JAPANESE ORTHOPAEDIC ASSOCIATION
Regenerative medicine with iPS cells, etc., which is under investigation, is expected to be employed for defect reconstruction. However, several biological reconstructive procedures should be further developed. These procedures are not inferior to prosthetic and allograft reconstructions in the short term, but rather are superior in the long term. Favorable outcomes are being obtained by combining recycled bone reconstruction and vascularized bone grafting, suggesting possible improvement in the future. Data should be accumulated to develop biological reconstruction in Japan. Although Japan has the challenge in terms of the ability to convey its message, the disadvantages of the procedures should be minimized.
CONCLUSION
The construction of an allogeneic bone grafting system should be promoted, while biological reconstruction methods developed in Japan should be further developed and convey our message clearly and logically.
Topics: Humans; Bone Neoplasms; Japan; Treatment Outcome; Plastic Surgery Procedures; Postoperative Complications; Bone Transplantation; Retrospective Studies
PubMed: 37088641
DOI: 10.1016/j.jos.2023.01.006 -
PloS One 2022Segmental bone defects present complex clinical challenges. Nonunion, malunion, and infection are common sequalae of autogenous bone grafts, allografts, and synthetic...
Segmental bone defects present complex clinical challenges. Nonunion, malunion, and infection are common sequalae of autogenous bone grafts, allografts, and synthetic bone implants due to poor incorporation with the patient's bone. The current project explores the osteogenic properties of periosteum to facilitate graft incorporation. As tissue area is a natural limitation of autografting, mechanical strain was implemented to expand the periosteum. Freshly harvested, porcine periosteum was strained at 5 and 10% per day for 10 days with non-strained and free-floating samples serving as controls. Total tissue size, viability and histologic examination revealed that strain increased area to a maximum of 1.6-fold in the 10% daily strain. No change in tissue anatomy or viability via MTT or Ki67 staining and quantification was observed among groups. The osteogenic potential of the mechanical expanded periosteum was then examined in vivo. Human cancellous allografts were wrapped with 10% per day strained, fresh, free-floating, or no porcine periosteum and implanted subcutaneously into female, athymic mice. Tissue was collected at 8- and 16-weeks. Gene expression analysis revealed a significant increase in alkaline phosphatase and osteocalcin in the fresh periosteum group at 8-weeks post implantation compared to all other groups. Values among all groups were similar at week 16. Additionally, histological assessment with H&E and Masson-Goldner Trichrome staining showed that all periosteal groups outperformed the non-periosteal allograft, with fresh periosteum demonstrating the highest levels of new tissue mineralization at the periosteum-bone interface. Overall, mechanical expansion of the periosteum can provide increased area for segmental healing via autograft strategies, though further studies are needed to explore culture methodology to optimize osteogenic potential.
Topics: Mice; Female; Humans; Animals; Swine; Periosteum; Osteogenesis; Transplantation, Homologous; Transplantation, Autologous; Bone Transplantation
PubMed: 36584151
DOI: 10.1371/journal.pone.0279519 -
Revista Medica de Chile May 2011The use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction.... (Review)
Review
The use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction. Classically auto and allografts have been used. The latter are the choice in large, complex defects. Allografts can be transplanted despite cell death, have osteoconduction and osteoinduction capacity, low antigenicity and biomechanical properties similar to the original bone. They can be obtained from living and death donors. They are stored by cryopreservation and lyophilization in entities called bone banks. This is a review about bone allografts and the organization and function of the bone banks.
Topics: Bone Banks; Bone Transplantation; Bone and Bones; Humans; Organizational Objectives; Tissue Preservation; Tissue and Organ Procurement; Transplantation, Homologous
PubMed: 22051719
DOI: No ID Found -
The Journal of Bone and Joint Surgery.... May 2007Bone allografts can be used in any kind of surgery involving bone from minor defects to major bone loss after tumour resection. This review describes the various types... (Review)
Review
Bone allografts can be used in any kind of surgery involving bone from minor defects to major bone loss after tumour resection. This review describes the various types of bone grafts and the current knowledge on bone allografts, from procurement and preparation to implantation. The surgical conditions for optimising the incorporation of bone are outlined, and surgeon expectations from a bone allograft discussed.
Topics: Bone Transplantation; Humans; Infections; Organ Preservation; Sterilization; Tissue Donors; Tissue and Organ Harvesting
PubMed: 17540738
DOI: 10.1302/0301-620X.89B5.19039 -
EBioMedicine Oct 2016Large bone defect treatment represents a great challenge due to the difficulty of functional and esthetic reconstruction. Tissue-engineered bone grafts created by in... (Meta-Analysis)
Meta-Analysis Review
Large bone defect treatment represents a great challenge due to the difficulty of functional and esthetic reconstruction. Tissue-engineered bone grafts created by in vitro manipulation of bioscaffolds, seed cells, and growth factors have been considered potential treatments for bone defect reconstruction. However, a significant gap remains between experimental successes and clinical translation. An emerging strategy for bridging this gap is using the in vivo bioreactor principle and flap prefabrication techniques. This principle focuses on using the body as a bioreactor to cultivate the traditional triad (bioscaffolds, seed cells, and growth factors) and leveraging the body's self-regenerative capacity to regenerate new tissue. Additionally, flap prefabrication techniques allow the regenerated bone grafts to be transferred as prefabricated bone flaps for bone defect reconstruction. Such a strategy has been used successfully for reconstructing critical-sized bone defects in animal models and humans. Here, we highlight this concept and provide some perspective on how to translate current knowledge into clinical practice.
Topics: Animals; Bone Regeneration; Bone Transplantation; Guided Tissue Regeneration; Humans; Tissue Engineering
PubMed: 27693103
DOI: 10.1016/j.ebiom.2016.09.016 -
The Iowa Orthopaedic Journal 2014Osteochondral lesions of the talus are being recognized as an increasingly common injury. They are most commonly located postero-medially or antero-laterally, while... (Review)
Review
Osteochondral lesions of the talus are being recognized as an increasingly common injury. They are most commonly located postero-medially or antero-laterally, while centrally located lesions are uncommon. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation (or similar methods) or osteochondral allograft transplantation. Allograft procedures have become popular due to inherent advantages over other resurfacing techniques. Cartilage viability is one of the most important factors for successful clinical outcomes after transplantation of osteochondral allografts and is related to storage length and intra-operative factors. While there is abundant literature about osteochondral allograft transplantation in the knee, there are few papers about this procedure in the talus. Failure of non-operative management, initial debridement, curettage or microfractures are an indication for resurfacing. Patients should have a functional ankle motion, closed growth plates, absence of cartilage lesions on the tibial side. This paper reviews the published literature about osteochondral allograft transplantation of the talus focusing on indications, pre-operative planning, surgical approaches, postoperative management, results and complications of this procedure.
Topics: Bone Transplantation; Cartilage; Humans; Talus; Transplantation, Homologous; Treatment Outcome
PubMed: 25328456
DOI: No ID Found