Reconstruction after hemimandibulectomy by a titanium mesh and particulate cancellous bone and marrow harvested from posterior ilia: a case report

A particulate cancellous bone and marrow (PCBM) graft combined with titanium (Ti-) mesh tray has become one of the most popular mandibular reconstruction methods. The technique has been applied to the mandibular discontinuity defects after segmental mandibulectomy. To the best of our knowledge, there are no reports on using the technique after hemimandibulectomy, during which a wide mandibular resection, including the condyle, is performed. Here we report firstly a case of mandibular reconstruction after hemimandibulectomy, using a plate and soft-tissue free flap, followed by a Ti-mesh and PCBM harvested from the bilateral posterior ilia, which was successful. This case report first revealed how bone resorption occurred clinically in mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. We also revealed the high predictability of the mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. Our report also provides a guiding principle to overcome the limitation of mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. However, our manuscript has limited evidence being a case report.

The Influence of Storage in Saline or Irradiation by Ultraviolet on Implant Hydrophilicity and Osseointegration: An Experimental Study in Rabbits

Storage in aqueous solution or ultraviolet (UV) irradiation can re t ain or regain the hydrophilicity of titanium implant surface. In this study, t hree types of commercial titanium implants were used : ZBL (ZDI Bone L evel ® ), CEL (C-tech Esthetic Line ® ) , and modSLA (Straumann SLActive ® ). ZBL and CEL implants were treated with UV irradiation for 4 h. Surface characterization of the four groups (ZBL, ZBL-UV, CEL-UV, modSLA) was evaluated by scanning electron microscopy and contact angle measurements. The in vivo bone response was evaluated by removal torque (RTQ) tests and histomorphometric analysis at 3, 6 , and 12 weeks post-implantation. A total of 144 implants and 36 rabbits were used for experiments according to a previously established randomization sequence. The ZBL-UV, CEL-UV , andmodSLA groups were hydrophilic, and nanostructures were observed on the modSLA implant surface.ModSLA achieved better RTQ value than ZBL at 12 weeks ( p <0.05). For histomorphometric analysis, ZBL-UV and CEL-UV implants showed higher bone area values in the cancellous bone zone at 6 weeks than did modSLA and ZBL implants ( p <0.05).In the cortical bone zone, all groups showed comparable bone-to-implant contact at all healing time points ( p >0.05).Both storage in saline and UV irradiation could retain or provoke hydr o philic surfaces and improve osseointegration. Compared to storage in saline, UV irradiation displayed slight advantages in promoting new bone formation in cancellous bone zone at an early stage.

Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty

In cemented joint arthroplasty, state-of-the-art cementing techniques include high-pressure pulsatile saline lavage prior to cementation. Even with its outstanding importance in cementation, there are surprisingly few studies regarding the physical parameters that define pulsatile lavage systems. To investigate the parameters of impact pressure, flow rate, frequency and the cleaning effect in cancellous bone, we established a standardized laboratory model. Standardized fat-filled carbon foam specimens representing human cancellous bone were cleaned with three different high-pressure pulsatile lavage systems. Via CT scans before and after cleaning, the cleaning effect was evaluated. All systems showed a cleaning depth of at least 3.0 mm and therefore can be generally recommended to clean cancellous bone in cemented joint arthroplasty. When comparing the three lavage systems, the study showed significant differences regarding cleaning depths and volume, with one system being superior to its peer systems. Regarding the physical parameters, high impact pressure in combination with high flow rate and longer distance to the flushed object seems to be the best combination to improve the cleaning of cancellous bone and therefore increase the chances of a deeper cement penetration that is required in cemented joint arthroplasty. In summary, this study provides the first standardized comparison of different lavage systems and thus gives initial guidance on how to optimally prepare cancellous bone for cemented joint arthroplasty.

Factors Affecting the Aluminum, Arsenic, Cadmium and Lead Concentrations in the Knee Joint Structures

Background: Toxic elements, such as aluminum (Al), arsenic (As), cadmium (Cd), and lead (Pb), are persistent environmental pollutants that can cause adverse effects on the health of exposed individuals. Bone is one of the primary target organs of accumulation and potential damage from toxic elements.Objectives: This study was performed to determine the Al, As, Cd, and Pb concentrations in the femoral cancellous bone, femoral cartilage, anterior cruciate ligament, meniscus, tibial cartilage, tibial cancellous bone and infrapatellar fat pad. Furthermore, the aim of this study was to explore the relationships between toxic element concentrations and related factors such as gender, age, place of residence, hypertension and diabetes, and to determine the correlations among these toxic elements in knee joint structures.Methods: The samples used this study were collected from 51 patients following total knee arthroplasty. The Al, As, Cd, and Pb concentrations were determined using inductively coupled plasma optic emission spectrometry.Results: Significant differences were found in the Al, As, Cd, and Pb concentrations among the knee joint structures. Cd concentration in the tibial cancellous bone in women was significantly higher than in men. Pb concentration in the infrapatellar fat pad of urban patients was significantly higher as compared to rural patients. Al concentrations in the femoral cancellous bone, femoral cartilage, anterior cruciate ligament, meniscus and tibial cartilage were significantly higher in patients living in urban areas than in rural areas. As concentration in the tibial cancellous bone of diabetic patients was significantly higher compared to non-diabetic patients. In addition, significant Spearman's positive correlations were found between Al and Pb in the knee joint structures.Conclusion: The obtained results of the investigated toxic elements may serve as a basis for establishing the reference values of Al, As, Cd, and Pb in the knee joint structures. The results reported in the study provides novel data regarding the relationships between the toxic element concentrations and gender, age, place of residence, hypertension and diabetes in the studied structures of knee joint. Furthermore, new interactions among these toxic elements were noted.

EFFICACY OF CORE DECOMPRESSION AND AUTOLOGOUS CANCELLOUS BONE GRAFTING IN AVASCULAR NECROSIS OF FEMORAL HEAD

BACKGROUND: Avascular necrosis (AVN) of the femoral head is a disease that usually affects patients in the 20-50 year age group of life. The disease progresses with time and if left untreated, it may leads to complete deterioration of the hip joint. Various treatments modalities are available as non-surgical, core decompression alone or with autologous bone graft or PRP or bone marrow aspirate or vascularised bular graft, osteotomies and hip replacement. We planned to evaluate the efcacy of core decompression and autologous bone grafting in the management of AVN of the hip. MATERIALS AND METHODS- We performed a prospective study with 20 patients of 20-50 years age group having cat-arlet stage 1 [8 patients ] and 2a [12 patients]. The study period was from January 2018 to December 2019. All patients were treated with core decompression and autologous cancellous bone grafting. Pre-operative Harris hip score [HHS], plain radiograph and MRI were compared with postoperative ones at different time intervals. RESULTS- Average Follow Up Period Was 12 Months And Average Age Group Of Presentation Was 31.1 Years . Males Were More Affected And Most Common Causes Were Idiopathic And Steroid Use. Average Preoperative Hhs Was 56.20 And Postoperative Hhs Was 80.15. At The End Of 1 Year, 12 Patients Showed Remission, 6 Patients Showed Preoperative Stage While 2 Patients Progressed To Advanced Stage And Required Arthroplasty. CONCLUSION-core Decompression And Autologous Bone Grafting Is Effective Treatment Modality In Early Avascular Necrosis Of Femur Head In Terms Of Radiological And Clinical Results And Delaying Arthroplasty

Three-Dimensional Porous Scaffolds Derived from Bovine Cancellous Bone Matrix Promote Osteoinduction, Osteoconduction, and Osteogenesis

The use of three-dimensional porous scaffolds derived from decellularized extracellular matrix (ECM) is increasing for functional repair and regeneration of injured bone tissue. Because these scaffolds retain their native structures and bioactive molecules, in addition to showing low immunogenicity and good biodegradability, they can promote tissue repair and regeneration. Nonetheless, imitating these features in synthetic materials represents a challenging task. Furthermore, due to the complexity of bone tissue, different processes are necessary to maintain these characteristics. We present a novel approach using decellularized ECM material derived from bovine cancellous bone by demineralization, decellularization, and hydrolysis of collagen to obtain a three-dimensional porous scaffold. This study demonstrates that the three-dimensional porous scaffold obtained from bovine bone retained its osteoconductive and osteoinductive properties and presented osteogenic potential when seeded with human Wharton’s jelly mesenchymal stromal cells (hWJ-MSCs). Based on its characteristics, the scaffold described in this work potentially represents a therapeutic strategy for bone repair.

Heterogeneous Tissue Modulus Improved Prediction of Mechanical Behavior in Osteoporotic Vertebral Cancellous Bone

The structural integrity of cancellous bone, which is essential to skeletal load-bearing capacity, is governed chiefly by apparent density, trabecular architecture, and tissue material properties. Metabolic bone disorders such as osteoporosis can affect each of these factors separately, resulting in compromised load-bearing function. While the impact of apparent density and architecture on bone mechanical behavior has been well-documented, much less is known about the influence of tissue material properties, particularly in osteoporotic bone. The goal of the present study is to isolate the influence of tissue material properties on the pre-yield mechanical response of normal and osteoporotic cancellous bone to uniaxial compression using finite element (FE) models derived from 3D micro-computed tomography images. Both average tissue material properties and the degree of tissue material heterogeneity vary between individuals. Therefore, three sets of FE models were created to study the relative importance of these two factors: 1) models with material homogeneity within and between subjects, 2) models with material homogeneity within subjects only, and 3) models with material heterogeneity within and between subjects. The results of finite element analyses were compared to data gathered from physical testing with matched conditions. For normal bone, incorporating material heterogeneity within and between subjects had no significant effect on model performance. For osteoporotic bone, incorporating material heterogeneity within subjects did not affect model performance, but models that incorporated subject-specific average material properties were significantly more accurate in replicating the results of physical testing. We conclude that, while the influence of bone apparent density and trabecular architecture on apparent stiffness are dominant in healthy bone, average material properties also play a role in osteoporotic bone. Osteoporosis is diagnosed based on apparent density alone, so our findings suggest a need to consider other patient-specific differences that may affect average tissue material properties, such a bone remodeling rate, in clinical assessments of osteoporotic bone structural integrity.