3D Biomimetic Porous Titanium (Ti6Al4V ELI) Scaffolds for Large Bone Critical Defect Reconstruction: An Experimental Study in Sheep

The main goal in the treatment of large bone defects is to guarantee a rapid loading of the affected limb. In this paper, the authors proposed a new reconstructive technique that proved to be suitable to reach this purpose through the use of a custom-made biomimetic porous titanium scaffold. An in vivo study was undertaken where a complete critical defect was experimentally created in the diaphysis of the right tibia of twelve sheep and replaced with a five-centimeter porous scaffold of electron beam melting (EBM)-sintered titanium alloy (EBM group n = 6) or a porous hydroxyapatite scaffold (CONTROL group, n = 6). After surgery, the sheep were allowed to move freely in the barns. The outcome was monitored for up to 12 months by periodical X-ray and clinical examination. All animals in the CONTROL group were euthanized for humane reasons within the first month after surgery due to the onset of plate bending due to mechanical overload. Nine months after surgery, X-ray imaging showed the complete integration of the titanium implant in the tibia diaphysis and remodeling of the periosteal callus, with a well-defined cortical bone. At 12 months, sheep were euthanized, and the tibia were harvested and subjected to histological analysis. This showed bone tissue formations with bone trabeculae bridging titanium trabeculae, evidencing an optimal tissue-metal interaction. Our results show that EBM-sintered titanium devices, if used to repair critical bone defects in a large animal model, can guarantee immediate body weight-bearing, a rapid functional recovery, and a good osseointegration. The porous hydroxyapatite scaffolds proved to be not suitable in this model of large bone defect due to their known poor mechanical properties.

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Effects of Diode and Nd:YAG Laser Irradiation on Friction Forces Between Two Types of Ceramic Brackets and Rhodium-Coated Archwires

Journal of lasers in medical sciences ◽

10.34172/jlms.2021.13 ◽

2021 ◽

Vol 12 (1) ◽

pp. e13-e13

Author(s):

Hannaneh Ghadirian ◽

Allahyar Geramy ◽

Mohammad Ali Keshvad ◽

Soolmaz Heidari ◽

Nasim Chiniforush

Keyword(s):

Laser Irradiation ◽

Diode Laser ◽

Nd:Yag Laser ◽

Yttrium Aluminum Garnet ◽

Testing Machine ◽

Control Group ◽

Friction Forces ◽

X Ray ◽

Custom Made ◽

Ceramic Brackets

Introduction: Ceramic brackets have gained increasing popularity among dental clinicians and orthodontic patients but friction is a major concern when using them. This study sought to assess the effects of diode and Nd:YAG (neodymium-doped yttrium aluminum garnet) laser irradiation on friction forces between two types of ceramic brackets and rhodium-coated esthetic archwires. Methods: Thirty polycrystalline and 30 poly-sapphire brackets were divided into 6 groups (n=10) as follows: (I) control polycrystalline brackets (no laser irradiation), (II) polycrystalline brackets subjected to diode laser irradiation, (III) polycrystalline brackets subjected to Nd:YAG laser irradiation, (IV) control poly-sapphire brackets (no laser irradiation), (V) poly-sapphire brackets subjected to diode laser irradiation, and (VI) poly-sapphire brackets subjected to Nd:YAG laser irradiation. The bracket slots were laser-irradiated on a custom-made table. Sixty 5-cm pieces of rhodium-coated archwires were used for the friction test in a universal testing machine at a speed of 10 mm/min. Ten brackets from the six groups underwent scanning electron microscopy (SEM), X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDX). Results: The frictional resistance value of polycrystalline brackets was significantly higher than that of poly-sapphire brackets, irrespective of laser type (P<0.05). Irradiation of diode and Nd:YAG lasers, compared with the control group, had no significant effect on friction, irrespective of bracket type (P>0.05). Conclusion: It appears that diode and Nd:YAG laser irradiation cannot significantly decrease the friction. Future studies are warranted on different laser types with variable exposure.

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Porous Titanium Membranes Combined with Various Graft Materials Induce Exophytic Bone Formation in Rabbit Calvaria

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.309-311.427 ◽

2006 ◽

Vol 309-311 ◽

pp. 427-432 ◽

Cited By ~ 3

Author(s):

Y. Kim ◽

Y.H. Kown ◽

J.B. Park ◽

J.H. Chung ◽

H.N. Lim ◽

...

Keyword(s):

Bone Formation ◽

Bone Graft ◽

Porous Titanium ◽

Control Group ◽

Bovine Bone ◽

Graft Material ◽

New Bone Formation ◽

Freeze Dried ◽

Custom Made ◽

Human Cancellous Bone

The purpose of this study was to examine if the application of custom-made porous titanium membranes combined with bone graft materials promotes exophytic bone formation in rabbit calvaria. For this purpose, round decorticated calvaria sites were created using a round carbide bur. In the control group, rectangular parallelepiped-shaped porous titanium membranes (RPTMs) were placed on the decorticated sites and fixed with metal pins. In the experimental groups, RPTMs were filled with one of the following bone graft materials prior to fixing with metal pins: bovine bone mineral (BBM), demineralized freeze-dried human cortical bone (DFDB) or freeze-dried human cancellous bone (FDB). Animals were sacrificed at 8 and 12 weeks after surgery, and new bone formation was assessed by histomorphometric as well as statistical analysis. The results indicate that at 8 and 12 weeks, all the experimental groups demonstrated exophytic bone formation. At 12 weeks, DFDB group revealed the most new bone formation (p<0.05) and resorption of grafted materials (p<0.05). On the basis of these findings, we conclude that RPTMs may be used as an augmentation membrane for guided bone regeneration and DFDB as an effective bone-inducing graft material.

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Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects

International Orthopaedics ◽

10.1007/s00264-020-04623-9 ◽

2020 ◽

Vol 44 (10) ◽

pp. 1957-1964

Author(s):

Giorgio Burastero ◽

Luca Cavagnaro ◽

Francesco Chiarlone ◽

Andrea Zanirato ◽

Lorenzo Mosconi ◽

...

Keyword(s):

Clinical Study ◽

Revision Surgery ◽

Bone Defects ◽

Porous Titanium ◽

Custom Made

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Femoral bone defect healing using two novel biocompatible degradable materials

Acta Veterinaria Brno ◽

10.2754/avb202089020163 ◽

2020 ◽

Vol 89 (2) ◽

pp. 163-169

Author(s):

Robert Srnec ◽

Andrea Nečasová ◽

Pavel Proks ◽

Miša Škorič ◽

Zita Filipejová ◽

...

Keyword(s):

Bone Defect ◽

Bone Marrow Cells ◽

Plate Osteosynthesis ◽

Bone Defects ◽

Femoral Diaphysis ◽

Control Group ◽

Histological Assessment ◽

Bone Defect Healing ◽

Large Bone ◽

Large Bone Defects

This study was conducted as an in vivo experiment in adult miniature pigs with the aim to test two new biomaterials. An iatrogenic defect was made into the central femoral diaphysis in the experimental animals and subsequently fixated by bridging plate osteosynthesis. Into the defect we implanted a cancellous autograft (control group), a pasty injectable scaffold (EXP A), and a porous 3D cylinder (EXP B). Radiological examination was performed in all animals at 0, 10, 20, 30 weeks after surgical procedure and histological assessment was performed. In the newly formed bone the osteoblastic activity was monitored. In terms of radiology, the most effective method was observed in the control group (completely healed 100%) compared to experimental groups EXP A (70.0%) and EXP B (62.5%). Histological assessment showed a higher cell count in the place of bone defect in the control group compared to experimental groups. Between the experimental groups, a higher count of bone marrow cells was found in group EXP B. Both newly developed biomaterials seem to be suitable as replacements for large bone defects, having good workability and applicability. However, compared to the control group treated with a cancellous autograft, the newly formed bone did not reach the same number of cells settling in and in some cases, full radiological healing was not reached. Nevertheless, the material was found to be grown into the original bone in all cases within the experimental groups. The new biomaterials have a great potential as a substitute in the treatment of large bone defects.

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Free Transplantation of a Tissue Engineered Bone Graft into an Irradiated, Critical-Size Femoral Defect in Rats

Cells ◽

10.3390/cells10092256 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2256

Author(s):

Ulrike Rottensteiner-Brandl ◽

Ulf Bertram ◽

Lara F. Lingens ◽

Katrin Köhn ◽

Luitpold Distel ◽

...

Keyword(s):

Bone Healing ◽

Bone Defects ◽

Severe Trauma ◽

In Vivo Studies ◽

Term Survival ◽

Femoral Defect ◽

Custom Made ◽

Healing Tissue ◽

Large Bone

Healing of large bone defects remains a challenge in reconstructive surgery, especially with impaired healing potential due to severe trauma, infection or irradiation. In vivo studies are often performed in healthy animals, which might not accurately reflect the situation in clinical cases. In the present study, we successfully combined a critical-sized femoral defect model with an ionizing radiation protocol in rats. To support bone healing, tissue-engineered constructs were transferred into the defect after ectopic preossification and prevascularization. The combination of SiHA, MSCs and BMP-2 resulted in the significant ectopic formation of bone tissue, which can easily be transferred by means of our custom-made titanium chamber. Implanted osteogenic MSCs survived in vivo for a total of 18 weeks. The use of SiHA alone did not lead to bone formation after ectopic implantation. Analysis of gene expression showed early osteoblast differentiation and a hypoxic and inflammatory environment in implanted constructs. Irradiation led to impaired bone healing, decreased vascularization and lower short-term survival of implanted cells. We conclude that our model is highly valuable for the investigation of bone healing and tissue engineering in pre-damaged tissue and that healing of bone defects can be substantially supported by combining SiHA, MSCs and BMP-2.

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Evaluation of usage of silicon-doped hydroxyapatite ceramics for treatment of fragmented bone fractures in dogs

Scientific Messenger of LNU of Veterinary Medicine and Biotechnology ◽

10.32718/nvlvet9905 ◽

2020 ◽

Vol 22 (99) ◽

pp. 29-37

Author(s):

M. V. Rublenko ◽

V. A. Chemerovskiy ◽

V. G. Andriiets ◽

N. V. Ulyanchich ◽

V. V. Kolomiets ◽

...

Keyword(s):

Bone Fractures ◽

Bone Defects ◽

Control Group ◽

Animal Group ◽

X Ray ◽

Hydroxyapatite Ceramics ◽

Silicon Doped ◽

Experimental Group ◽

Tubular Bones

None of the methods of osteosynthesis provides the consolidation of bone fragments which have lost contact with soft tissues. It makes extremely difficult treating of this type fractures. Bone defect between the fragments and absence of a primary biological matrix complicates revascularization, causes long-term life of the connective tissue and cells of cartilaginous phenotype in the fracture zone. It is leads to a long-term consolidation of the fracture. Composites of hydroxyapatite and calcium phosphates are considered as bioactive and therefore the most promising for bone defects replacing. The aim of this investigation was clinical, radiological and hematological evaluation using of silicon-doped ceramics for fragmented bone fractures in dogs. For study was chosen dogs with accidental fragmented fractures of tubular bones which treated by extracortical osteosynthesis method. Animal was divided into two groups. A bone defects were filled with ceramics (GTlKg-3) for experimental animal group (n = 7), while no filling of bone defects in control animal group(n = 7) was performed. Protocol of anesthesia included medetomidine, butorphanol tartrate and epidural anesthesia with 2 % lidocaine solution. Animals of the control group began to lean on the injured limb from the 12–15th day after surgery, while the animal of research group from the 8-9th day. Complete limb repair in dogs of the control group occurred on the 38–42th day, but such period for experimental group animals was shorter – 25–27th day after the osteosynthesis. X-ray investigation (60th day) of experimental group dogs showed new formed bone tissue with osteosclerotic zones without a periosteal reaction, bone tissue, with a normal view of the epiphyseal areas and the bone marrow cavity. This is evidence of localized reparative osteogenesis (within bone trauma only), and completed fracture consolidation. At the same time in cases of the control group we found lower X-ray density of new bone, periosteum was thickened with excessive proliferation of the endosteum, especially below the site of bone injury. Thus, in case the absence of hydroxyapatite matrix in bone defects there were compensatory increasing proliferation of periosteum and endoosteum. Fragmented fractures of tubular bones in dogs have occurred by erythrocytopenia, that quickly disappear due to the reparative osteogenesis in dog of experimental group. These animals have had leukocytosis increasing due to the first three days after osteosynthesis as a reaction to the implantation of a calcium-phosphorus composite material. Dogs of control group have had second wave of leukocytosis increasing on forty-second day associated with elongated remodeling process. Areparative osteogenesis can be accelerated in 1.5 times in case of replacement of bone defects with silicon doped hydroxyapatite ceramics. It is possibility realized thru moderate reduction of active phase of inflammation and acceleration of proliferative phase, mainly from endosteum side with early mineralization of bone regenerate. The dynamics of hematology parameters is a typical for the tubular bone consolidation that indicates about moderate inflammation and demonstrate biological tolerance of silicon-doped hydroxyapatite ceramics.

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A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

The Open Orthopaedics Journal ◽

10.2174/1874325001812010525 ◽

2018 ◽

Vol 12 (1) ◽

pp. 525-535

Author(s):

Giorgio Burastero ◽

Luca Cavagnaro ◽

Francesco Chiarlone ◽

Bernardo Innocenti ◽

Lamberto Felli

Keyword(s):

Bone Loss ◽

Optimal Solution ◽

Bone Defects ◽

Porous Titanium ◽

Titanium Implants ◽

New Device ◽

Custom Made ◽

Knee Revision Surgery ◽

Surgical Options ◽

Clinical And Radiological Results

Background: Bone loss management is considered one of the most difficult challenges for orthopaedic surgeon. In massive bone defects, few surgical options are available and they do not offer a reliable or optimal solution for knee reconstruction. Objective: The aim of this paper is to present and justify a new custom-made approach for complex metadiaphyseal bone defects management in knee revision surgery. Methods: We report a case of a 66-year-old woman who underwent a staged left total knee arthroplasty revision for infection with Anderson Orthopaedic Research Institute classification III uncontained femoral and tibial metadiaphyseal bone defects following five prior surgeries. Along with a case discussion, we describe clinical and radiological outcomes of 3 similar patients treated with this new custom-made device. Results: To manage these problems, we developed new, custom porous titanium devices for both femoral and tibial reconstruction tailored to a patient’s specific bone loss. Since, 2014, we treated four cases using custom-made porous titanium cones and we had optimal clinical and radiological results, with no instances of loosening, component migration, or mismatches between preoperative planning and intraoperative findings. Conclusion: In extremely selected cases, this new device can be considered a possible and viable surgical step between “off the shelf” reconstruction implants and knee substitution with a tumor megaprosthesis.

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Effect of Cerium-Containing Hydroxyapatite in Bone Repair in Female Rats with Osteoporosis Induced by Ovariectomy

Minerals ◽

10.3390/min11040377 ◽

2021 ◽

Vol 11 (4) ◽

pp. 377

Author(s):

Ewerton Vieira ◽

Marcos Silva ◽

Antonio Maia-Filho ◽

Daniel Ferreira ◽

José Figuerêdo-Silva ◽

...

Keyword(s):

Bone Repair ◽

Bone Growth ◽

Antimicrobial Properties ◽

Public Health Problem ◽

Bone Defects ◽

Female Rats ◽

Precipitation Method ◽

Control Group ◽

X Ray Diffraction ◽

X Ray

Osteoporosis is a public health problem, with bone loss being the main consequence. Hydroxyapatite (HA) has been largely used as a bioceramic to stimulate bone growth. In our work, a cerium-containing HA (Ce-HA) has been proposed and its effects on the antimicrobial and bone-inducing properties were investigated. The synthesis of the materials occurred by the suspension–precipitation method (SPM). The XRD (X-ray Diffraction) confirmed the crystalline phase, and the Rietveld refinement confirmed the crystallization of HA and Ce-HA in a hexagonal crystal structure in agreement with ICSD n° 26205. Characterizations by FT-IR (Fourier Transform Infrared Spectroscopy), XPS (X-ray Photoemission Spectroscopy), and FESEM-EDS (Field Emission Scanning Electron Microscope-Energy Dispersive X-ray Spectroscopy) confirmed the presence of cerium (Ce3+ and Ce4+). The antibacterial activity of Has was evaluated against Staphylococcus aureus 25,923 and Escherichia coli 25,922 strains, which revealed that the material has antimicrobial properties and the cytotoxicity assay indicated that Ce-containing HA was classified as non-toxic. The effects of Ce-HA on bone repair, after application in bone defects in the tibia of female rats with osteoporosis induced by ovariectomy (OVX), were evaluated. After 15 and 30 days of implantation, the samples were analyzed by Raman, histology and X-ray microtomography. The results showed that the animals that had the induced bone defects filled with the Ce-HA materials had more expressive bone neoformation than the control group.

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Application of structural allogenous bone graft in two-stage exchange arthroplasty for knee periprosthetic joint infection: a case control study

10.21203/rs.3.rs-779204/v1 ◽

2021 ◽

Author(s):

ChiehAn Chuang ◽

Sheng-Hsun Lee ◽

Chih-Hsiang Chang ◽

Chih-Chien Hu ◽

Hsin-Nung Shih ◽

...

Keyword(s):

Survival Rate ◽

Bone Graft ◽

Joint Infection ◽

Bone Defects ◽

Control Group ◽

Study Group ◽

Free Survival ◽

Fresh Frozen ◽

Large Bone ◽

Large Bone Defects

Abstract Background: Knee prosthetic joint infection (PJI) is a common but devastating complication after knee arthroplasty. The revision surgeries for knee PJI may become more challenging when it is associated with large bone defects. The application of structural bone allograft in knee revision surgeries with large bone defects is not a new technique. However, there is a lack of literature reporting its efficacy in PJI cases. This study aimed to investigate the outcome of structural fresh frozen allogenous bone grafts in treating patients in knee PJI with large bone defects. Methods: We performed a retrospective cohort analysis of knee PJI cases treated with two-stage exchange arthroplasty at our institution from 2010 to 2016. 12 patients with structural allogenous bone graft reconstructions were identified as the study group. 24 patients without structural allograft reconstructions matched with the study group by age, gender, and Charlson comorbidity index were enrolled as the control group. The functional outcome of the study group was evaluated with the Knee Society Score (KSS). Treatment success was assessed according to the Delphi-based consensus definition. The infection relapse rate and implant survivorship were compared between groups. Results: Revision knees with structural allograft presented excellent improvement in the KSS (33.1 to 75.4). There was no significant difference between infection relapse-free survival rate and prosthesis survival rate in two groups. The 8-year prosthesis survival rate was 90.9% in the study group and 91% in the control group (p = 0.913). The 8-year infection relapse-free survival rate was 80% and 83.3% in the study group and control group, respectively (p = 0.377). Conclusion: The structural fresh frozen allogenous bone graft provided an effective way for bone defect reconstruction in knee PJI with accountable survival rate. Meanwhile, using structural allografts did not increase the relapse rate of infection.

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In vivo study on the healing of bone defect treated with non-thermal atmospheric pressure gas discharge plasma

PLoS ONE ◽

10.1371/journal.pone.0255861 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0255861

Author(s):

Akiyoshi Shimatani ◽

Hiromitsu Toyoda ◽

Kumi Orita ◽

Yoshihiro Hirakawa ◽

Kodai Aoki ◽

...

Keyword(s):

Plasma Treatment ◽

Bone Regeneration ◽

Bone Defect ◽

Atmospheric Pressure ◽

Atmospheric Pressure Plasma ◽

Control Group ◽

Untreated Control Group ◽

Large Bone Defect ◽

X Ray ◽

Large Bone

Medical treatment using non-thermal atmospheric pressure plasma (NTAPP) is rapidly gaining recognition. NTAPP is thought to be a new therapeutic method because it could generate highly reactive species in an ambient atmosphere which could be exposed to biological targets (e.g., cells and tissues). If plasma-generated reactive species could stimulate bone regeneration, NTAPP can provide a new treatment opportunity in regenerative medicine. Here, we investigated the impact of NTAPP on bone regeneration using a large bone defect in New Zealand White rabbits and a simple atmospheric pressure plasma (helium microplasma jet). We observed the recovery progress of the large bone defects by X-ray imaging over eight weeks after surgery. The X-ray results showed a clear difference in the occupancy of the new bone of the large bone defect among groups with different plasma treatment times, whereas the new bone occupancy was not substantial in the untreated control group. According to the results of micro-computed tomography analysis at eight weeks, the most successful bone regeneration was achieved using a plasma treatment time of 10 min, wherein the new bone volume was 1.51 times larger than that in the plasma untreated control group. Using H&E and Masson trichrome stains, nucleated cells were uniformly observed, and no inclusion was confirmed, respectively, in the groups of plasma treatment. We concluded the critical large bone defect were filled with new bone. Overall, these results suggest that NTAPP is promising for fracture treatment.

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