Skip to main content
Erschienen in: Clinical Orthopaedics and Related Research® 2/2012

01.02.2012 | Symposium: Papers Presented at the Annual Meetings of The Hip Society

The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

verfasst von: Letitia Lim, MD, J. Dennis Bobyn, PhD, Kristian M. Bobyn, BA, Louis-Philippe Lefebvre, MEng, Michael Tanzer, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 2/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap healing and porous implant fixation.

Questions/purposes

We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous implant.

Methods

We inserted porous titanium implants into the proximal metaphyses of canine femora and humeri, with an initial 3-mm gap between host cancellous bone and implants. We left the gaps empty (control; n = 12) or filled them with either demineralized bone matrix (n = 6) or devitalized demineralized bone matrix (negative control; n = 6) and left them in situ for 4 or 12 weeks. We quantified volume healing of the gap with new bone using three-dimensional micro-CT scanning and quantified apposition and ingrowth using backscattered scanning electron microscopy.

Results

The density of bone inside gaps filled with demineralized bone matrix reached 64% and 93% of surrounding bone density by 4 and 12 weeks, respectively. Compared with empty controls and negative controls at 4 and 12 weeks, gap healing using demineralized bone matrix was two to three times greater and bone ingrowth and apposition were up to 15 times greater.

Conclusions

Demineralized bone matrix promotes rapid bone ingrowth and gap healing around porous implants.

Clinical Relevance

Demineralized bone matrix has potential for enhancing implant fixation in revision arthroplasty.
Literatur
1.
Zurück zum Zitat Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am. 2002;84:716–720.PubMedCrossRef Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am. 2002;84:716–720.PubMedCrossRef
2.
Zurück zum Zitat Bae H, Zhao L, Zhu D, Kanim LE, Wang JC, Delamarter RB. Variability across ten production lots of a single demineralized bone matrix product. J Bone Joint Surg Am. 2010;92:427–435.PubMedCrossRef Bae H, Zhao L, Zhu D, Kanim LE, Wang JC, Delamarter RB. Variability across ten production lots of a single demineralized bone matrix product. J Bone Joint Surg Am. 2010;92:427–435.PubMedCrossRef
3.
Zurück zum Zitat Bae HW, Zhao L, Kanim LE, Wong P, Delamarter RB, Dawson EG. Intervariability and intravariability of bone morphogenetic proteins in commercially available demineralized bone matrix products. Spine (Phila Pa 1976). 2006;31:1299–1306; discussion 1307–1308. Bae HW, Zhao L, Kanim LE, Wong P, Delamarter RB, Dawson EG. Intervariability and intravariability of bone morphogenetic proteins in commercially available demineralized bone matrix products. Spine (Phila Pa 1976). 2006;31:1299–1306; discussion 1307–1308.
4.
Zurück zum Zitat Barrack RL, Cook SD, Patrón LP, Salkeld SL, Szuszczewicz E, Whitecloud TS 3rd. Induction of bone ingrowth from acetabular defects to a porous surface with OP-1. Clin Orthop Relat Res. 2003;417:41–49.PubMed Barrack RL, Cook SD, Patrón LP, Salkeld SL, Szuszczewicz E, Whitecloud TS 3rd. Induction of bone ingrowth from acetabular defects to a porous surface with OP-1. Clin Orthop Relat Res. 2003;417:41–49.PubMed
5.
Zurück zum Zitat Bobyn JD. Next generation porous metals for biologic fixation. In: Glassman AH, Lachiewicz PF, Tanzer, M, eds. Orthopaedic Knowledge Update: Hip and Knee Reconstruction 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:45–58. Bobyn JD. Next generation porous metals for biologic fixation. In: Glassman AH, Lachiewicz PF, Tanzer, M, eds. Orthopaedic Knowledge Update: Hip and Knee Reconstruction 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:45–58.
6.
Zurück zum Zitat Boyan BD, Sylvia VL, Liu Y, Sagun R, Cochran DL, Lohmann CH, Dean DD, Schwartz Z. Surface roughness mediates its effects on osteoblasts via protein kinase A and phospholipase A2. Biomaterials. 1999;20:2305–2310.PubMedCrossRef Boyan BD, Sylvia VL, Liu Y, Sagun R, Cochran DL, Lohmann CH, Dean DD, Schwartz Z. Surface roughness mediates its effects on osteoblasts via protein kinase A and phospholipase A2. Biomaterials. 1999;20:2305–2310.PubMedCrossRef
7.
Zurück zum Zitat Cook SD, Salkeld SL, Patron LP, Barrack RL. The effect of demineralized bone matrix gel on bone ingrowth and fixation of porous implants. J Arthroplasty. 2002;17:402–408.PubMedCrossRef Cook SD, Salkeld SL, Patron LP, Barrack RL. The effect of demineralized bone matrix gel on bone ingrowth and fixation of porous implants. J Arthroplasty. 2002;17:402–408.PubMedCrossRef
8.
Zurück zum Zitat Efe T, Schmitt J. Analyses of prosthesis stem failures in noncemented modular hip revision prostheses. J Arthroplasty. 2011;26:665.e7–665.e12.CrossRef Efe T, Schmitt J. Analyses of prosthesis stem failures in noncemented modular hip revision prostheses. J Arthroplasty. 2011;26:665.e7–665.e12.CrossRef
9.
Zurück zum Zitat Einhorn TA, Lane JM, Burstein AH, Kopman CR, Vigorita VJ. The healing of segmental bone defects induced by demineralized bone matrix: a radiographic and biomechanical study. J Bone Joint Surg Am. 1984;66:274–279.PubMed Einhorn TA, Lane JM, Burstein AH, Kopman CR, Vigorita VJ. The healing of segmental bone defects induced by demineralized bone matrix: a radiographic and biomechanical study. J Bone Joint Surg Am. 1984;66:274–279.PubMed
10.
Zurück zum Zitat Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84:454–464.PubMed Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84:454–464.PubMed
11.
Zurück zum Zitat Gamradt SC, Lieberman JR. Bone graft for revision hip arthroplasty: biology and future applications. Clin Orthop Relat Res. 2003;417:183–194.PubMed Gamradt SC, Lieberman JR. Bone graft for revision hip arthroplasty: biology and future applications. Clin Orthop Relat Res. 2003;417:183–194.PubMed
12.
Zurück zum Zitat Gazdag AR, Lane JM, Glaser D, Forster RA. Alternatives to autogenous bone graft: efficacy and indications. J Am Acad Orthop Surg. 1995;3:1–8.PubMed Gazdag AR, Lane JM, Glaser D, Forster RA. Alternatives to autogenous bone graft: efficacy and indications. J Am Acad Orthop Surg. 1995;3:1–8.PubMed
13.
Zurück zum Zitat Greis PE, Kang JD, Silvaggio V, Rubash HE. A long-term study on defect filling and bone ingrowth using a canine fiber metal total hip model. Clin Orthop Relat Res. 1992;274:47–59.PubMed Greis PE, Kang JD, Silvaggio V, Rubash HE. A long-term study on defect filling and bone ingrowth using a canine fiber metal total hip model. Clin Orthop Relat Res. 1992;274:47–59.PubMed
14.
Zurück zum Zitat Gross AE, Duncan CP, Garbuz D, Mohamed EM. Revision arthroplasty of the acetabulum in association with loss of bone stock. Instr Course Lect. 1999;48:57–66.PubMed Gross AE, Duncan CP, Garbuz D, Mohamed EM. Revision arthroplasty of the acetabulum in association with loss of bone stock. Instr Course Lect. 1999;48:57–66.PubMed
15.
Zurück zum Zitat Hacking SA, Harvey EJ, Tanzer M, Krygier JJ, Bobyn JD. Acid etched microtexture for enhancement of bone growth into porous coated implants. J Bone Joint Surg Br. 2003;85:1182–1189.PubMedCrossRef Hacking SA, Harvey EJ, Tanzer M, Krygier JJ, Bobyn JD. Acid etched microtexture for enhancement of bone growth into porous coated implants. J Bone Joint Surg Br. 2003;85:1182–1189.PubMedCrossRef
16.
Zurück zum Zitat Hacking SA, Tanzer M, Harvey EJ, Krygier JJ, Bobyn JD. Relative contributions of chemistry and topography to the osseointegration of hydroxyapatite coatings. Clin Orthop Relat Res. 2002;405:24–38.PubMedCrossRef Hacking SA, Tanzer M, Harvey EJ, Krygier JJ, Bobyn JD. Relative contributions of chemistry and topography to the osseointegration of hydroxyapatite coatings. Clin Orthop Relat Res. 2002;405:24–38.PubMedCrossRef
17.
Zurück zum Zitat Jafari SM, Bender B, Coyle C, Parvizi J, Sharkey PF, Hozack WJ. Do tantalum and titanium cups show similar results in revision hip arthroplasty? Clin Orthop Relat Res. 2010;468:459–465.PubMedCrossRef Jafari SM, Bender B, Coyle C, Parvizi J, Sharkey PF, Hozack WJ. Do tantalum and titanium cups show similar results in revision hip arthroplasty? Clin Orthop Relat Res. 2010;468:459–465.PubMedCrossRef
18.
Zurück zum Zitat Jensen TB, Overgaard S, Lind M, Rahbeck O, Bünger C, Søballe K. Osteogenic protein-1 increases the fixation of implants grafted with morcellised bone allograft and ProOsteon bone substitute: an experimental study in dogs. J Bone Joint Surg Br. 2007;89:121–126.PubMedCrossRef Jensen TB, Overgaard S, Lind M, Rahbeck O, Bünger C, Søballe K. Osteogenic protein-1 increases the fixation of implants grafted with morcellised bone allograft and ProOsteon bone substitute: an experimental study in dogs. J Bone Joint Surg Br. 2007;89:121–126.PubMedCrossRef
19.
Zurück zum Zitat Jones AC, Arns CH, Sheppard AP, Hutmacher DW, Milthorpe BK, Knackstedt MA. Assessment of bone ingrowth into porous biomaterials using MICRO-CT. Biomaterials. 2007;28:2491–2504.PubMedCrossRef Jones AC, Arns CH, Sheppard AP, Hutmacher DW, Milthorpe BK, Knackstedt MA. Assessment of bone ingrowth into porous biomaterials using MICRO-CT. Biomaterials. 2007;28:2491–2504.PubMedCrossRef
20.
Zurück zum Zitat Johnson EE, Urist MR, Finerman GA. Resistant nonunions and partial or complete segmental defects of long bones: treatment with implants of a composite of human bone morphogenetic protein (BMP) and autolyzed, antigen-extracted, allogeneic (AAA) bone. Clin Orthop Relat Res. 1992;277:229–237.PubMed Johnson EE, Urist MR, Finerman GA. Resistant nonunions and partial or complete segmental defects of long bones: treatment with implants of a composite of human bone morphogenetic protein (BMP) and autolyzed, antigen-extracted, allogeneic (AAA) bone. Clin Orthop Relat Res. 1992;277:229–237.PubMed
21.
Zurück zum Zitat Kakiuchi M, Hosoya T, Takaoka K, Amitani K, Ono K. Human bone matrix gelatin as a clinical alloimplant: a retrospective review of 160 cases. Int Orthop. 1985;9:181–188.PubMedCrossRef Kakiuchi M, Hosoya T, Takaoka K, Amitani K, Ono K. Human bone matrix gelatin as a clinical alloimplant: a retrospective review of 160 cases. Int Orthop. 1985;9:181–188.PubMedCrossRef
22.
Zurück zum Zitat Kang JD, McKernan DJ, Kruger M, Mutschler T, Thompson WH, Rubash HE. Ingrowth and formation of bone in defects in an uncemented fiber-metal total hip-replacement model in dogs. J Bone Joint Surg Am. 1991;73:93–105.PubMed Kang JD, McKernan DJ, Kruger M, Mutschler T, Thompson WH, Rubash HE. Ingrowth and formation of bone in defects in an uncemented fiber-metal total hip-replacement model in dogs. J Bone Joint Surg Am. 1991;73:93–105.PubMed
23.
Zurück zum Zitat Kieswetter K, Schwartz Z, Hummert TW, Cochran DL, Simpson J, Dean DD, Boyan BD. Surface roughness modulates the local production of growth factors and cytokines by osteoblast-like MG-63 cells. J Biomed Mater Res. 1996;32:55–63.PubMedCrossRef Kieswetter K, Schwartz Z, Hummert TW, Cochran DL, Simpson J, Dean DD, Boyan BD. Surface roughness modulates the local production of growth factors and cytokines by osteoblast-like MG-63 cells. J Biomed Mater Res. 1996;32:55–63.PubMedCrossRef
24.
Zurück zum Zitat Kosashvili Y, Safir O, Backstein D, Lakstein D, Gross AE. Salvage of failed acetabular cages by nonbuttressed trabecular metal cups. Clin Orthop Relat Res. 2010;468:466–471.PubMedCrossRef Kosashvili Y, Safir O, Backstein D, Lakstein D, Gross AE. Salvage of failed acetabular cages by nonbuttressed trabecular metal cups. Clin Orthop Relat Res. 2010;468:466–471.PubMedCrossRef
25.
Zurück zum Zitat Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE. Revision total hip arthroplasty with a modular tapered stem. Hip Int. 2010;20:136–142.PubMed Lakstein D, Kosashvili Y, Backstein D, Safir O, Lee P, Gross AE. Revision total hip arthroplasty with a modular tapered stem. Hip Int. 2010;20:136–142.PubMed
26.
Zurück zum Zitat Maruyama M, Terayama K, Ito M, Takei T, Kitagawa E. Hydroxyapatite clay for gap filling and adequate bone ingrowth. J Biomed Mater Res. 1995;29:329–336.PubMedCrossRef Maruyama M, Terayama K, Ito M, Takei T, Kitagawa E. Hydroxyapatite clay for gap filling and adequate bone ingrowth. J Biomed Mater Res. 1995;29:329–336.PubMedCrossRef
27.
Zurück zum Zitat Nehme A, Lewallen DG, Hanssen AD. Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty. Clin Orthop Relat Res. 2004;429:201–208.PubMedCrossRef Nehme A, Lewallen DG, Hanssen AD. Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty. Clin Orthop Relat Res. 2004;429:201–208.PubMedCrossRef
28.
Zurück zum Zitat Oakes DA, Lee CC, Lieberman JR. An evaluation of demineralized bone matrices in a rat femoral defect model. Clin Orthop Relat Res. 2003;413:281–290.PubMedCrossRef Oakes DA, Lee CC, Lieberman JR. An evaluation of demineralized bone matrices in a rat femoral defect model. Clin Orthop Relat Res. 2003;413:281–290.PubMedCrossRef
29.
Zurück zum Zitat Ramappa M, Bajwa A, Kulkarni A, McMurtry I, Port A. Early results of a new highly porous modular acetabular cup in revision arthroplasty. Hip Int. 2009;19:239–244.PubMed Ramappa M, Bajwa A, Kulkarni A, McMurtry I, Port A. Early results of a new highly porous modular acetabular cup in revision arthroplasty. Hip Int. 2009;19:239–244.PubMed
30.
Zurück zum Zitat Sampath TK, Reddi AH. Dissociative extraction and reconstitution of bone matrix components involved in local bone differentiation. Proc Natl Acad Sci U S A. 1981;78:7599–7603.PubMedCrossRef Sampath TK, Reddi AH. Dissociative extraction and reconstitution of bone matrix components involved in local bone differentiation. Proc Natl Acad Sci U S A. 1981;78:7599–7603.PubMedCrossRef
31.
Zurück zum Zitat Schwartz Z, Mellonig JT, Carnes DL Jr, Dean DD, Cochran DL, Boyan BD. Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation. J Periodontol. 1996;67:918–926.PubMed Schwartz Z, Mellonig JT, Carnes DL Jr, Dean DD, Cochran DL, Boyan BD. Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation. J Periodontol. 1996;67:918–926.PubMed
32.
Zurück zum Zitat Shen WJ, Chung KC, Wang GJ, Balian G, McLaughlin RE. Demineralized bone matrix in the stabilization of porous-coated implants in bone defects in rabbits. Clin Orthop Relat Res. 1993;293:346–352.PubMed Shen WJ, Chung KC, Wang GJ, Balian G, McLaughlin RE. Demineralized bone matrix in the stabilization of porous-coated implants in bone defects in rabbits. Clin Orthop Relat Res. 1993;293:346–352.PubMed
33.
Zurück zum Zitat Shih HN, Shih LY, Sung TH, Chang YC. Restoration of bone defect and enhancement of bone ingrowth using partially demineralized bone matrix and marrow stromal cells. J Orthop Res. 2005;23:1293–1299.PubMed Shih HN, Shih LY, Sung TH, Chang YC. Restoration of bone defect and enhancement of bone ingrowth using partially demineralized bone matrix and marrow stromal cells. J Orthop Res. 2005;23:1293–1299.PubMed
34.
Zurück zum Zitat Sumner DR, Turner TM, Urban RM, Turek T, Seeherman H, Wozney JM. Locally delivered rhBMP-2 enhances bone ingrowth and gap healing in a canine model. J Orthop Res. 2004;22:58–65.PubMedCrossRef Sumner DR, Turner TM, Urban RM, Turek T, Seeherman H, Wozney JM. Locally delivered rhBMP-2 enhances bone ingrowth and gap healing in a canine model. J Orthop Res. 2004;22:58–65.PubMedCrossRef
35.
Zurück zum Zitat Sumner DR, Turner TM, Urban RM, Virdi AS, Inoue N. Additive enhancement of implant fixation following combined treatment with rhTGF-beta2 and rhBMP-2 in a canine model. J Bone Joint Surg Am. 2006;88:806–817.PubMedCrossRef Sumner DR, Turner TM, Urban RM, Virdi AS, Inoue N. Additive enhancement of implant fixation following combined treatment with rhTGF-beta2 and rhBMP-2 in a canine model. J Bone Joint Surg Am. 2006;88:806–817.PubMedCrossRef
36.
Zurück zum Zitat Tiedeman JJ, Connolly JF, Strates BS, Lippiello L. Treatment of nonunion by percutaneous injection of bone marrow and demineralised bone matrix—an experimental study in dogs. Clin Orthop Relat Res. 1991;268:294–302.PubMed Tiedeman JJ, Connolly JF, Strates BS, Lippiello L. Treatment of nonunion by percutaneous injection of bone marrow and demineralised bone matrix—an experimental study in dogs. Clin Orthop Relat Res. 1991;268:294–302.PubMed
37.
Zurück zum Zitat Wang J, Glimcher MJ. Characterization of matrix induced osteogenesis in rat calvarial bone defects: II. Origins of bone-forming cells. Calcif Tissue Int. 1999;65:486–493.PubMedCrossRef Wang J, Glimcher MJ. Characterization of matrix induced osteogenesis in rat calvarial bone defects: II. Origins of bone-forming cells. Calcif Tissue Int. 1999;65:486–493.PubMedCrossRef
38.
Zurück zum Zitat Wazen RM, Lefebvre LP, Baril E, Nanci A. Initial evaluation of bone ingrowth into a novel porous titanium coating. J Biomed Mater Res B Appl Biomater. 2010;94:64–71.PubMed Wazen RM, Lefebvre LP, Baril E, Nanci A. Initial evaluation of bone ingrowth into a novel porous titanium coating. J Biomed Mater Res B Appl Biomater. 2010;94:64–71.PubMed
Metadaten
Titel
The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth
verfasst von
Letitia Lim, MD
J. Dennis Bobyn, PhD
Kristian M. Bobyn, BA
Louis-Philippe Lefebvre, MEng
Michael Tanzer, MD
Publikationsdatum
01.02.2012
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 2/2012
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-011-2011-y

Weitere Artikel der Ausgabe 2/2012

Clinical Orthopaedics and Related Research® 2/2012 Zur Ausgabe

Symposium: Papers Presented at the Annual Meetings of The Hip Society

Incidence of Contralateral THA After Index THA for Osteoarthritis

Symposium: Papers Presented at the Annual Meetings of The Hip Society

Ceramic Bearings for Total Hip Arthroplasty Have High Survivorship at 10 Years

Symposium: Papers Presented at the Annual Meetings of The Hip Society

Tantalum Augments for Paprosky IIIA Defects Remain Stable at Midterm Followup

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.