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Recommendations and Considerations for the Use of Biologics in Orthopedic Surgery

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Abstract

Reconstruction of extensive bone defects remains technically challenging and has considerable medical and financial impact on our society. Surgical procedures often require a bone/substitute graft to enhance and accelerate bone repair. Bone autografts are associated with morbidity related to bone harvesting and are limited in quantity. Alternatively, bone allografts expose the patient to the risk of transmission of infectious disease. Synthetic bone graft substitutes, such as calcium sulfates, hydroxyapatite, tricalcium phosphate, and combinations, circumvent some of the disadvantages of auto- and allografts, but have limited indications. Biomedical research has made possible the stimulation of the body’s own healing mechanisms, either by delivering exogenous growth factors locally, or by stimulating their local production by gene transfer. Among all known factors having osteoinductive properties, only two bone morphogenetic proteins (for specific indications) and demineralized bone matrix have been approved for clinical use. In addition, ongoing research is exploring the efficacy of cell therapy and tissue engineering. The present report examines the composition, biological properties, indications, clinical experience and regulations of several of the biotherapeutics employed for bone reconstruction.

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Acknowledgements

Supported in part by the Ellenburg Chair in Surgery, Stanford University. SBG holds stock/stock options from Biomimedica, Biomimetic Therapeutics, StemCor, Accelalox and Tibion. No competing financial interests exist for the authors.

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  1. Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Stanford, Redwood City, California, 94063, USA

    Stefan Zwingenberger, Christophe Nich, Roberto D. Valladares, Zhenyu Yao &  Stuart B. Goodman

  2. Department of Orthopaedics, University Hospital Carl Gustav Carus at Technical University Dresden, Dresden, Germany

    Stefan Zwingenberger & Maik Stiehler

  3. Laboratoire de Biomécanique et Biomatériaux Ostéo-Articulaires, UMR CNRS 7052, Faculté de Médecine, Université Paris 7, Paris, France

    Christophe Nich

  4. Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique, Hôpitaux de Paris, Université Paris 5, Paris, France

    Christophe Nich

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  1. Stefan Zwingenberger
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Correspondence to Stuart B. Goodman.

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Zwingenberger, S., Nich, C., Valladares, R.D. et al. Recommendations and Considerations for the Use of Biologics in Orthopedic Surgery. BioDrugs 26, 245–256 (2012). https://doi.org/10.1007/BF03261883

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