Ideal xenograft or a perfect bone substitute?-A retrospective review and analysis of the historical concept of ivory implants in orthopaedics.

PURPOSE: Surgical treatment of fractures has evolved with the development of anaesthesia in 1846. Experiments with different implants both organic and non-organic had led to introduction of sometimes extremely peculiar materials coming from different species like ox bone or elephant's ivory. The aim of this article is to present not widely known concept of ivory use in bone surgery that set its foot in the history of orthopaedics and laid foundations for orthobiologic reconstructions. METHODS: Retrospective analysis of articles and books published between 1846 and 2017 that describe various examples of ivory application in the treatment of fresh fractures, non-unions and reconstruction of joints. RESULTS: Our research shows that ivory to the surgical world was introduced by Friedrich Dieffenbach, founder of the modern plastic surgery. It was also used with different rate of success by many of the famous surgeons of the nineteenth and twentieth century to include Trendelenburg, Billroth, Volkmann, Paget and Hey Groves. Ivory was immensely popular in bone surgery and became material of choice demonstrating amazing biological properties and very low rate of infections. CONCLUSION: Ivory has served well in successful treatment of various orthopaedic conditions for over 100 years. In this article, we are using history as a stepping stone to examine material that is not rejected by the body and promotes bony healing without increased infection or other complications. It is worth considering further analysis of historically acquired specimens for further development of materials for further orthopaedic fracture and reconstructive techniques.

A history of calcium orthophosphates (CaPO4) and their biomedical applications.

The historical development of a scientific knowledge on calcium orthophosphates (CaPO4) from 1770-s till 1950 is described. Many forgotten and poorly known historical facts and approaches have been extracted from old publications and then they have been analyzed, systematized and reconsidered from the modern point of view. The chosen time scale starts with the earliest available studies of 1770-s (to the best of my findings, CaPO4 had been unknown before), passes through the entire 19th century and finishes in 1950, because since then the amount of publications on CaPO4 rapidly increases and the subject becomes too broad. Furthermore, since publications of the second half of the 20th century are easily accessible, the substantial amount of them has been already reviewed by other researchers. The reported historical findings clearly demonstrate that the substantial amount of the scientific facts and experimental approaches has been known for very many decades and, in fact, the considerable quantity of relatively recent investigations on CaPO4 is just either a further development of the earlier studies or a rediscovery of the already forgotten knowledge.

Materials used in cranioplasty: a history and analysis.

Cranioplasty, one of the oldest surgical procedures used to repair cranial defects, has undergone many revolutions over time to find the ideal material to improve patient prognosis. Cranioplasty offers cosmetic and protective benefits for patients with cranial defects. The first primitive cranioplasty procedures date back to 7000 bc and used metal and gourds to repair cranial defects. Cranioplasty was first documented by Fallopius who described repair using gold plates; the first bone graft was documented by van Meekeren. The first significant improvement for this procedure began with experimentation involving bone grafts in the late 19th century as a more natural approach for repairing cranial defects. The next impetus for advancement came because of wartime injuries incurred during World Wars I and II and involved experimentation with synthetic materials to counter the common complications associated with bone grafts. Methyl methacrylate, hydroxyapatite, ceramics, and polyetheretherketone implants among other materials have since been researched and used. Research now has shifted toward molecular biology to improve the ability of the patient to regenerate bone using bone growth factors. This paper reviews the evolution of materials used over time in addition to the various advantages and pitfalls associated with each change. It is important for neurosurgeons to be mindful of how these techniques have evolved in order to gain a better understanding of this procedure and how it has been adapted.

Historical review of bone prefabrication.

Prefabricated tissue represents a bridge between traditional reconstructive surgery and tissue engineering. Initially used in the 1960s in reconstructive plastic surgery, in the 1980s it was also used in orthopedics. The term "prefabricated" indicates a process of neovascularization of a tissue by implanting a vascular pedicle inside the tissue itself; this tissue can be then reimplanted either at a short distance through the pedicle itself, or as a free graft by microvascular anastomosis. The purpose of prefabrication is to build a tissue (muscle, bone, skin, or composite) with characteristics as similar as possible to those of the defect to fill, thus minimizing morbidity in the donor site and improving the reconstructive effectiveness. We present a review of the literature that includes the main experiments performed until now in which a bone segment has been reconstructed using scaffolds and growth factors in relationship to the local blood supply or to the use of a vascular pedicle.

Historic and current strategies in bone tissue engineering: do we have a hope in Hench?

Professors Larry Hench and Julia Polak formed the Tissue Engineering and Regenerative Medicine Centre (TERM) at Imperial College London to foster collaborations between biologists and materials scientists. Early work at the center elucidated the biomolecular interactions between primary human osteoblasts and 45S5 Bioglass . As research efforts expanded, the team discovered that the dissolution products of both 45S5 Bioglass and 58S sol-gel bioactive glasses had osteoblastic stimulatory properties. To address the shortage of appropriate cells for bone tissue engineering applications, TERM scientists also demonstrated the differentiation of embryonic stem (ES) cells to osteoblasts when treated with the dissolution products of bioactive glasses. They also found that the soluble factors ascorbic acid, beta -glycerophosphate, and dexamethasone preferentially differentiated ES cells to osteoblasts, and their combination with the dissolution products of bioactive glasses stimulated differentiation even further. Taken together, these results demonstrate the suitability of bioactive glasses as scaffolds for bone tissue engineering as they not only provide an osteoconductive and osteoproductive substrate, but also actively stimulate cells to express appropriate osteoblastic phenotypes. Professor Hench's vision to pioneer regenerative medicine research continues with the aim of developing novel therapeutics to treat musculoskeletal disability.

Repairing holes in the head: a history of cranioplasty.

Cranioplasty is almost as ancient as trephination, yet its fascinating history has been neglected. There is strong evidence that Incan surgeons were performing cranioplasty using precious metals and gourds. Interestingly, early surgical authors, such as Hippocrates and Galen, do not discuss cranioplasty and it was not until the 16th century that cranioplasty in the form of a gold plate was mentioned by Fallopius. The first bone graft was recorded by Meekeren, who in 1668 noted that canine bone was used to repair a cranial defect in a Russian man. The next advance in cranioplasty was the experimental groundwork in bone grafting, performed in the late 19th century. The use of autografts for cranioplasty became popular in the early 20th century. The destructive nature of 20th century warfare provided an impetus to search for alternative metals and plastics to cover large cranial defects. The metallic bone substitutes have largely been replaced by modern plastics. Methyl methacrylate was introduced in 1940 and is currently the most common material used. Research in cranioplasty is now directed at improving the ability of the host to regenerate bone. As modern day trephiners, neurosurgeons should be cognizant of how the technique of repairing a hole in the head has evolved.