Non-invasive massive growing prostheses reduce infection in paediatric cancer patients.

PURPOSE: In this study, we asked the question of whether non-invasive (NI) extendible bone tumour implants are as reliable and reduce infection when compared with patients who received a minimally invasive (MI) extendible implant. METHODS: Forty-two NI extendible bone tumour implants were investigated at a mean follow-up of 22 months (range, 1-87 months) and 63 MI implants at a mean follow-up of 49 months (range, 1-156 months). RESULTS: Kaplan-Meier analysis showed that the probability of MI implant survival was 58.8% compared with 78.6% in NI patients. No significant difference between these two patient groups was found. Infection was the main reason for failure in the MI implant group where nine (35%) implants were revised. However, only one (11%) NI implant was revised for infection ( p = 0.042). None of the NI implants failed due to aseptic loosening; however, six (23%) MI implants were revised for aseptic loosening of the intramedullary stem. Four (15%) of the failed MI implants were revised due to full extension and five (56%) of failed NI implants were replaced as the implant had been fully extended where the patient still required growth. CONCLUSION: Where possible, an NI massive prosthesis should be used in this patient group. Our results suggest that MI prostheses should be infrequently used due to the high incidence of infection. Lengthening of NI prostheses is painless, can be carried out in the clinic and is more cost-effective. However, further work is required to increase the amount of growth potential available in these implants.

CXCR4 Has the Potential to Enhance Bone Formation in Osteopenic Rats.

Osteoporosis is characterized by reduced bone mass and aberrant bone microarchitecture, thus increasing susceptibility to fracture due to reduced strength and quality. The aims of this study were to investigate the role of CXCR4 transfected on stem cell homing and osteogenic characteristics in osteopenic rats, particularly elucidating the effect on cell migration. METHODS: Mesenchymal stem cells (MSCs) were harvested from young, and ovariectomized animals and transfected with CXCR4; these cells were administered intravenously in ovariectomized rats. Micro CT and mechanical testing were completed after 12 weeks. RESULTS: Rats injected with young CXCR4 transfected cells had significantly higher bone mineral density (BMD) compared to placebo injected rats (p < 0.05). Rats injected with ovariectomized CXCR4 transfected cells had higher BMD compared to those injected with saline or nontransfected cells (p < 0.04). L4 vertebral stiffness was significantly higher in rats treated with young CXCR4 transfected cells compared to all other groups (p < 0.05). CONCLUSION: CXCR4 genetically modified cells from young and ovariectomized sources improve some aspects of bone formation in the ovariectomized model of osteoporosis and, thus, may play a role in patient treatment regimens.

The effect of increased microporosity on bone formation within silicate-substituted scaffolds in an ovine posterolateral spinal fusion model.

This study compared the bone forming capacity of the same formulation of silicate-substituted bone graft substitute materials with different microporosity in an instrumented posterolateral spinal fusion ovine model. Materials with a strut porosity of (i) 22.5% (SiCaP) or (ii) 36.0% (SiCaP(+)) were packed along either side of the spine. Bone apposition rates, % new bone formation, % bone-implant contact, and % graft resorption were quantified at 8, 12, and 24 weeks post surgery. Computed Tomography (CT) was used to grade the formation of fusion bridges between vertebrae. Results showed no significant difference in bone apposition rates, % new bone formation, and % bone-implant contact when the two materials were compared. However, at 8 weeks, a significantly higher CT score was obtained in the SiCaP(+) group (0.83 ± 0.17) when compared with the SiCaP group (0.17 ± 0.17; p = 0.027). Significantly less scaffold remained in the SiCaP(+) group at 12 weeks (p = 0.018). Both SiCaP and SiCaP(+) formulations augmented bone formation. Increasing the strut porosity did not significantly increase bone formation however, at 8 weeks it promoted the formation of more highly mineralized bone resulting in a significantly higher CT score, suggesting the bone tissue formed was more mature. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 805-814, 2017.

Long-term survival of cemented distal femoral endoprostheses with a hydroxyapatite-coated collar: a histological study and a radiographic follow-up.

BACKGROUND: The objective of this study was to examine the degree of osteointegration into a hydroxyapatite-coated collar and relate this finding to aseptic loosening in patients with a distal femoral replacement used to treat primary bone cancer. Our hypothesis was that the implant collar would increase osteointegration and reduce the rate of aseptic implant loosening. METHODS: Sixty-one patients treated with a primary cemented distal femoral prosthesis between 1992 and 2001 were included in this study. The mean duration of follow-up was 8.5 years (range, two to eighteen years). Extracortical bone growth into the grooved hydroxyapatite-coated collar was quantified radiographically. Histological sections through four hydroxyapatite-coated collars and four implants with no collar, retrieved following amputation due to local recurrence or at autopsy at a mean of 3.5 years (range, 1.4 to 6.1 years) after implantation, were evaluated as well. RESULTS: Five (8%) of the implants were revised because of aseptic loosening, 3% of the implants fractured, and 3% were revised because of infection. Six limbs (10%) required amputation because of local tumor recurrence. On radiographs, osteointegration into the collar was seen to have occurred in 70% of the patients and did not correlate with sex, age, diagnosis, or length of time postoperatively. Histological analysis showed mature lamellar bone within the grooves of the hydroxyapatite-coated collar, and bone was observed in direct contact with the hydroxyapatite coating. Extracortical bone failed to make direct contact with the surface of the implants manufactured without a collar. CONCLUSIONS: The use of cemented distal femoral massive bone tumor prostheses with a hydroxyapatite-coated collar located at the shoulder of the implant was followed by a low (8%) rate of revision due to aseptic loosening. The use of hydroxyapatite grooved collars may lead to osteointegration of the implant shoulder (collar) and may reduce the rate of aseptic loosening.

Augmentation of bone growth onto the acetabular cup surface using bone marrow stromal cells in total hip replacement surgery.

Aseptic loosening of acetabular components in total hip arthroplasty is the major cause of implant failure. Our hypothesis was that spraying autologous bone marrow-derived stromal cells (BMSCs) in fibrin glue onto the surface of hydroxyapatite-coated uncemented acetabular components would increase bone formation and contact in a caprine model. Ten million BMSCs were sprayed onto the acetabular cup at the time of surgery. Animals in the control group received fibrin glue only. Ground reaction force measurements were taken preoperatively and at 6 and 12 weeks postsurgery. After retrieval at 12 weeks new bone formation, bone-implant contact and fibrous tissue thickness adjacent to the cup were quantified. Viability and proliferation assays showed that the majority of the BMSCs survived spraying in fibrin glue at pressures of up to 1.5 atm. New bone growth adjacent to the bone implant interface in the BMSC-treated group (71.42 +/- 8.97%) was 30% greater than in control (54.22 +/- 16.56%) although this difference was not statistically significant. However, significantly increased new bone formation was measured at the periphery of the cup (zone 5) in the BMSC-treated group (71.97 +/- 10.91%) when compared with control (23.85 +/- 15.13%, p = 0.028). Bone-implant contact was significantly greater in the BMSC-treated group (20.03 +/- 4.64%) (control: 13.71 +/- 8.32%, p = 0.027); correspondingly, the average thickness of the fibrous tissue membrane where present was significantly reduced at the periphery of the cups in the BMSC-treated group (327.49 +/- 20.38 mum) when compared with control (887.21 +/- 158.89 mum) (p = 0.02). This study has clinical applications as greater bone contact at the cup surface will improve fixation and may decrease longer-term aseptic loosening by preventing wear debris-induced bone loss at the implant interface.

Role of hydroxyapatite coating in resisting wear particle migration and osteolysis around acetabular components.

The main problem facing the longevity of total joint replacements is wear particle-induced osteolysis, particularly around the acetabular component. Ovine Total Hip Replacement surgery was performed with roughened femoral heads in order to enhance wear debris generation in vivo. The resistance to aseptic loosening of acetabular components with different surface coatings was investigated. Implants remained in vivo for 1 year. Sheep were randomly assigned to one of six experimental groups where the acetabular cup was fixed utilising an: (a) cemented polyethylene acetabular cup, (b) metal backed grit blasted surface, (c) metal backed plasma sprayed titanium porous coating, (d) metal backed sintered beaded coating, (e) Hydroxyapatite (HA)-coated grit blasted surface (f) and HA-coated porous components. Ground Reaction Force (GRF) was used to asses the functional performance of the implants and data was collected pre-operatively and at 12, 24, 36 and 52 weeks post op. Wear debris generated was analysed and radiographs taken prior to preparation of thin sections. Fibrous tissue (FT) thickness and bone contact at 1 mm intervals along the acetabular bone-implant interface was calculated. GRF data demonstrated significant differences between experimental groups. In all groups there was an increase in the function of the hip after surgery and up to 24 weeks but thereafter the function of the group with the grit blasted surface reduced whereas the function of the other groups did not significantly change. Average wear particles generated were <1 microm in size. The cemented group demonstrated a significantly thicker average FT layer (2.69 mm) when compared with all other groups (p<0.05 in all cases) except the grit blasted group (1.56 mm). HA porous coated cups demonstrated significantly least fibrous tissue adjacent to its interface when compared with all other groups (cemented p<0.05, grit blasted p=0.029, porous p<0.05, sintered beads p<0.05 and HA grit blasted p<0.05). Significantly increased bone contact to HA-coated porous cups (73.33%) when compared with all groups was identified except HA-coated grit blasted cups where no significant difference was demonstrated. Radiographic signs of loosening were visible in all groups except the HA-coated porous group. Results demonstrated that HA porous coated acetabular components significantly enhanced bone ingrowth in the presence of wear particles, preventing their migration and reducing osteolysis. Non-HA-coated porous and sintered beaded components provided a more effective seal against the ingress of wear debris when compared with cemented cups.