Epidermal growth factor or platelet-rich plasma combined with induced membrane technique in the treatment of segmental femur defects: an experimental study

Ökkeş Bilal,Duran Topak,Betül Kızıldağ,Mustafa Kınaş,Abdulkadir Yasir Bahar,Ergül Belge Kurutaş

doi:10.1186/s13018-020-02142-2

Abstract

ObjectiveExtensive bone defects remain a therapeutic challenge necessitating alternative surgical approaches with better outcomes. Can increase the effectiveness of PRP or EGF treatment in surgical treatment of large bone defects with Masquelet technique?Aim of this study examined potential therapeutic benefits of the Masquelet technique with induced membranes in combination with platelet-rich plasma (PRP) or epidermal growth factor (EGF) in a rat model of segmental femur defect.MethodsThree groups each consisting of 20 Sprague-Dawley rats were defined as follows: EGF group, PRP group, and control group. A femoral bone defect was created and filled with antibiotic embedded polymethyl methacrylate. Half of the animals in each group were sacrificed at week 6 and the pseudo-membranes formed were analyzed. In the remaining half, the cement was removed and the space was filled with autograft. After another 6 weeks, the structures formed were examined radiologically, histologically, and biochemically.ResultsAt week 6, both PRP and EGF groups had significantly higher membrane CD31, TGF-beta, and VEGF levels than controls. At week 12, when compared to controls, PRP and EGF groups had significantly higher membrane CD31 levels and the PRP group had significantly higher membrane TGF levels. Regarding bone tissue levels, PRP and EGF groups had significantly higher VEGF levels and the EGF group had significantly higher BMP levels. In addition, PRP and EGF groups had higher radiological scores than controls. However, the two experimental groups did not differ with respect to any parameter tested in this study.ConclusionBoth PRP and EGF seem to be associated with histological, biochemical, and radiological improvements in experimental rat model of Masquelet technique, warranting in further clinical studies.Level of evidenceLevel 5

Highlights

Extensive bone defects due to traumatic injury remain a therapeutic challenge in terms of anatomical and functional outcomes
Masquelet technique has been described as a two-stage treatment strategy for large bone defects that consists of a temporary cement spacer followed by bone grafting [2]
This study examining the effect of two therapeutic approaches, i.e., Platelet-rich plasma (PRP) and epidermal growth factor (EGF), on bone healing when used as an adjunct to the Masquelet technique for the management extensive bone defects has provided promising results in terms of a potential therapeutic benefit

Summary

Introduction

Extensive bone defects due to traumatic injury remain a therapeutic challenge in terms of anatomical and functional outcomes. Masquelet technique has been described as a two-stage treatment strategy for large bone defects that consists of a temporary cement spacer followed by bone grafting [2]. As a result of its potential therapeutic effects, PRP has recently gained significant attention as a safe nonsurgical adjunctive treatment modality for osteoarthritis and musculoskeletal repair [4]. Despite the lack of definitive evidence for the therapeutic benefit of PRP in bone healing [5, 6], a multitude of recent experimental and clinical publications have suggested a potential utility [7,8,9,10,11,12,13]

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