Abstract
Background:A commercially available nanocrystalline hydroxyapatite paste Ostim® has been reported in few recent studies to surpass other synthetic bone substitutes with respect to the observed clinical results. However, the integration of this implantable material has been histologically evaluated only in animal experimental models up to now. This study aimed to evaluate the tissue incorporation of Ostim® in human cancellous bone after reconstructive bone surgery for trauma.Methods:Biopsy specimens from 6 adult patients with a total of 7 tibial, calcaneal or distal radial fractures were obtained at the time of osteosynthesis removal. The median interval from initial operation to tissue sampling was 13 (range 3–15) months. Samples were stained with Masson-Goldner, von Kossa, and toluidine blue. Osteoid volume, trabecular width and bone volume, and cortical porosity were analyzed. Samples were immunolabeled with antibodies against CD68, CD56 and human prolyl 4-hydroxylase to detect macrophages, osteoblasts, and fibroblasts, respectively. TRAP stainings were used to identify osteoclasts.Results:Histomorphometric data indicated good regeneration with normal bone turnover: mean osteoid volume was 1.93% of the trabecular bone mass, trabecular bone volume – 28.4%, trabecular width – 225.12 μm, and porosity index – 2.6%. Cortical and spongious bone tissue were well structured. Neither inflammatory reaction, nor osteofibrosis or osteonecrosis were observed. The implanted material was widely absorbed.Conclusion:The studied nanocrystalline hydroxyapatite paste showed good tissue incorporation. It is highly biocompatible and appears to be a suitable bone substitute for juxtaarticular comminuted fractures in combination with a stable screw-plate osteosynthesis.
Highlights
A commercially available nanocrystalline hydroxyapatite paste Ostim® has been reported in few recent studies to surpass other synthetic bone substitutes with respect to the observed clinical results
Human allografts offer an abundantly available alternative, which circumvents the potential morbidity of autograft harvest, but relies on a sophisticated bone banking system and carries the potential of disease transmission and immunogenicity
The relative concerns over the use of either autograft or allograft have led to the development of numerous entirely synthetic bone graft substitutes
Summary
A commercially available nanocrystalline hydroxyapatite paste Ostim® has been reported in few recent studies to surpass other synthetic bone substitutes with respect to the observed clinical results. This study aimed to evaluate the tissue incorporation of Ostim® in human cancellous bone after reconstructive bone surgery for trauma. Operative reconstruction of bone defects beyond a certain size is mandatory and still remains a challenge to trauma and orthopedic surgeons. In about 10% of all reconstructive operations because of traumatic, resectional, or congenital defects, bone transplants and bone substitute materials are necessary [2]. Autologous cancellous bone remains the "gold standard" in the reconstruction of bone defects because of its unsurpassed biological activity even in implant sites with low osteogenic potential. Human allografts offer an abundantly available alternative, which circumvents the potential morbidity of autograft harvest, but relies on a sophisticated bone banking system and carries the potential of disease transmission and immunogenicity. The relative concerns over the use of either autograft or allograft have led to the development of numerous entirely synthetic bone graft substitutes
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