Bone Graft Replacement Research Articles

Zinc nanoparticles induced eggshell collagen membrane used for guided bone regeneration: A novel approach in rabbit models.

Conventional methods of guided bone regeneration (GBR) in bone tissue engineering frequently encounter challenges in attaining adequate antibacterial and osteogenic qualities owing to intrinsic limits. The purpose of this preclinical study was to assess the effectiveness of two distinct membranes, Healiguide® and a unique GBR membrane produced from eggshell membranes (ESM), in combination with bone graft replacement in animal models. The objective of this study was to evaluate the efficacy of a new guided bone regeneration membrane developed from eggshell membrane that incorporates zinc nanoparticles for the regeneration of bone tissue in rabbit models. Groups A (no membrane), B (new ESM GBR membrane), and C (Healiguide® membrane) were assigned to three groups, with eight male New Zealand rabbits weighing two-three kilograms each. Standardized surgical procedures were implemented, and histological analysis along with radiographic examination was used for follow-up assessments six and 12weeks after surgery. Radiographic examination and histological sectioning revealed differences in bone density and quality between the groups. Group B showed the highest level of bone regeneration, followed by Groups C and A. Statistical analysis confirmed a significant difference between the groups (p < 0.05). The eggshell membrane showed encouraging results in the enhancement of bone regeneration and integration in rabbit models. These results suggest its potential as a viable alternative to GBR in bone tissue engineering, with promising prospects for improving clinical outcomes. However, additional studies and clinical trials are required to confirm its safety and effectiveness for medical use.

Mechanical Properties, Drug Release, Biocompatibility, and Antibacterial Activities of Modified Emulsified Gelatin Microsphere Loaded with Gentamicin Composite Calcium Phosphate Bone Cement In Vitro.

Bone defects are commonly addressed with bone graft substitutes; however, surgical procedures, particularly for open and complex fractures, may pose a risk of infection. As such, a course of antibiotics combined with a drug carrier is often administered to mitigate potential exacerbations. This study involved the preparation and modification of emulsified (Em) crosslinking-gelatin (gel) microspheres (m-Em) to reduce their toxicity. The antibiotic gentamicin was impregnated into gel microspheres (m-EmG), which were incorporated into calcium phosphate bone cement (CPC). The study investigated the effects of m-EmG@CPC on antibacterial activity, mechanical properties, biocompatibility, and proliferation and mineralization of mouse progenitor osteoblasts (D1 cells). The average size of the gel microspheres ranged from 22.5 to 16.1 μm, with no significant difference between the groups (p > 0.05). Most of the oil content within the microspheres was transferred through modification, resulting in reduced cytotoxicity. Furthermore, antibiotic-impregnated m-EmG did not compromise the intrinsic properties of the microspheres and exhibited remarkably antibacterial effects. After combining with CPC (m-EmG@CPC), the microspheres did not significantly hinder the CPC reaction and produced the main product, hydroxyapatite (HA). However, the compressive strength of the largest microsphere content of 0.5 wt.% m-EmG in CPC decreased significantly from 59.8 MPa of CPC alone to 38.7 MPa of 0.5m-EmG@CPC (p < 0.05). The 0.5m-EmG@CPC composite was effective against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) in drug release and antibacterial tests. Compared with m-EmG alone, the 0.5m-EmG@CPC composite showed no toxicity to mouse fibroblast cells (L929). Additionally, the proliferation and mineralization of mouse osteoblastic osteoprogenitor cells (D1 cells) did not have a negative impact on the 0.5m-EmG@CPC composite over time in culture compared with CPC alone. Results suggest that the newly developed antibacterial 0.5m-EmG@CPC composite bone cement did not negatively affect the performance of osteoprogenitor cells and could be a new option for bone graft replacement in surgeries.

Advances in the use of calcium silicate-based materials in bone tissue engineering

As the main means of treating bone defects, bone grafts are in high demand. Recently, the development of suitable bone graft replacement materials has received significant research attention because of the drawbacks of autologous and allogeneic bone grafts. The applications of ceramic bone graft materials, such as calcium phosphate, calcium sulfate, and hydroxyapatite, are limited by various factors. Calcium silicate,a new bone graft material, exhibits high biocompatibility and osteoinductivity. This paper summarizes the main methods for synthesizing calcium silicate and compares their advantages and disadvantages in detail. The mechanical and antimicrobial properties of calcium silicate can be improved to fulfil the biological and mechanical requirements of bone graft materials by adding materials such as B2O3, SiO2, Ag, Zn, Ti, and chitosan. Recent research progress in calcium silicate ceramics in preliminary clinical applications as well as 3D printing applications is also reviewed, which provide the impetus for the clinical application of calcium silicate ceramics. Finally, the article suggests future directions for the development of calcium silicate-based materials and offer prospects for their application as bone repair and replacement materials.

Biomedical applications of ion-doped bioactive glass: a review

Bioactive glasses (BG) have been used in biomedical (dental applications or bone graft replacement for bone healing) and technological applications, and researchers have focused on the use of BGs in wound therapeutic and soft tissue. Researchers are concentrating their efforts on the creation of novel treatments for microbial infections due to the worrisome and rapid rise in drug-resistant microbial-related infections. In this review paper, we will discuss the main representatives of antimicrobial efficiency of metallic ion-doped bioactive glasses and their potential applications in the medical field. We will also go over the most important currently used and newly developed methods for surface and bulk modification of metallic ion-doped BG concerning new surgical therapy, which are used to enhance bio integration, pathogen killing effectiveness, decrease or eliminate cancer cells, mechanistic integration, a reduction in material costs, improved in BG bioactivity, angiogenic potential, biocompatibility, osteoconductive, biodegradability and mechanical integration. The integration and regulated release of antibacterial metallic ions like silver, copper, zinc, manganese, cerium, and gallium cations into the BG are one of the most appealing methods for preventing bacterial growth and reproduction. The porosity of BG matrixes (metallic ion-doped BG with micro-, meso-, and macro-porous porosity types), in combination with their low cytotoxicity, high specific surface area, and tunable pore structure, greatly facilitates the formation of hydroxyapatite or hydroxyl carbonate apatite.

Role of Biomaterials Used for Periodontal Tissue Regeneration-A Concise Evidence-Based Review.

Periodontal infections are noncommunicable chronic inflammatory diseases of multifactorial origin that can induce destruction of both soft and hard tissues of the periodontium. The standard remedial modalities for periodontal regeneration include nonsurgical followed by surgical therapy with the adjunctive use of various biomaterials to achieve restoration of the lost tissues. Lately, there has been substantial development in the field of biomaterial, which includes the sole or combined use of osseous grafts, barrier membranes, growth factors and autogenic substitutes to achieve tissue and bone regeneration. Of these, bone replacement grafts have been widely explored for their osteogenic potential with varied outcomes. Osseous grafts are derived from either human, bovine or synthetic sources. Though the biologic response from autogenic biomaterials may be better, the use of bone replacement synthetic substitutes could be practical for clinical practice. This comprehensive review focuses initially on bone graft replacement substitutes, namely ceramic-based (calcium phosphate derivatives, bioactive glass) and autologous platelet concentrates, which assist in alveolar bone regeneration. Further literature compilations emphasize the innovations of biomaterials used as bone substitutes, barrier membranes and complex scaffold fabrication techniques that can mimic the histologically vital tissues required for the regeneration of periodontal apparatus.

Direct 3D Printing of Seashell Precursor toward Engineering a Multiphasic Calcium Phosphate Bone Graft

Multiphasic calcium phosphate (Ca-P) has widely been explored for bone graft replacement. This study represents a simple method of developing osteoinductive scaffolds by direct printing of seashell resources. The process demonstrates a coagulation-assisted extrusion-based three-dimensional (3D) printing process for rapid fabrication of multiphasic calcium phosphate-incorporated 3D scaffolds. These scaffolds demonstrated an interconnected open porous architecture with improved compressive strength and higher surface area. Multiphasic calcium phosphate (Ca-P) and hydroxyapatite present in the multi-scalar naturally resourced scaffold displayed differential protein adsorption, thus facilitating cell adhesion, migration, and differentiation, resulting in enhanced deposition of the extracellular matrix. The microstructural and physicochemical attributes of the scaffolds also lead to enhanced stem cell differentiation as witnessed from gene and protein expression analysis. Furthermore, the histological study of subcutaneous implantation evidently portrays promising biocompatibility without foreign body reaction. Neo-tissue in-growth was manifested with abundant blood vessels, thus indicative of excellent vascularization. Notably, cartilaginous and proteoglycan-rich tissue deposition indicated ectopic bone formation via an endochondral ossification pathway. The hierarchical interconnected porous architectural tribology accompanied with multiphasic calcium phosphate composition manifests its successful implication in enhancing stem cell differentiation and promoting excellent tissue in-growth, thus making it a plausible alternative in bone tissue engineering applications.

Three-dimensional-printed individualized porous implants: A new “implant-bone” interface fusion concept for large bone defect treatment

Bone defect repairs are based on bone graft fusion or replacement. Current large bone defect treatments are inadequate and lack of reliable technology. Therefore, we aimed to investigate a simple technique using three-dimensional (3D)-printed individualized porous implants without any bone grafts, osteoinductive agents, or surface biofunctionalization to treat large bone defects, and systematically study its long-term therapeutic effects and osseointegration characteristics. Twenty-six patients with large bone defects caused by tumor, infection, or trauma received treatment with individualized porous implants; among them, three typical cases underwent a detailed study. Additionally, a large segmental femur defect sheep model was used to study the osseointegration characteristics. Immediate and long-term biomechanical stability was achieved, and the animal study revealed that the bone grew into the pores with gradual remodeling, resulting in a long-term mechanically stable implant-bone complex. Advantages of 3D-printed microporous implants for the repair of bone defects included 1) that the stabilization devices were immediately designed and constructed to achieve early postoperative mobility, and 2) that osseointegration between the host bone and implants was achieved without bone grafting. Our osseointegration method, in which the “implant-bone” interface fusion concept was used instead of “bone-bone” fusion, subverts the traditional idea of osseointegration.

3D-Printed Individualized Porous Implants for Large Bone Defects: Novel Therapeutic Approach Involving 'Implant-Bone' Interface Fusion

Background: Bone defect repairs are based on bone graft fusion or replacement. However, current large bone defect treatments are inadequate and lack reliable technology. Therefore, we aimed to investigate a simple technique that uses three-dimensional (3D)-printed individualized porous implants without any bone grafts, osteoinductive agents, or surface biofunctionalization to treat large bone defects and systematically study its long-term therapeutic effects and osseointegration characteristics. Methods: Twenty-six patients with large bone defects caused by a tumor, infection, or trauma received treatment with an individualized porous implant; among these, three typical cases underwent a detailed study. Additionally, the large segmental femur defect sheep model was used to study the osseointegration characteristics. Findings: Immediate and long-term biomechanical stability was achieved in patients, and the animal study revealed that the bone grew into the pores with gradual remodeling, resulting in a long-term mechanically stable bone-implant complex. Interpretation: Advantages of 3D-printed microporous implants for the repair of bone defects included the following: stabilization devices were immediately designed and constructed to achieve early postoperative mobility and osseointegration between the host bone and implants was achieved without bone-grafting. Our osseointegration method, in which a microporous metal was used instead of a bone, subverts the traditional idea of osseointegration. Funding: This work was supported by the Ministry of Science and Technology of the People's Republic of China (no. 2016YFB1101501), Beijing Municipal Science & Technology Commission (Project Z181100001718195), and Beijing AKEC Medical Co., Ltd. Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: Study animals: Approval from the Animal Ethics Committee of Peking University Health Science Center (approval no. LA2014214). The study protocol was approved by Peking University Third Hospital Medical Science Research Ethics Committee (IR6761- 2016146). All patients provided informed consent.

Management Options in Avascular Necrosis of Talus.

Avascular necrosis (AVN) of the talus can be a cause of significant disability and is a difficult problem to treat. The most common cause is a fracture of the talus. We have done a systematic review of the literature with the following aims: (1) identify and summarize the available evidence in literature for the treatment of talar AVN, (2) define the usefulness of radiological Hawkins sign and magnetic resonance imaging in early diagnosis, and (3) provide patient management guidelines. We searched MEDLINE and PUBMED using keywords and MESH terminology. The articles' abstracts were read by two of the authors. Forty-one studies met the inclusion criteria of the 335 abstracts screened. The interventions of interest included hindfoot fusion, conservative measures, bone grafting, vascularized bone graft, core decompression, and talar replacement. All studies were of Level IV evidence. We looked to identify the study quality, imprecise and sparse data, reporting bias, and the quality of evidence. Based on the analysis of available literature, we make certain recommendations for managing patients of AVN talus depending on identified disease factors such as early or late presentation, extent of bone involvement, bone collapse, and presence or absence of arthritis. Early talar AVN seems best treated with protected weight bearing and possibly in combination with extracorporeal shock wave therapy. If that fails, core decompression can be considered. Arthrodesis should be saved as a salvage procedure in late cases with arthritis and collapse, and a tibiotalocalcaneal fusion with bone grafting may be needed in cases of significant bone loss. Role of vascularized bone grafting is still not defined clearly and needs further investigation. Future prospective, randomized studies are necessary to guide the conservative and surgical management of talar AVN.

Bone regeneration using composite non-demineralized xenogenic dentin with beta-tricalcium phosphate in experimental alveolar cleft repair in a rabbit model

BackgroundAlveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone.MethodsUnilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were filled with β-TCP, whereas 8 defects filled with composite xenogenic dentin with β-TCP. Bone regeneration of the healed defects was compared at the 8 weeks after intervention. Quantification of bone formation was analyzed using micro-computed tomography (µCT) and histomorphometric analysis.ResultsµCT and histomorphometric analysis revealed that defects filled with composite dentin/β-TCP showed statistically higher bone volume fraction, bone mineral density and percentage residual graft volume when compared to β-TCP alone. An improved surgical handling of the composite dentin/β-TCP graft was also noted.ConclusionsComposite xenogenic dentin/β-TCP putty expresses enhanced bone regeneration compared to β-TCP alone in the reconstruction of rabbit alveolar clefts defects.

A Viscoelastic Study of Poly(ε-Caprolactone) Microsphere Sintered Bone Tissue Engineering Scaffold

Tissue engineering scaffolds are intended as a replacement for conventional bone grafts used in the treatment of bone damages. One of the challenges in bone tissue engineering is to fabricate scaffolds with large pores, high porosity, and at the mean time proper mechanical properties suitable for bone applications. The elastic properties Young’s modulus and yield strength) of these scaffolds have been mostly considered but since bone is a viscoelastic material it is necessary to evaluate this behavior of the scaffolds as well. In the current study the novel method of microsphere sintering as a bottom-up approach was used to fabricate porous three dimensional (3D) bone scaffolds made of poly(e-caprolactone) with controlled properties. Different variables effective on the mechanical and architectural properties of the scaffold (including time and temperature of the sintering process) were investigated and the optimum conditions (100 min and 64.5 °C) to fabricate scaffolds with the highest possible mechanical properties and porosity were determined (Young’s modulus = 33.61 MPa, yield strength = 2.2 MPa, with 44.5% porosity). Then the viscoelastic properties of this scaffold was evaluated and studied using stress relaxation test (25% stress relaxation) and generalized Maxwell model and compared to bone. Based on these results, the highly interconnected scaffold showed proper mechanical properties, pore size and structure proper for bone tissue engineering.

Characterisation of a novel poly (ether ether ketone)/calcium sulphate composite for bone augmentation

BackgroundCalcium sulphate (CS) has been used in bone grafting since the 1800s. It has not replaced autograft as the gold standard, however, since its dissolution occurs rapidly in bodily fluids, meaning that the material cannot support long-term bone growth. Here, the polymer poly (ether ether ketone) (PEEK) was used to slow dissolution in in vitro physiological environments and augment the mechanical properties of the material.MethodsPEEK/CS specimens were fabricated by combining powders of PEEK and CS with water, resulting in a hardening paste. To enhance physical interactions between phases, cylindrical specimens were heat-treated to melt and fuse the PEEK. Following analysis of physical and chemical interactions by SEM and FT-IR respectively, dynamic ageing in PBS and compression testing was undertaken to measure how the PEEK influenced the mechanical properties of the final parts. Changes in structure and chemistry were determined using helium pycnometry, SEM and analysis of powder XRD patterns.ResultsPowders of PEEK and CS hemihydrate (CSH) (CaSO4.0.5H2O) were combined with PEEK at 0 wt%, 2.5 wt%, 20 wt%, 40 wt% and 80 wt% and at a P:L ratio of 0.85 g/mL. The subsequently hardened structures were heat-treated, which initiated the melting of PEEK and dehydration of CSD (CaSO4.2H2O) to the CS anhydrite (CSA) (CaSO4) phase, which changed colour and apparent volume. FT-IR and SEM analysis revealed heat treatment of PEEK/CS specimens facilitated both physical and chemical interactions between phases. Over a period of 21 days of ageing in PBS, the hydration of CS was determined by XRD and improved specimen longevity at all levels of PEEK wt% loading was measured compared with the control. Importantly, increasing PEEK wt% loading resulted in a marked increase in the mechanical properties of PEEK/CS specimens in terms of both compressive strength and modulus.ConclusionsReinforcement of CS with PEEK significantly enhanced in vitro dissolution resistance, in addition to enhancing mechanical properties. This composite therefore has significant future potential as a bone graft replacement.

Keratocystic odontogenic tumor of mandible

Keratocystic odontogenic tumor is considered to be a benign cystic neoplasia of jaw bone with a higher rate of recurrence. It is noted to be third most common odontogenic cyst after radicular and dentigerous cyst. Most common location is posterior mandible and ascending ramus. A case with odontogenic keratocyst of the right posterior mandible is presented with proper clinical and radiographic examinations along with histopathological investigation. Cystic lesion was surgically resected with iliac crest bone graft replacement and reconstruction plate placement. Follow-up of 1 year is completed with repeated radiographic examinations in 4 months interval with no evidence of recurrence.

Use of bone graft replacement in spinal fusions

The rationale for the increasing use of bone graft replacement lies in the need for increased graft volume, the avoidance of typical autograft donor site morbidity, and the potential improvement of fusion rates in revision and complex reconstructive surgery. The purpose of this work is to offer the spinal surgeon an evidence-based guide for choosing the appropriate grafting material and for using it effectively. Evidence-based overview of physical and biological properties, clinical indications and results of osteoconductive and osteoinductive bone replacement materials. The ideal bone replacement material should be osteoinductive and conductive, non-pathogenic, minimally antigenic, and (if required) mechanically stable. Compared to autograft, vascularization and remodeling of the fusion mass are delayed using allograft. Allogenous bone and demineralized bone matrix (DBM) possess limited osteoinductive properties and carry the risk of potential infectious disease transmission. Plasma-rich plasma (PRP) and bone marrow aspirate are commonly used in conjunction with an osteoconductive carrier materials. On-label use of bone morphogenetic proteins (BMPs) is currently restricted to mono- and bisegmental anterior lumbar fusion. The fusion rates obtained with BMPs match those of autologous bone graft. Potential risks of rhBMP in clinical use include soft tissue reactions, radiculitis and potentially increased risk of cancer. Osteoconductive ceramics (HA, CC, CS, ß-TCP) are useful graft extenders and carriers for bone growth enhancers and antibiotics. Osteoconductive bioceramics with different mechanical and biological properties are available for use as graft extenders. In a defined group of anterior interbody fusion procedures (ACDF, ALIF), satisfactory fusion rates (> 90%) may be obtained with exclusive use of graft extenders, whereas their solitary use in posterolateral fusions is not advisable. Genuine bone replacement is currently feasible with BMPs. Their use should be restricted to specific indications such as complex revision surgery and pseudarthrosis.

Primary Failure of Eruption (PFE) and ankylosis of permanent molars: the surgeon’s experience

Eruption abnormalities involving permanent molars are clinically rare and can be particularly challenging to treat. When there is an obstacle in the eruption pathway, these teeth can be successfully set in the arch most of the time, once the obstacle is cleared. On the other hand, teeth afflicted with ankylosis or Primary Failure of Eruption (PFE) cannot be orthodontically displaced.PFE has a genetic origin and leads to open bite that can be severe, in relation to a reduced alveolar height. PFE is often also associated with class III malocclusion and dental agenesis, which makes the treatment plan even more complicated.This article first describes the characteristics of PFE and ankylosis and then presents our own experience, through several clinical cases. One case illustrates and discusses the limits of orthodontics in managing molars showing PFE, despite alveolar corticotomies and bone anchorage devices. Two other clinical cases describe global rehabilitation by osteotomy, bone graft and extensive prosthetic replacement.

Can Low Dose rhBMP-2 Replace Iliac Crest Bone Graft in Achieving Successful Fusion in Adults with a Long Fusion to the Sacrum?

BMP has been effective as a bone graft replacement in spinal fusion. Low dose BMP (LDBMP) has been used to treat adult deformities instead of the published large doses of 20mg per level. There is a paucity of literature describing the efficacy of low dose rh-BMP-2 (LDBMP) in multilevel adult deformity patients.

Treatments for Avascular Necrosis of the Talus

Avascular necrosis (AVN) of the talus is a challenging entity to treat. Poor outcomes remain all too common. The purpose of this systematic review was to: identify and summarize all available evidence for the treatment of talar AVN; provide treatment recommendations; and highlight gaps in the literature. We searched MEDLINE and EMBASE using a unique algorithm. The Oxford Level of Evidence Guidelines and GRADE recommendations were used to rate the quality of evidence and to make treatment recommendations. 19 studies fit the inclusion criteria constituting 321 ankles at final follow-up. The interventions of interest included hindfoot fusion, conservative measures, bone grafting, vascularized bone graft, core decompression, and talar replacement. All studies were Level IV evidence. Due to study quality, imprecise and sparse data, and potential for reporting bias, the quality of evidence is "very low". Studies investigating conservative therapy showed that prolonged protective weight bearing provides the best outcomes in early talar AVN. Given the "very low" GRADE recommendation, understanding of talar AVN would be significantly altered by higher quality studies. Early talar AVN seems best treated with protected weightbearing and possibly in combination with ESWT. If that fails, core decompression may be an attractive treatment option. Arthrodesis should be saved as a salvage procedure. Future prospective, randomized studies are necessary to guide the conservative and surgical management of talar AVN. Level II.

In vivo evaluation of resorbable bone graft substitutes in beagles: Histological properties

Calcium phosphate cement (CPC) is a promising material for use in minimally invasive surgery for bone defect repairs due to its bone-like apatitic final setting product, biocompatibility, bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping into complicated geometrics. However, even though CPC is stable in vivo, the resorption rate of this bone cement is very slow and its long setting time poses difficulties for clinical use. Calcium sulfate dehydrate (CSD) has been used as a filler material and/or as a replacement for cancellous bone grafts due to its biocompatibility. However, it is resorbed too quickly to be optimal for bone regeneration. This study examines the invivo response of a hydroxyapatite (HA), [apatitic phase (AP)]/calcium sulfate (CSD) composite using different ratios in the mandibular premolar sockets of beagles. The HA (AP)/CSD composite materials were prepared in the ratios of 30/70, 50/50, and 70/30 and then implanted into the mandibular premolar sockets for terms of 5 and 10 weeks. The control socket was left empty. The study shows better new bone morphology and more new bone area in the histological and the histomorphometric study of the HA (AP)/CSD in the 50/50 ratio.

Treatment Outcome of Pelvic Osteosarcoma a 20 Year Experience in a Single Institution

Purpose: Osteosarcoma of limbs shows excellent therapeutic results due to development of diagnostic and treatment methods. However, osteosarcoma of pelvic bone is known to have lower incidence than those of limbs and poorer prognosis. This study is performed to research the diagnosis, treatment, treatment outcomes, and complications of osteosarcoma of pelvic bone and propose standards for adequate treatment. Objective and Method: 16 cases that were diagnosed as osteosarcoma of pelvic bone from January 1988 to October 2010 in Kosin University Gospel Hospital were analyzed. Follow-up periods were at least 2 months up to 60 months. There were 6 cases of male and 10 cases of female, and mean age was 44.3 (14 ~ 74) years old. 5 cases were accompanied by pulmonary metastasis at the time of the diagnosis. Surgical treatment including preoperative and postoperative chemotherapy was performed in 9 cases, and only chemotherapy and radiation were performed in 1 case. Among 9 cases having undergone surgical treatment, 3 cases were performed with biological reconstruction using autogenous bone graft and total hip replacement together, 1 case was performed with extracorporeal irradiated recycled autogenous bone graft, 1 case was performed with reconstruction using tumor prosthesis, and 4 cases were performed with wide excision. Retrospective review was done about diagnostic procedures, treatment methods and results, and complications. Results: Mean period from the onset of symptoms to the time of the diagnosis was 6.3 (3 ~ 12) months, and the symptoms were 7 cases of hip pain, each 3 cases of lumbar pain and radiating pain to lower limbs, pelvic mass, each 2 cases of inguinal pain, and each 1 case of thigh pain, Among the 9 cases performed with preoperative and postoperative chemotherapy and surgical treatment, there were 6 cases of T-10 protocol, 2 cases of T-20 protocol, and 1 case of IA (Intraarterial) Cis protocol. In the 1 case that haven’t undergone surgical treatment, T-10 protocol was performed. 13 of the 16 cases were expired, with the mean time of 15 (2 ~ 47 months) from the time of the diagnosis to death. Complications were 4 cases of surgical infection, and 1 case of peroneal nerve palsy. Conclusion: Osteosarcoma occurred in the pelvic bone may delay the start of the diagnosis and treatment, and prognosis is too bad. Early diagnosis is important, and this purpose, high-resolution and precise imaging tests performed with tumorrelated blood tests is necessary. In addition, preoperative systemic chemotherapy, rather than intra-aterial chemotherapy is recommended.

Bone Progenitors Produced by Direct Osteogenic Differentiation of the Unprocessed Bone Marrow Demonstrate High Osteogenic PotentialIn VitroandIn Vivo

Tissue-engineered bone grafts seeded with mesenchymal stem cells (MSCs) have been sought as a replacement for bone grafts currently used for bone repair. For production of osteogenic constructs, MSCs are isolated from bone marrow (BM) or other tissues, expanded in culture, then trypsinized, and seeded on a scaffold. Predifferentiation of seeded cells is often desired. We describe here bone progenitor cells (BPCs) obtained by direct osteogenic differentiation of unprocessed BM bypassing isolation of MSCs. Human BM aspirates were incubated for 2 weeks with a commonly used osteogenic medium (OM), except no fetal calf serum, serum substitutes, or growth factors were added, because responding stem and/or progenitor cells were present in the BM milieu. The adherent cells remaining after the culture medium and residual BM were washed out, expressed high levels of bone-specific alkaline phosphatase (ALP) on their surface, demonstrated high ALP activity, were capable of mineralization of the intercellular space, and expressed genes associated with osteogenesis. These parameters in BPCs were similar and even at higher levels compared to MSCs subjected to osteogenic differentiation for 2 weeks. The yield of BPCs per 1 mL BM was 0.71±0.39×106. In comparison, the yield of MSCs produced by adhesion of mononuclear cells derived from the same amount of BM and cultured in a commercial growth medium for 2 weeks was 0.3±0.17×106. When a scaffold was added to the BM-OM mixture, and the mixture was cultured in a simple rotational bioreactor; the resulting BPCs were obtained already seeded on the scaffold. BPCs seeded on scaffolds were capable of proliferation for at least 6 weeks, keeping high levels of ALP activity, expressing osteogenic genes, and mineralizing the scaffolds. Autologous rat BPCs seeded on various scaffolds were transplanted into critical-size calvarial defects. Six weeks after transplantation of polylactic acid/polyglycolic acid scaffolds, 76.1%±18.3% of the defects were filled with a new bone, compared to 37.9%±28.4% in the contralateral defects transplanted with the scaffolds without cells.