Calcium Phosphate Cement Research Articles

Treatment of critical bone defects using calcium phosphate cement and mesoporous bioactive glass providing spatiotemporal drug delivery

Calcium phosphate cements (CPC) are currently widely used bone replacement materials with excellent bioactivity, but have considerable disadvantages like slow degradation. For critical-sized defects, however, an improved degradation is essential to match the tissue regeneration, especially in younger patients who are still growing. We demonstrate that a combination of CPC with mesoporous bioactive glass (MBG) particles led to an enhanced degradation in vitro and in a critical alveolar cleft defect in rats. Additionally, to support new bone formation the MBG was functionalized with hypoxia conditioned medium (HCM) derived from rat bone marrow stromal cells. HCM-functionalized scaffolds showed an improved cell proliferation and the highest formation of new bone volume. This highly flexible material system together with the drug delivery capacity is adaptable to patient specific needs and has great potential for clinical translation.

Mechanical behaviour of wollastonite-based cement composites incorporating fibres and recycled rubber aggregates

Calcium phosphate cement (CPC) is a wollastonite-based inorganic cement that hardens at room temperature to a brittle cementitious material with low fracture behaviour. Recycled rubber aggregates from end-of-life tyres were incorporated up to 17.5 wt% into the CPC matrix to produce high-strength composites with improved strain capacities for structural repair purposes. Furthermore, the effects of 0.75% and 1.5% volume fibre content (Vf) of macro polypropylene, amorphous metallic and recycled carbon fibres on the flexural behaviour of CPC were studied. The synergy between the rubber aggregates and the selected corrosion-resistant fibres in improving the fracture properties of the plain CPC was investigated. The changes in other mechanical properties of CPC such as modulus of rupture, compressive and splitting tensile strength due to the inert inclusions (i.e. rubber aggregates and/or fibres) were determined. It was found that increasing the quantity of inert inclusions in the cement matrix improved the fracture energy of the plain CPC. Incorporating 1.5% Vf of macro polypropylene, amorphous metallic, and recycled carbon fibres into the CPC matrix produced cementitious composites with fracture energies that were 11.8 times, 63.4 times, and 75.8 times that of plain cement, respectively. For the rubberised fibre-reinforced CPC composites, a positive synergistic relationship was observed between rubber aggregates and macro polypropylene fibres while a negative synergistic relationship was found between rubber aggregates and the other fibres (amorphous metallic and recycled carbon fibres). The rubber aggregates decreased the flexural, compressive and splitting tensile strengths of the plain CPC, while the fibre inclusions improved these properties.

Incorporation of synthetic water-soluble curcumin polymeric drug within calcium phosphate cements for bone defect repairing.

Modified macroporous structures and active osteogenic substances are necessary to overcome the limited bone regeneration capacity and low degradability of self-curing calcium phosphate cement (CPC). Curcumin (CUR), which possesses strong osteogenic activity and poor aqueous solubility/bioavailability, esterifies the side chains in hyaluronic acid (HA) to form a water-soluble CUR-HA macromolecule. In this study, we incorporated the CUR-HA and glucose microparticles (GMPs) into the CPC powder to fabricate the CUR-HA/GMP/CPC composite, which not only retained the good injectability and mechanical strength of bone cements, but also significantly increased the cement porosity and sustained release property of CUR-HA in vitro. CUR-HA incorporation greatly improved the differentiation ability of bone marrow mesenchymal stem cells (BMSCs) to osteoblasts by activating the RUNX family transcription factor 2/fibroblast growth factor 18 (RUNX2/FGF18) signaling pathway, increasing the expression of osteocalcin and enhancing the alkaline phosphatase activity. In addition, in vivo implantation of CUR-HA/GMP/CPC into femoral condyle defects dramatically accelerated the degradation rate of cement and boosted local vascularization and osteopontin protein expression, and consequently promoted rapid bone regeneration. Therefore, macroporous CPC based composite cement with CUR-HA shows a remarkable ability to repair bone defects and is a promising translational application of modified CPC in clinical practice.

Calcium Phosphate Cements as Carriers of Functional Substances for the Treatment of Bone Tissue.

Interest in calcium phosphate cements as materials for the restoration and treatment of bone tissue defects is still high. Despite commercialization and use in the clinic, the calcium phosphate cements have great potential for development. Existing approaches to the production of calcium phosphate cements as drugs are analyzed. A description of the pathogenesis of the main diseases of bone tissue (trauma, osteomyelitis, osteoporosis and tumor) and effective common treatment strategies are presented in the review. An analysis of the modern understanding of the complex action of the cement matrix and the additives and drugs distributed in it in relation to the successful treatment of bone defects is given. The mechanisms of biological action of functional substances determine the effectiveness of use in certain clinical cases. An important direction of using calcium phosphate cements as a carrier of functional substances is the volumetric incorporation of anti-inflammatory, antitumor, antiresorptive and osteogenic functional substances. The main functionalization requirement for carrier materials is prolonged elution. Various release factors related to the matrix, functional substances and elution conditions are considered in the work. It is shown that cements are a complex system. Changing one of the many initial parameters in a wide range changes the final characteristics of the matrix and, accordingly, the kinetics. The main approaches to the effective functionalization of calcium phosphate cements are considered in the review.

Utility of biphasic calcium phosphate cement as a seal for root-end filling.

The recently developed biphasic calcium phosphate cement (BCPC) consists of α-tricalcium phosphate-tetracalcium phosphate as the solid phase and calcium phosphate solution as the liquid phase. BCPC powder is composed of a single solid solution with a monomodal size distribution. Here, we used a bacterial leakage model to examine the utility of BCPC as a seal for root-end filling. We prepared large (median particle size=9.96 µm; BCPC-L) and small (median particle size=4.84 µm; BCPC-S) BCPC powders. In total, 45 single-rooted teeth were instrumented, resected at the root-end, and retrofilled with experimental materials. Mineral trioxide aggregate (MTA) was used as the control. After visual confirmation of BCPC powder size and retrofilling quality by microscopy, bacterial leakage tests were conducted using Enterococcus faecalis. The bacterial leakage tests did not reveal any significant differences between BCPC-S and MTA. Our findings suggest that BCPC-S is useful for root-end filling.

Lateral Bone Augmentation Using a Three-Dimensional-Printed Polymeric Chamber to Compare Biomaterials.

The aim of this study was to test the suitability of calcium phosphate cement mixed with poly(lactic-co-glycolic acid) (CPC-PLGA) microparticles into a ring-shaped polymeric space-maintaining device as bone graft material for lateral bone augmentation. Therefore, the bone chambers were installed on the lateral portion of the anterior region of the mandibular body of mini-pigs. Chambers were filled with either CPC-PLGA or BioOss® particles for comparison and left for 4 and 12 weeks. Histology and histomorphometry were used to obtain temporal insight in material degradation and bone formation. Results indicated that between 4 and 12 weeks of implantation, a significant degradation of the CPC-PLGA (from 75.1% to 23.1%), as well as BioOss material, occurred (from 40.6% to 14.4%). Degradation of both materials was associated with the presence of macrophage-like and osteoclast-like cells. Furthermore, a significant increase in bone formation occurred between 4 and 12 weeks for the CPC-PLGA (from 0.1% to 7.2%), as well as BioOss material (from 8.3% to 23.3%). Statistical analysis showed that bone formation had progressed significantly better using BioOss compared to CPC-PLGA (p < 0.05). In conclusion, this mini-pig study showed that CPC-PLGA does not stimulate lateral bone augmentation using a bone chamber device. Both treatments failed to achieve "clinically" meaningful alveolar ridge augmentation.

Potential Combination of Acemannan Sponge and Calcium Phosphate Cement-Calcium Sulfate Hemihydrate (CPC-CSH) as Direct Pulp Capping Alternative Materials for Reparative Dentin Formation

Abstract Background Health problem that affects hard tissues of the teeth is dental caries, which is experienced by around 2.3 billion people in the world, with prevalence in Indonesia reaching 88.8. Direct pulp capping (DPC) is a vital pulp therapy used to maintain pulp vitality. Calcium hydroxide (Ca(OH)2) is the gold standard pulp capping material, but has poor adhesion to dentin and mechanical properties, bacterial infiltration, formation of tunnel defects in the pulp resorption, and dentin bridge. Therefore, it is necessary to develop alternative therapy, namely, a combination of acemannan sponge and calcium phosphate cement (CPC)-calcium sulfate hemihydrate (CSH) for reparative dentin formation. Purpose This article describes the potential combination of acemannan sponge and CPC-CSH as DPC alternative materials for reparative dentin formation. Reviews Acemannan extracted from aloe vera exhibits anti-inflammatory, antimicrobial, and cytocompatibility properties. As DPC material, acemannan induces pulp proliferation and differentiation to osteoblast-like, growth factor synthesis, and promotes reparative dentin formation. However, acemannan sponge is radiolucent, allowing misinterpretation between pulp and acemannan sponge. CPC can be combined with CSH to shorten the setting time. CPC-CSH is radiopaque, has good compressive strength, and biocompatibility. CPC-CSH is a calcium-based material with neutral pH that can induce the dentin bridge formation. CPC-CSH showed good bioactivity because it induces the formation of apatite which plays a significant part in dentin and pulp regeneration. Conclusion The combination of acemannan sponge and CPC-CSH has the potential as DPC alternative materials for reparative dentin formation.

球状多孔質β型リン酸三カルシウム顆粒を用いたセメントの作製と評価

Calcium phosphate cements (CPCs) with macropores and micropores for high bone regeneration ability are desired. CPCs with macropores and micropores which were prepared by combining porous granules have been reported. In this study, the cement system composed of β-tricalcium phosphate (β-TCP) granules and phosphoric acid solution was selected, and the effects of the characteristics of granules on the microstructures and properties of the cements were examined. The spherical porous β-TCP granules with high porosity and irregular porous β-TCP granules with low porosity were prepared, and they were mixed with a phosphoric acid solution. When the spherical porous granules with high porosity were used, the granules were packed uniformly in the cement, and the size distribution of the macropores formed among the granules was narrower than that of the cement prepared using the irregular porous β-TCP granules with low porosity. The cement with high porosity can be obtained from the spherical porous granules with high porosity. The cement prepared using the spherical granules with high porosity showed lower compressive strength and higher dissolution rate than the cement prepared using irregular granules with low porosity.

Synergy of inorganic and organic inks in bioprinted tissue substitutes: Construct stability and cell response during long-term cultivation in vitro

Microextrusion bioprinting, within the emerging field of biofabrication, holds great promise for developing in vitro tissue models or implantable constructs that mimic complexity of native tissues. Despite the considerable progress made fabricating cell-laden scaffolds, mono-material approaches often cannot reproduce complex tissue architecture or satisfy biomechanical requirements, a particular challenge for hard, mineralized bone tissue. Thus, in this work, we focus on the fabrication of high-strength, partly-mineralized composite bone substitutes via multi-channel (bio)printing of inorganic and organic (bio)inks – with the aim of synergistically integrating the advantages of both phases. A hydroxyapatite (HAp) matrix-mimicking, clinically approved, ready-to-use calcium phosphate cement (CPC) ink as a stiff, mechanically robust phase is combined with an organic eggwhite-functionalized bioink of alginate-methylcellulose (AlgMC + EW) delivering cells in a spatially defined distribution. As proven in a novel systematic assessment, cell-free CPC ink and cell-laden AlgMC + EW bioinks exhibited excellent co-printability and shape fidelity in simple, more complex and anatomically shaped biphasic designs. The mechanical properties of such biphasic constructs were tailored via adjusting the ratio of inorganic and organic component. The survival and fate of human mesenchymal stem cells (MSC) and primary human pre-osteoblasts (hOB) in bioprinted inorganic/organic biphasic structures in response to CPC and EW functionalization during a long-term cultivation were investigated, revealing a defined, cell-friendly bioink delivery which allows cells to migrate and proliferate, as well as proving great potential for 3D osteogenesis. In line with further suggested technological refinements, this creates a toolbox for targeted design and construction of possibly pre-vascularized bone structures in clinically relevant dimensions.

Calcium phosphate bone cements as local drug delivery systems for bone cancer treatment.

Bone cancer is usually a metastatic disease, affecting people of all ages. Its effective therapy requires a targeted drug administration locally at the cancer site so that the surrounding healthy organs and tissues stay unharmed. Upon a thorough literature search, a tremendous number of published articles are reporting on development of calcium phosphate cements (CPCs) for the treatment of a variety of diseases, such as osteoporosis, osteoarthritis, osteomyelitis, and other musculoskeletal disorders. However, just a limited number of research employs CPCs specifically for bone cancer treatment. In this review article, we study the factors influencing the local drug release from CPCs and particularly focus on bone cancer therapy. Finally, we locate the deficiencies in the literature regarding this specific topic and propose which other perspectives should be considered and discussed in future articles.

Enhanced Cell Osteogenic Differentiation in Alendronate Acid and Flufenamic Acid Drug-Impregnated Nanoparticles of Mesoporous Bioactive Glass Composite Calcium Phosphate Bone Cement In Vitro.

This study aims to compare the anti-osteoporotic drugs alendronic acid (ALN) and flufenamic acid (FA) alone impregnate into nanoparticles of mesoporous bioactive glass (nMBG), which further composites calcium phosphate cement (CPC) and investigates their in vitro performance. The drug release, physicochemical properties, and biocompatibility of nMBG@CPC composite bone cement are tested, and the effect of the composites on improving the proliferation and differentiation efficiency of mouse precursor osteoblasts (D1 cells) is also investigated. Drug release shows that FA impregnates nMBG@CPC composite, a large amount of FA is released rapidly within 8 h, gradually reaching a stable release within 12 h, followed by a slow and sustained release within 14 days, and then reaches a plateau within 21 days. The release phenomenon confirms that the drug-impregnated nBMG@CPC composite bone cement effectively achieves slow drug delivery. The working time and setting time of each composite are within 4-10 min and 10-20 min, respectively, meeting the operational requirements of clinical applications. The addition of nMBG nanoparticles in the CPC matrix did not prevent the aggregation phenomenon under microstructural observation, thus resulting in a decrease in the strength of the nMBG@CPC composite. However, after 24 h of immersed reaction, the strength of each 5 wt.% nMBG impregnated with different concentrations of FA and ALN is still greater than 30 MPa, which is higher than the general trabecular bone strength. The drug-impregnated nMBG@CPC composites did not hinder the product formation and exhibit biocompatibility. Based on the proliferation and mineralization of D1 cells, the combination of nMBG with abundant FA and ALN in CPC is not conducive to the proliferation of D1 cells. However, when D1 cells are contact cultured for 21 days, alkaline phosphatase (ALP) enzyme activity shows higher ALP secretion from drug-impregnated nMBG@CPC composites than drug-free composites. Accordingly, this study confirms that nMBG can effectively impregnate the anti-osteoporosis drugs FA and ALN, and enhance the mineralization ability of osteoblasts. Furthermore, drug-impregnated nMBG applications can be used alone or in combination with CPC as a new option for osteoporotic bone-filling surgery.

Antibacterial effect and biological reaction of calcium phosphate cement impregnated with iodine for use in bone defects.

Calcium phosphate cement (CPC) is often used to repair bone defects that occur after bone tumor and fracture treatment. To address bone defect cases with a high infection risk, developing CPCs with a longlasting wide-spectrum antibacterial effect is critical. Povidone-iodine has a wide antibacterial spectrum. Though there have been some reports of CPC containing antibiotics, no report of CPC with iodine has been described. In this study, the antibacterial effect and biological reaction of CPC impregnated with iodine was investigated. Iodine release from CPC and bone cement with various iodine contents (2.5, 5, and 20%) was evaluated, and 5 %-iodine CPC retained more iodine than the other CPCs after one week. Antibacterial activity against Staphylococcus aureus and Escherichia coli was also investigated, showing that 5 %-iodine had an antibacterial effect for up to eight weeks. Cytocompatibility was assessed, and 5 %-iodine CPC showed the same amount of fibroblast colony formation as control samples. CPCs with varying iodine contents (0, 5, and 20%) were then inserted into lateral femora of Japanese white rabbits for histological analysis. Osteoconductivity was evaluated using scanning electron microscopy, and hematoxylin-eosin staining. Consecutive bone formation was observed around all CPCs at eight weeks. These results indicate that CPC impregnated with iodine exhibits antimicrobial activity and cytocompatibility, and therefore, it may be effective for bone defect cases with high infection risk.

Tunable calcium phosphate cement formulations for predictable local release of doxycycline

Background Osteomyelitis is a bacterial infection, which leads to bone loss. Local treatment focuses on elimination of bacteria, which is preferable for simultaneous management of the bone defect after sequestrectomy and bone reconstruction in one-stage treatment of osteomyelitis. Calcium phosphate cements (CPCs) have attracted increased attention as bone substitute material because of their injectability and in situ self-setting properties, which allow for minimally invasive surgical procedures and local drug delivery.Methods We herein established a system to achieve different release profiles of the antibiotic drug doxycycline from CPC by finetuning their formulation. These CPC formulations were generated via facile addition of hydrolytically degrading PLGA particles, varying doses of doxycycline, and addition of the lubricant CMC.Results The CPC formulations exhibited appropriate handling properties in terms of injectability and setting time. Furthermore, doxycycline release profiles showed an adequate burst release followed by a cumulative release of up to 100% over a period of 8 weeks. Importantly, the released doxycycline retained its antibacterial activity against Staphylococcus aureus, the major pathogen causing osteomyelitis. Using an in vivo implantation model, antibacterial efficacy was demonstrated by a rapid decrease of inoculated S. aureus at the CPC surface and within surrounding tissues.Conclusions Our data show the versatility of the CPC system toward local antibacterial therapy, extending its application beyond bone substitution.

The Osteogenic Properties of Calcium Phosphate Cement Doped with Synthetic Materials: A Structured Narrative Review of Preclinical Evidence.

Bone grafting is commonly used as a treatment to repair bone defects. However, its use is challenged by the presence of medical conditions that weaken the bone, like osteoporosis. Calcium phosphate cement (CPC) is used to restore bone defects, and it is commonly available as a bioabsorbable cement paste. However, its use in clinical settings is limited by inadequate mechanical strength, inferior anti-washout characteristics, and poor osteogenic activity. There have been attempts to overcome these shortcomings by adding various natural or synthetic materials as enhancers to CPC. This review summarises the current evidence on the physical, mechanical, and biological properties of CPC after doping with synthetic materials. The incorporation of CPC with polymers, biomimetic materials, chemical elements/compounds, and combination with two or more synthetic materials showed improvement in biocompatibility, bioactivity, anti-washout properties, and mechanical strength. However, the mechanical property of CPC doped with trimethyl chitosan or strontium was decreased. In conclusion, doping of synthetic materials enhances the osteogenic features of pure CPC. The positive findings from in vitro and in vivo studies await further validation on the efficacy of these reinforced CPC composites in clinical settings.

Calcium Phosphate Cement Composed of Hydroxyapatite Modified Silica and Polyeugenol as a Bone Filler Material

A composite of hydroxyapatite modified silica (HASiO2) and 10% (w/w) polyeugenol (PE) was synthesized to produce a calcium phosphate cement with antibacterial activity. The compatibility of the composite (HASiO2_PE) with bone filler requirements was determined due to its crystal, surface, antibacterial, and cytocompatibility properties. The results showed that compositing HASiO2 and PE did not affect HA's chemical dan crystal properties. The presence of PE changed HASiO2 morphology to be coarser and denser than before composited. PE tends to agglomerate but does not affect the hydrophilicity of HASiO2. The presence of PE increased the surface area and total pore volume but lowered the average pore size. Different from pure PE, the composite of HASiO2_PE that contains of 10% PE has higher antibacterial activity toward Escherichia coli than Staphylococcus aureus. The composite is biocompatible because the cytotoxicity test toward pre-osteoblast cells resulted in an IC50 of 2092 μg/mL. Thus, due to its chemical, surface, antibacterial, and cytocompatibility properties, the HASiO2_PE composite can be recommended as a bone filler material.

Intramedullary Fixation with Cannulated Screw After Resection of Enchondroma in the Hand: Technique Description and Case Series

Enchondromas are primary, benign bone neoplasms that arise from intramedullary proliferation of hyaline cartilage cells. Slow and progressive in growth, enchondromas can lead to bone destruction, deformities, and fractures. The treatment of enchondromas remains controversial. We hereby describe the technique for bone fixation using headless intramedullary screws (HISs) after enchondroma resection in the long bones of the hand. From January 2018 to June 2021, all patients treated with HISs after the resection of enchondroma of the hand were retrospectively assessed and included in the study. The series comprised four patients with a minimum postoperative follow-up period of 12 months. Postoperative functional results were measured according to Takigawa criteria and postoperative radiographic results were graded according to the Tordai system. After tumor resection and screw fixation, one patient had autologous bone grafting from the iliac crest, and another had the defect filled with calcium phosphate cement. All patients were followed up for at least 12 months, and the mean healing time of the pathologic fracture was 5 weeks. There were neither complications related to the procedure nor the need for a second surgery. We describe the technique of intramedullary headless screws for bone fixation after enchondroma resection in the long bones of the hand, as well as the excellent functional, cosmetic, and radiographic results of four patients treated with the technique presented herewith. Therapeutic IV.

Tough, Injectable Calcium Phosphate Cement Based Composite Hydrogels to Promote Osteogenesis

Osteoporosis is one of the most disabling consequences of aging, and osteoporotic fractures and a higher risk of subsequent fractures lead to substantial disability and deaths, indicating that both local fracture healing and early anti-osteoporosis therapy are of great significance. However, combining simple clinically approved materials to achieve good injection and subsequent molding and provide good mechanical support remains a challenge. To meet this challenge, bioinspired by natural bone components, we develop appropriate interactions between inorganic biological scaffolds and organic osteogenic molecules, achieving a tough hydrogel that is both firmly loaded with calcium phosphate cement (CPC) and injectable. Here, the inorganic component CPC composed of biomimetic bone composition and the organic precursor, incorporating gelatin methacryloyl (GelMA) and N-Hydroxyethyl acrylamide (HEAA), endow the system with fast polymerization and crosslinking through ultraviolet (UV) photo-initiation. The GelMA-poly (N-Hydroxyethyl acrylamide) (GelMA-PHEAA) chemical and physical network formed in situ enhances the mechanical performances and maintains the bioactive characteristics of CPC. This tough biomimetic hydrogel combined with bioactive CPC is a new promising candidate for a commercial clinical material to help patients to survive osteoporotic fracture.

Magnesium–Calcium Phosphate Cements with Sodium Hyaluronate

Magnesium–Calcium Phosphate Cements with Sodium Hyaluronate

Utilization of carbonated calcium phosphate cement for contouring cranioplasty in patients with syndromic craniosynostosis.

Carbonated calcium phosphate (CCP) cement is an alloplastic material which has been increasingly utilized for cranioplasty reconstruction; however, there is a paucity of data investigating its use in patients with syndromic craniosynostosis. The purpose of this study was to characterize our institutional experience with CCP cement for secondary contouring cranioplasty in these patients to establish safety and aesthetic efficacy. Patients with syndromic craniosynostosis undergoing cranioplasty with CCP cement from 2009 to 2022 were retrospectively reviewed for prior medical and surgical history, cranioplasty size, cement usage, and postoperative complications. Aesthetic ratings of the forehead region were quantified using the Whitaker scoring system at three timepoints: preoperative (T1), < 6months postoperative (T2), and > 1year postoperative (T3). Twenty-one patients were included. Age at surgery was 16.2 ± 2.8years, forehead cranioplasty area was 135 ± 112 cm2, and mass of cement was 17.2 ± 7.8g. Patients were followed for 3.0 ± 3.1years. Whitaker scores decreased from 1.9 ± 0.4 at T1 to 1.4 ± 0.5 at T2 (p = 0.005). Whitaker scores at T2 and T3 were not significantly different (p = 0.720). Two infectious complications (9.5%) were noted, one at 4.5months postoperatively and the other at 23months, both requiring operative removal of CCP cement. Our results suggest that aesthetic forehead ratings improve after CCP contouring cranioplasty and that the improvement is sustained in medium-term follow-up. Complications were uncommon, suggesting that CCP is relatively safe though longer-term follow-up is needed before reaching definitive conclusions.

Hierarchically porous calcium phosphate scaffold with degradable PLGA microsphere network

Calcium phosphate cement (CPC) is widely used in orthopedics, dentistry and spine surgery because of its excellent biocompatibility, osteoconductivity, arbitrary shaping and self-setting ability. However, slow degradation rate of CPC decreases its bone regeneration efficacy. Herein, poly (lactic co-glycolic acid) microspheres (PLGAm) and wollastonite (WS) were mixed with CPC powder to prepare CPC composite pastes, and then the composite pastes were perfused into poly (lactic co-glycolic acid) network (PLGAnw) to construct composite bone repair materials. The degradation of PLGAnw generated interconnected macropores with the short side of about 468 μm along horizontal axis and the long side of about 785 μm along longitudinal axis, while PLGAm degradation generated isolated or partially connected relative smaller spherical macropores with the size range of 53–106 μm and 106–150 μm, respectively, which was same with PLGAm; in addition, CPC formed micro/nano pores after hydration, thus constructing in-situ hierarchically porous CPC composite scaffolds. Meanwhile, PLGAnw and PLGAm also significantly promoted the degradation of CPC due to the release of acidic by-products. Therefore, the introduction of PLGA network and microspheres not only can evidently accelerate degradation of CPC, but also in-situ form connected macropores and hierarchically porous after their degradation, which are expected to improve bone repair effect of CPC.