Cancellous Bone Chips Research Articles

Differences in Outcomes Based on the Degree to Which Bone Defects Are Filled with Cancellous Allochip Bone Grafts in Hand Enchondroma Patients

Background/Objectives: Enchondroma, the most common benign cartilage tumor in the hand, often presents as pain, swelling, or pathological fractures. While curettage is the standard treatment preventing fractures, the optimal way of managing the bone cavity remains debated. In this study, we investigated the impact of a filled bone defect on radiologic and clinical outcomes among patients with enchondroma. Methods: We retrospectively reviewed patients with solitary enchondroma of the hand who underwent curettage followed by allogeneic cancellous bone chip impaction grafting. The patients were divided into two groups based on the extent to which their bone defects were filled post-curettage: Group 1 (complete filling) and Group 2 (incomplete filling, i.e., <50%). We reviewed demographic data, local recurrence data, complications, information on consolidation duration, data on range of motion (ROM), and functional scores. Results: This study included 59 patients (25 males and 34 females; mean age, 30.4 ± 11.9 years, with a range of 8–78). Group 1 contained 35 patients, and Group 2 contained 24. No nonunion occurred following curettage and grafting. The mean radiological consolidation period was 6.4 weeks (range: 5–18). There was no significant difference in consolidation time between Group 1 (6.8 weeks) and Group 2 (6.9 weeks) (p = 0.166). The ROM and functional scores also showed no significant differences between the groups, with musculoskeletal society scores of 98.8 for Group 1 and 99.8 for Group 2 (p = 0.63). Conclusions: This study demonstrates that the use of the impaction technique combined with cancellous allochip bone grafting yields favorable results in the treatment of solitary hand enchondroma. The extent to which the bone defect was filled did not significantly impact the overall outcomes.

Two-Stage Revision ACL Reconstruction with Arthroscopic Tunnel Bone Grafting

Background: Anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and due to the increased number of primary reconstructions being performed, the number of revision ACL reconstructions is also increasing. Indications: Two-stage revision ACL reconstruction has lower failure rates compared to 1-stage and is indicated when significant tunnel expansion has occurred or malpositioned tunnels prohibit an adequate reconstruction. In this presentation, 2-stage revision ACL reconstruction was performed with an arthroscopic bone grafting technique of both the femoral and tibial tunnels secondary to tunnel osteolysis. Technique Description: Standard diagnostic arthroscopy is performed, and any chondral or meniscal pathology is addressed. The remnant ACL graft and all hardware are removed. The tunnels are debrided thoroughly. Using a modified syringe, the tunnels are packed with a mixture of cancellous bone chips and cortical fibers that have been hydrated with whole blood and platelet-rich plasma (PRP). The patient is placed into a brace postoperatively, and a computed tomography (CT) is obtained approximately 4 to 6 months postoperatively to assess for bone healing. Revision ACL reconstruction is performed once indicated with standard rehabilitation and return to play protocol. Results: Both 1-stage and 2-stage revision ACL reconstructions have been demonstrated to have significant improvement in outcomes scores preoperatively to postoperatively. However, 2-stage has lower failure rates compared to single-stage and has a high return to level of play. Discussion/Conclusion: Revision ACL reconstruction is becoming more commonly performed, and 2-stage revision is frequently required due to multiple factors. In this video, we demonstrate bone grafting for revision ACL reconstruction for tunnel osteolysis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Aesthetic Reconstruction of an Old Burr Hole Defect Using a Cancellous Bone Chip and a Porous Polyethylene Implant.

Burr hole trephination is a minimally invasive procedure but can leave a depressed scar at the surgical site. Various materials have been studied to fill such defects; however, to the best of our knowledge, there are no reports of reconstructing old, depressed scars from burr hole surgery. This report presents a patient with depressed scarring near the anterior hairline of the frontal bone on both sides due to burr hole trephination for a subdural hematoma 27 years prior. Computed tomography scans revealed bony defects under the scar. Reconstruction of the bony defect was performed by debriding the bony bed, filling it with hydrated alloplastic cancellous bone, and covering it with a porous SynPOR polyethylene titanium-reinforced implant. During 1 year of follow-up, the reconstruction was maintained without complications. The patient was satisfied with the esthetic outcome. Thus, old bony defects can be repaired using the appropriate materials and techniques.

Minimization of lumbar interbody fusion by percutaneous full-endoscopic lumbar interbody fusion (PELIF), and its minimally invasiveness comparison with minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF)

ObjectiveIn fusion surgery, minimization of muscle damage and bone resection is important. To achieve these, we have developed a percutaneous full endoscopic lumbar interbody fusion (PELIF). We report the detailed operation procedure, and moreover a comparison of its minimally invasiveness with that of the minimally invasive surgery-transforminal lumbar interbody fusion (MIS-TLIF). Methods52 patients were treated with PELIF. Total discectomy and cartilage endplate removal were performed using an 8 mm rotate-cutter. A cage was sandwiched between two L-retract sliders, which protected the exiting root. The cancellous bone chips were harvested from the pelvis with a 5 mm trephine.On the other hand, 74 patients were treated with MIS-TLIF. ResultsIn PELIF, bleeding volume, VAS (back pain), ODI, JOA score, and Macnab’s criteria were significantly superior to MIS-TLIF except for VAS (leg symptom).The MRI cross-sectional area of degenerative spondylolisthesis was significantly improved after PELIF, but that of MIS-TLIF was significantly broader.PELIF was superior to MIS-TLIF in fat degeneration of multifidus muscle in the cross-sectional MRI under 50 years old.CT recognized insufficient fusion in one case of PELIF and seven cases of MIS-TLIF, with a tendancy to have more insufficient fusion in MIS-TLIF. ConclusionsPELIF provides clear visualization under continuous water irrigation. PELIF is an indirect decompression without canal invasion. The dura mater, intestine, and large blood vessels don’t appear in the surgical field. It is understood that PELIF is a less invasive surgery than MIS-TLIF.

Rotator Cuff Repair With Bone Grafting of Greater Tuberosity Cyst: A Technique Video

Background: Nearly 500,000 rotator cuff repairs are performed annually in the United States. Cysts within the humeral head have been reported to occur in more than half of patients diagnosed with a rotator cuff tear. They are related to age-related degeneration and rotator cuff dysfunction, and may arise from congenital abnormalities. Indications: Humeral head cysts may pose technical challenges during rotator cuff repair. Cysts located at the footprint of a planned rotator cuff repair can decrease biological healing capacity and reduce the fixation strength of suture anchors. One treatment strategy to address bone loss secondary to humeral head cysts is to incorporate cancellous allograft bone chips, which provide an osteoconductive scaffold for bone formation. Technique Description: Standard arthroscopic portals were established and during arthroscopy, the rotator cuff tear was identified, and tissue was mobilized. The cyst was debrided to healthy, bleeding bone using curettes and an arthroscopic shaver. A 2.5 mL sterile syringe was packed with crushed, cancellous allograft bone chips. The tip of the syringe was removed to allow for a wider aperture to facilitate injection of bone chips. Through an accessory, percutaneous portal just lateral to the acromion, the syringe was inserted into the cyst site, and bone graft contents were injected into the cyst. Pressure was applied to the syringe to impact the bone graft material. The bone chips were impacted with the syringe plunger. Following rotator cuff repair, the patient underwent subacromial decompression, distal clavicle excision, and open sub-pectoral biceps tenodesis with suture anchor fixation. Discussion/Conclusion: Greater tuberosity cysts can impose a technical challenge during arthroscopic rotator cuff repair. Incorporation of impacted cancellous allograft bone chips is an efficient, reproducible method to enhance healing of the RTC tendon enthesis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Simple curettage and allogeneic cancellous bone chip impaction grafting in solitary enchondroma of the short tubular bones of the hand

Enchondroma is the most common bone tumor in the hand. While standard surgical procedure is intra-lesional excision and bone grafting, there is a dispute between allogeneic bone, autogenous bone, and synthetic bone substitute grafting. Diverse adjuvant treatments have been introduced to reduce recurrence, but results are mixed with controversies. Meanwhile, whether existing descriptive classification could predict treatment outcome remains unclear. Thus, we reviewed patients with solitary enchondroma of the hand who underwent simple curettage followed by allogeneic cancellous bone chip impaction grafting. Eighty-eight patients with more than 5 years of follow-up were enrolled. Demographic data, local recurrence, and complications were reviewed. Duration of consolidation and the difference according to Takigawa classification were assessed. Range of motion (ROM), and functional scores were also evaluated. There were 51 women and 37 men, with a mean age of 37.9 years. Mean follow-up was 10.2 years. Recurrence occurred only in one patient. There was no complication. Mean postoperative total active motions of fingers and thumb were 239° and 132.9°. Mean modified Disabilities of the Arm, Shoulder, Hand score, and Musculoskeletal Tumor Society Score were 1.63, and 99.2 at the last follow-up. Consolidation, ROM, and functional scores according to Takigawa classification showed no significant differences. This study suggests that simple curettage with impaction grafting of allogeneic cancellous bone chip is a feasible method for treating solitary enchondromas involving short tubular bone of the hand with good long-term outcomes. Postoperative recurrence and complication rates were very low. Radiographic and clinical results were good regardless of the previous radiological classification.

Fusion rates based on type of bone graft substitute using minimally invasive scoliosis surgery for adolescent idiopathic scoliosis

BackgroundMinimally invasive scoliosis surgery (MISS) is currently introduced on novel technique for surgical treatment of adolescent idiopathic scoliosis (AIS). This study is aimed to evaluate the efficacy of facet fusion in MISS compared to posterior fusion in conventional open scoliosis surgery (COSS) and compare facet fusion rates based on three bone graft substitutes in MISS for adolescent idiopathic scoliosis (AIS).MethodsEighty six AIS patients who underwent scoliosis surgery were divided into two groups: the COSS group and the MISS group. COSS was performed through posterior fusion with allograft. MISS was applied via facet fusion with three bone graft substitutes. The MISS group was further divided into three subgroups based on graft substitute: Group A (allograft), Group B (demineralized bone matrix [DBM]), and group C (demineralized cancellous bone chips). Fusion rate was measured using conventional radiographs to visualize loss of correction > 10°, presence of lysis around implants, breaks in fusion mass, and abnormal mobility of the fused segment.ResultsThe fusion rates showed no significant difference in COSS and MISS groups (p = 0.070). In the MISS group, the fusion rates were 85, 100, and 100% in groups A, B, and C, respectively, with no significant difference (p = 0.221). There were no statistical differences between groups A, B, and C in terms of correction rate, fusion rate, and SRS-22 scores (p > 0.05).ConclusionsThe facet fusion in MISS showed comparable to posterior fusion in COSS with regard to radiological and clinical outcomes. Furthermore, the type of graft substitute among allograft, DBM, and demineralized cancellous bone chips did not affect facet fusion rate or clinical outcomes in MISS. Therefore, MISS showed comparable fusion rate (with no influences on the type of graft substitute) and clinical outcomes to those of COSS in the surgical treatment of AIS.

Enhanced osteogenesis by addition of cancellous bone chips at xenogenic bone augmentation: In vitro and in vivo experiments.

To investigate and compare the influence of deproteinized bovine bone mineral (DBBM) combined with autologous cortical (CorBC) or cancellous bone chips (CanBC) as bone grafts on guided bone regeneration (GBR) in vivo and in vitro. Defects were created in the mandibular buccal alveolar ridges in dogs and randomly filled with 3 groups of bone grafts: DBBM, DBBM + CorBC, or DBBM + CanBC. Osteogenesis was evaluated by sequential fluorescent labeling and histological analysis. Moreover, rat bilateral calvaria defects were randomly grafted with DBBM, DBBM + CorBC, or DBBM + CanBC. A blank group was included as control. Defect healing was assessed by histological staining, micro-CT, and quantitative polymerase chain reaction. In vitro migration, proliferation, and osteogenic differentiation assays were performed by stimulating rat bone marrow mesenchymal stem cells (rBMSCs) with cortical (CorBCM) or cancellous bone conditioned medium (CanBCM) to unveil the cellular mechanism. In the canine model, the augmented sites of DBBM + CanBC exhibited higher mineralized tissue proportion than the other two groups (DBBM: 0.61 ± 0.03 versus DBBM + CorBC: 0.69 ± 0.07 versus DBBM + CanBC: 0.86 ± 0.06; p < .05). In the rat model, the BV/TV value of DBBM + CanBC (0.51 ± 0.01) was higher than those of DBBM + CorBC (0.41 ± 0.02), DBBM (0.31 ± 0.01), and Control (0.10 ± 0.01; p < .01). Further radiological, histological and transcriptional results showed similar trends. In vitro experiments revealed that CorBCM and especially CanBCM could enhance rBMSCs migration, proliferation, and osteogenic differentiation. In vivo and in vitro experiments verified favorable synergistic effect of mixing autologous bone chips with DBBM on osteogenesis. Furthermore, CanBC presented more powerful osteogenic effect than CorBC.

Mentoplasty with Cancellous Bone Chip Scaffolding: An Innovative Technique for Chin Aesthetics.

The facial skeleton is foundational for facial aesthetics. The authors describe an alternative technique for cosmetic chin augmentation that does not require alloplastic implants, osseous genioplasty, or autologous bone harvesting. In this new and innovative technique for chin augmentation, tissue bank allograft cancellous bone chips serve as a scaffold for bony ingrowth. The use of bone chips allows for aesthetic contouring with small adjustments in the facial skeleton. The objective of this article is to provide further information on this novel technique and demonstrate the efficacy and safety of tissue bank allograft cancellous bone chips as an alternative graft material for cosmetic chin augmentation. Retrospective review of patients who underwent chin augmentation with cancellous bone chips from July of 2015 to March of 2019 was performed. Photographic results from several patients are included. No patients developed infections, required reoperation, or went on to have explantation of the graft material. Initial results suggest cancellous bone chips are a safe, efficacious alternative graft material for cosmetic chin augmentation. Therapeutic, IV.

Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction.

Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction.

New Bone Formation in the Whole Decellularized Cortical Bone Scaffold Using the Model of Revitalizing a Haversian System.

Decellularized allogeneic bone chips act as scaffolds for bone tissue regeneration. Owing to their lack of osteogenic potentials compared to autologous bone graft, decellularized bone scaffolds (DBSs) have applied only to small partial bone defects in clinical settings. Furthermore, only decellularized cancellous bone chips have been limitedly used for the purpose of bone regeneration. The cortical bone has less porosity and less osteogenic materials such as bone morphogenetic proteins in comparison with cancellous bone. In this study, we tried to accelerate new bone formation within the decellularized cortical bone scaffold using a vascular pedicle as an in vivo bioreactor.Forty DBSs were divided into 4 groups with different conditionings (DBS+ demineralized bone matrix [DBM], DBS+DBM+me+mesenchymal stem cells, DBS+DBM+vascular pedicle, and DBS+DBM+vascular pedicle+mesenchymal stem cells) and implanted into the back of 5 rabbits. Half of the DBSs were examined at 8 weeks and the other half at 16 weeks to determine vascularization level and osteogenesis within each group. New bone formation and bone-forming cells related to osteogenesis were observed via histological staining. Inclusion of the vascular pedicle resulted in larger areas of bone regeneration. With time, osteon structures became more prominent in groups containing the vascular pedicle.In summary, vascularized DBSs combined with a vascular pedicle have shown promising results for bone regeneration, thereby representing potential therapeutic alternatives for autologous bone grafts or bone tissue free transfer in large or segmental bone defects. In addition, demineralized whole cortical bone matrix along with vascular pedicle and various bone inductive materials, such as DBM and recombinant human bone morphogenetic protein-2, may be an additional new option of an ideal osteoinductive system.

Improved osteogenesis in rat femur segmental defects treated with human allograft and zinc adjuvants.

Bone allograft is widely used to treat large bone defects or complex fractures. However, processing methods can significantly compromise allograft osteogenic activity. Adjuvants that can restore the osteogenic activity of processed allograft should improve clinical outcomes. In this study, zinc was tested as an adjuvant to increase the osteogenic activity of human allograft in a Rag2 null rat femoral defect model. Femoral defects were treated with human demineralized bone matrix (DBM) mixed with carboxy methyl cellulose containing ZnCl2 (0, 75, 150, 300 µg) or Zn stearate (347 µg). Rat femur defects treated with DBM-ZnCl2 (75 µg) and DBM-Zn stearate (347 µg) showed increased calcified tissue in the defect site compared to DBM alone. Radiograph scoring and µCT (microcomputed tomography) analysis showed an increased amount of bone formation at the defects treated with DBM-Zn stearate. Use of zinc as an adjuvant was also tested using human cancellous bone chips. The bone chips were soaked in ZnCl2 solutions before being added to defect sites. Zn adsorbed onto the chips in a time- and concentration-dependent manner. Rat femur defects treated with Zn-bound bone chips had more new bone in the defects based on µCT and histomorphometric analyses. The results indicate that zinc supplementation of human bone allograft improves allograft osteogenic activity in the rat femur defect model.

Faster bone union progression and less sclerosis at the osteotomy margin after medial opening-wedge high tibial osteotomy using highly porous β-tricalcium phosphate granules versus allogeneic bone chips: A matched case–control study

BackgroundThis study compared bone union progression using highly porous (80% porosity) β-tricalcium phosphate (β-TCP) granules or allogeneic bone chips in the gap created by medial opening-wedge high tibial osteotomy (MOWHTO). MethodsThe study population consisted of 54 patients who received MOWHTO with locking plate fixation: 27 patients using highly porous β-TCP granules, and 27 age- and sex-matched patients using allogeneic bone chips. Bone union progression was evaluated 1, 3, 6, and 12 months postoperatively. The presence of radiographic sclerosis at the osteotomy margin was also assessed. ResultsAmong all patients, the highest degree of bone union observed 12 months postoperatively was grade 4. As postoperative time passed, bone union progression of highly porous β-TCP granules increased linearly and was statistically significant compared with that of cancellous allogeneic bone chips (P = 0.014). The presence of radiographic sclerosis at the osteotomy margin was significantly less common in the β-TCP group than in the allograft group (P = 0.003) and was the strongest predictor of delayed progress of bone union (odds ratio = 6.16, P = 0.006). ConclusionsPatients who underwent MOWHTO using highly porous β-TCP granules had faster new bone remodeling, less radiographic sclerosis at the osteotomy margin, and no inferior clinical outcome compared with allogeneic bone chips, as determined at the 1-year follow up. The presence of radiographic sclerosis at the osteotomy margin in patients undergoing MOWHTO using allogeneic bone or synthetic bone substitute may indicate delayed progress of bone union.

A Prospective, Randomized Study Evaluating Clinical and Radiographic Efficacy of Lumbar Interbody Fusion Performed Using a Truss Technology-Based Interbody Fusion Device With Homologous Bone or Bone Marrow Aspirate.

Our group used vertebral bone marrow aspirate (BMA) with an anterior truss-based interbody implant to promote fusion. This implant has biomechanical characteristics that may enhance bone on-growth and through-growth and allow for the use of BMA clot alone. The primary end point was comparison of the proportion of patients who achieved fusion with the implant packed with either crushed cancellous homologous bone chips (CCB) alone or with BMA clot alone. Patients were randomized to receive either BMA clot or CCB in the implant. Both groups also had supplemental fixation. Clinical assessments were performed preoperatively and postoperatively at 3, 6, and 12 months, including for the Oswestry Disability Index, leg and back visual analog scale, EQ5-D, reoperations, complications, and adverse events. Radiographs were obtained prior to discharge and at 3, 6, and 12 months postoperatively. A computed tomography scan was performed 3 months postoperatively. Radiographs were assessed by an independent radiologist to determine fusion status and evidence of subsidence. Between January 2015 and February 2016, 42 consecutive patients were randomized into 1 of the 2 study groups. There were significant postoperative changes within both groups in pain improvement across all outcome scales. There were no significant differences between groups in change scores from preoperative to assessments at any follow-up time point, with the exception of the change in EQ-5D and visual analog scale at 6 months; however, there was no difference at 3 or 12 months. There were no device-related adverse events in either group. All patients achieved grade II fusion at 3 months postoperatively. There was no significant difference in implant subsidence between groups or smokers versus nonsmokers. The clinical outcomes of this study suggest that reliable fusion can be obtained using an anterior truss-based implant with either CCB or BMA alone. 2.

Primary stability of a press-fit cup in combination with impaction grafting in an acetabular defect model.

The objectives of this study were to (a) assess primary stability of a press-fit cup in a simplified acetabular defect model, filled with compacted cancellous bone chips, and (b) to compare the results with primary stability of a press-fit cup combined with two different types of bone graft substitute in the same defect model. A previously developed acetabular test model made of polyurethane foam was used, in which a mainly medial contained defect was implemented. Three test groups (N = 6 each) were prepared: Cancellous bone chips (bone chips), tricalciumphosphate tetrapods + collagen matrix (tetrapods + coll), bioactive glass S53P4 + polyethylene glycol-glycerol matrix (b.a.glass + PEG). Each material was compacted into the acetabulum and a press-fit cup was implanted. The specimens were loaded dynamically in the direction of the maximum resultant force during level walking. Relative motion between cup and test model was assessed with an optical measurement system. At the last load step (3000 N), inducible displacement was highest for bone chips with median [25th percentile; 75th percentile] value of 113 [110; 114] µm and lowest for b.a.glass + PEG with 91 [89; 93] µm. Migration at this load step was highest for b.a.glass + PEG with 868 [845; 936] µm and lowest for tetrapods + coll with 491 [487; 497] µm. The results show a comparable behavior under load of tetrapods + coll and bone chips and suggest that tetrapods + coll could be an attractive alternative to bone chips. However, so far, this was found for one specific defect type and primary stability should be further investigated in additional/more severe defects.

Comparison of Alveolar Ridge Preservation with Autograft Cancellous Bone Transplant and PRF Following Canine Tooth Extraction in Dog

Objective- Due to its specific position, the canine tooth is more exposed to the injuries, fractures and pulp necrosis. In these cases, the damaged teeth are usually pulled out. The root of this tooth is very large and sometimes extends over the premolar teeth. To extract it, a large amount of alveolar bone tissue should be harvested. Moreover, the cavity remains very large, which results in forming a cavity after repairing. It can be very effective in the form of closure of the mouth and lips.Design- Experimental studyAnimals- five adult male dogs Procedures- In this research, five dogs were selected and their maxillary canine teeth in right and left (10 teeth in total) were surgically removed. Then the right dental cavity was filled with insulin PRF and the left one filled with autograft cancellous bone chips. Three weeks after the surgery, the cavity was sampled for histopathological examination. Factors such as epithelialization rate, fibroplasia, fibrotic reaction and intensity of inflammation were studied. Results- The average score obtained from histological studies implies that epithelialization in PRF group is significantly higher than the other group, and there is no significant difference in other parameters.Conclusion and Clinical Relevance- Since PRF preparation is easy, it is not painful and risky for the patient and does not require any special care after the surgery. Therefore, it is used preferably.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT The need for improved fusion technology led to the development of a lumbar interbody fusion implant with unique biomechanical characteristics that has the potential to enhance bone on-growth and through-growth. The proprietary implant using truss-based technology allows loading along the trusses throughout the fusion volume of the device which may promote stem cell differentiation into osteoblast and speed up the fusion process. PURPOSE It is hypothesized that fusions performed using the truss-based technology will result in higher fusion rates and reduced times for bone formation due to the biomechanical properties of the implant design when compared to annular implant designs. The purpose of this study was to evaluate the performance of the truss-based technology with two different graft materials, crushed cancellous allograft bone or autologous bone marrow aspirate. STUDY DESIGN/SETTING Prospective, randomized clinical trial performed in a university setting. PATIENT SAMPLE Between January 2015 and February 2016, 42 consecutive patients were recruited, consented and randomized into one of two previously defined study groups and underwent the index study procedure. There was one patient in Group 2 that withdrew from the study prior to surgery. In addition, there were 2 patient deaths due to cardiac events (one in each group) determined to be unrelated to the surgical procedure. OUTCOME MEASURES The clinical outcome measures included the Oswestry Disability Index (ODI), Visual/Analog Scales (VAS) separately assessing back and leg pain, EQ5-D and adverse events. METHODS Patients were randomized into one of two treatment groups (Group 1: crushed cancellous allograft bone vs. Group 2: autologous bone marrow aspirate [BMA] both receiving one- or two-level lumbar interbody fusion with supplemental fixation. It was determined that a total of 40 patients (20 patients per group) were needed to achieve a statistical significance level of 0.05. The 4WEB Anterior Spine Truss System Interbody Fusion Device (ASTS; 4WEB Medical, Frisco, TX, USA) was used in all cases. Clinical and radiographic data was obtained prior to hospital discharge and at 3, 6 and 12-months postoperatively. All radiographs were independently reviewed. RESULTS Except for changes from the preoperative assessment for total EQ-5D (p CONCLUSIONS The clinical and radiographic results from this prospective, randomized study have shown that reliable clinical and radiographic evidence of fusion can be obtained utilizing a truss-based web technology implant independent of the use of either crushed cancellous homologous bone chips or BMA alone. As a result of these findings, there may be intraoperative biologic cost reduction implications across multiple patient populations.

Bone morphogenic protein-2 use in revision total hip arthroplasty with acetabular defects.

The restoration of acetabular bone stock during revision hip arthroplasty remains a challenge. There have been no clinical series reporting the efficacy of bone morphogenic protein-2 (rhBMP-2) in the revision hip setting. We retrospectively reviewed the radiographs and records of 15 patients who received rhBMP-2 mixed with allograft bone chips (+BMP), and 14 who received allograft bone chips alone (-BMP) for their acetabular defect during revision total hip arthroplasty with a mean two-year follow up. Radiographs were evaluated for acetabular defect size, superior cup migration, and changes in the lateral cup abduction angle. Modified Harris hip scores were used for evaluation of clinical outcomes. Patients in the +BMP group compared to the -BMP group had significantly larger amounts of cancellous bone chips used (72.1±35.5cc vs. 38.6±14.1cc; p=0.003). Mean rhBMP-2 used per case was 7.4±3.1mg in the +BMP group. Three patients in the -BMP group had cup migration which was not observed in the +BMP group. Mean Harris hip scores (HHS) improved post-operatively in both groups (40.1±20.9 to 71.9±19, p<.0001). No local adverse reaction was noted in the +BMP group. rhBMP-2 had modest clinical benefit in the setting of revision THA. Cost of this synthetic biologic versus the added clinical benefit should be carefully considered when being used in the revision hip setting.

Osteoblast and Bacterial Culture from Cryopreserved Skull Flap after Craniectomy: Laboratory Study.

ObjectiveCranioplasty using a cryopreserved skull flap is a wide spread practice. The most well-known complications of cranioplasty are postoperative surgical infections and bone flap resorption. In order to find biological evidence of cryopreserved cranioplasty, we investigated microorganism contamination of cryopreserved skulls and cultured osteoblasts from cryopreserved skulls.MethodsCryopreserved skull flaps of expired patients stored in a bone bank were used. Cryopreserved skulls were packaged in a plastic bag and wrapped with cotton cloth twice. After being crushed by a hammer, cancellous bone between the inner and outer table was obtained. The cancellous bone chips were thawed in a water bath of 30°C rapidly. After this, osteoblast culture and general microorganism culture were executed. Osteoblast cultures were done for 3 weeks. Microorganism cultures were done for 72 hours.ResultsA total of 47 cryopreserved skull flaps obtained from craniectomy was enrolled. Of the sample, 11 people were women, and the average age of patients was 55.8 years. Twenty four people had traumatic brain injuries, and 23 people had vascular diseases. Among the patients with traumatic brain injuries, two had fracture compound comminuted depressed. The duration of cryopreservation was, on average, 83.2 months (9 to 161 months). No cultured osteoblast was observed. No microorganisms were cultured.ConclusionIn this study, neither microorganisms nor osteoblasts were cultured. The biological validity of cryopreserved skulls cranioplasty was considered low. However, the usage of cryopreserved skulls for cranioplasty is worthy of further investigation in the aspect of cost-effectiveness and risk-benefit of post-cranioplasty infection.

Comparative efficiency of goat mesenchymal stem cell isolation from bone marrow and bone chip

Bone marrow mesenchymal stem cell (BM-MSC) is a type of adult stem cell that offers tremendous potential in clinical use and gene-based therapies. The use of mesenchymal stem cells (MSCs) in animal models has shown promising evidences for the cure of certain human diseases. However, in animals certain obstacles like lack of standardised isolation methods and tissues used to derive MSCs often leading to lower yield of MSCs along with cumbersome characterisation steps can hamper their use, particularly for autologous stem cell therapy. In the present experiment, MSCs were isolated from bone marrow and cancellous bone chip collected from iliac crest of goats. The yield of MSCs derived from bone marrow and bone chip was compared and MSCs derived from both the sources were characterized based on cell morphology, plastic adherence, colony-forming property and expression of cell surface markers. Furthermore, these cells were cryopreserved and evaluated for post thaw viability. Interestingly, the yield of bone chip-derived MSCs was ∼3000 times higher when compared with bone-marrow-derived MSCs. MSCs derived from both the sources were plastic adherent, displayed fibroblastoid morphology, exhibited MSC-specific marker expression profile (CD105+CD90+CD45−CD34−), and possessed colony forming capacity when cultured at lower densities. Thus, it was concluded that bone chip could be used as an efficient tissue source for MSC isolation in goats.