Study DesignRetrospective cohort study.ObjectiveTo compare the clinical outcomes and cost-effectiveness of vertebroplasty augmented with demineralized bone matrix (VPDBM) and conventional bone cement vertebroplasty (VPBC) in osteoporotic vertebral compression fractures (OVCFs).MethodsOne hundred eighty-seven patients with acute OVCFs were reviewed (VPDBM, n = 103; VPBC, n = 84). Clinical outcomes were assessed using Visual Analog Scale (VAS) and Koval grade, and radiographic outcomes included vertebral kyphotic angle (VKA), local kyphotic angle (LKA), and correction angle. Treatment failure was defined as refracture requiring hospitalization or reoperation, persistent or worsening pain or function, or radiographic deterioration. Deterioration-free survival (DFS) was analyzed using Kaplan-Meier and Cox regression. Cost-effectiveness was evaluated from the hospital perspective.ResultsBoth groups showed significant postoperative improvement in VAS and Koval grade, without between-group differences at 12months. Immediate correction angle favored VPBC (P = .041), but this was not sustained. Composite treatment failure was lower with VPDBM (12.6% vs 27.4%), with odds ratio 0.38 (95% CI, 0.18-0.81), risk ratio 0.46 (95% CI, 0.25-0.85), and absolute risk reduction 14.8% (NNT 6.8; P = .010). Kaplan-Meier analysis showed superior DFS in VPDBM (log-rank P = .034). Adjusted Cox regression showed no significant difference (aHR 0.58; 95% CI, 0.24-1.39; P = .222). VPDBM was cost-effective, with ICER ₩43 978 ($32.0) per 1% DFS gain, below common willingness-to-pay thresholds.ConclusionVPDBM reduced treatment failures and improved DFS compared with VPBC, while remaining cost-effective in OVCF management.

Bone morphogenetic protein (BMP) stimulated osteoinduction is critical for bone regeneration. Human demineralized bone matrix (DBM) has been one of the most widely used bone graft substitutes, but its osteoinductive potential is weak and clinical effectiveness limited in part due to ineffective processing methods. Here, we describe a novel process designed to enhance allograft bioactivity by increasing the bioavailability of the native BMPs present within the matrix the product of which we call Natural Matrix Protein® (NMP®). BMP-7 release was quantified from NMP and DBM prepared from both bovine and human cortical bone. In both species, NMP significantly increased BMP-7 levels in acidic and physiologic extracts compared to DBM. NMP also demonstrated sustained release of BMP-7 and total protein for up to 12 weeks in simulated body fluid. Osteoinductive potential was evaluated in vitro using C2C12 cells and osteoinductivity in vivo in the athymic rat model. Direct treatment of cells with NMP in vitro produced a greater than tenfold increase in alkaline phosphatase activity at 40 mg/mL. In vivo, human NMP showed increased osteoinductivity compared to human DBM histologically, and the recovered NMP explants had significantly more mineralized bone and a higher bone volume fraction compared to DBM and to Infuse® Bone Graft (105µg rhBMP-2 on an absorbable collagen sponge) as measured by microCT. These findings demonstrate that the novel NMP process reproducibly increases BMP-7 bioavailability, that NMP implants produce sustained BMP and protein release and have marked increase in osteoinductive activity.

Craniofacial bone defects, particularly alveolar clefts, pose significant clinical challenges in pediatric patients due to complex anatomy and the limitations of current grafting options. Although autologous bone grafts remain the clinical gold standard, their use is restricted by donor-site morbidity, limited tissue availability, high cost, and risks such as infection, chronic pain, and functional impairment. Decellularized and demineralized bone matrix (DDBM) offers an attractive alternative but lacks controlled drug-release capability and cannot be monitored in real time in patients. To address these limitations, we developed indocyanine green-encapsulated bone-derived nanoparticles (ICG/BPs) from porcine DDBM, combining the intrinsic osteoinductive and osteoconductive properties of DDBM with near-infrared (NIR) imaging functionality. In this study, we fabricated two ICG/BP formulations , crosslinked (X-ICG/BP) and uncrosslinked (UnX-ICG/BP), and compared their in vitro degradation, release profiles, and in vivo performance in a rat model of cavity-type alveolar defects. Crosslinking improved particle stability and prolonged ICG release, and NIR imaging enabled real-time, non-invasive monitoring of particle degradation and retention within the defect. Additionally, both ICG/BP formulations supported bone regeneration, with X-ICG/BPs demonstrating greater regeneration, tissue organization, and vascularization. Overall, these findings highlight the tunability and theranostic potential of ICG/BPs and support their continued development as an image-guided functional biomaterial for craniofacial bone repair.

Evaluation of Simultaneous Implant Placement and Maxillary Sinus Floor Augmentation with Gelatin Sponge versus Allogenic Demineralized Bone Matrix: (A randomized controlled clinical trial)

The rising number of spinal fusion procedures has increased the demand for effective bone graft substitutes. Although recombinant human bone morphogenetic protein-2 is clinically used for its osteoinductive properties, dose-dependent complications limit its broader application. Demineralized bone matrix (DBM) and bioactive glass (BAG) are alternative materials, but their comparative and combined osteogenic potential remains unclear. This study evaluated the in vitro osteoinductive activity of BMP-2, DBM, BAG, and a composite nano-BAG + DBM formulation. An in vitro C2C12 alkaline phosphatase (ALP) assay was used to assess osteogenic differentiation following exposure to BMP-2 (50 ng/mL) and test materials at 20 and 50 mg/mL. Gel-based formulations were standardized to 1 g total weight and included the following: nano-BAG + DBM (33:33:33 of cortical DBM, 45S5 BAG, and porcine gelatin; marketed as NanoFuse DBM), BAG + Gel (50:50 BAG and gelatin), and DBM + Gel (50:50 DBM and gelatin). Wet/frozen DBM (100% DBM) served as the native reference. ALP activity was measured at 410 nm and normalized to total protein content. Wet/frozen DBM exhibited the highest ALP activity (>94.420 units/mg protein), followed by nano-BAG + DBM at 50 mg/mL, which exceeded the assay's upper detection limit (>92.473 units/mg). DBM + Gel showed moderate activity, while BAG + Gel and the negative control showed minimal induction. BMP-2 at 50 ng/mL demonstrated lower activity (31.700 units/mg) than nano-BAG + DBM. NanoFuse DBM demonstrated dose-dependent osteoinductive activity and may offer a safer, more efficient alternative to BMP-2 and traditional grafts in spinal fusion, trauma, and joint reconstruction. NanoFuse DBM demonstrated dose-dependent osteoinductive activity and outperformed DBM, BAG, and BMP-2 at the tested dose. These findings support its potential as a bone graft substitute in spinal fusion and other orthopedic applications where improved biological performance and safety are critical. Further research is needed to optimize BMP-2 dosing and evaluate NanoFuse DBM's in vivo efficacy.

BackgroundThe management of retro-acetabular osteolysis in revision hip arthroplasty with acetabular component retention remains controversial and challenging due to limited access to the area.Surgical technique and methodsFourteen patients with well-fixed and well-aligned acetabular components underwent revision surgery and a retained shell. A vinyl urinary catheter and syringe were used to deliver demineralized bone matrix putty to the bone defect after debridement. Clinical outcome and radiographic follow-up were scheduled at a minimum of 2 years.ResultsThe revision arthroplasty survivorship rate with this technique was 85.7% (12 of 14 patients) at a median follow-up of 6 years. One cup failed due to an aseptically loosening cup, and another from late septic loosening. Significant improvement of the University of California Los Angeles (UCLA) score, Harris Hip Score (HHS) pain subscale, and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) were observed at a median 6-year follow-up.ConclusionsManagement of retro-acetabular osteolysis with injected demineralized bone matrix using a syringe and vinyl urinary catheter is a reliable, easy, low-cost method with satisfactory mid-term clinical outcome improvement.Video Supplementary InformationThe online version contains supplementary material available at 10.1186/s42836-025-00349-4.

Demineralized bone matrix (DBM) is an organic demineralized matrix heavily utilized for filling bone defects in cranial vault reconstruction. Newer products without carriers, which offer improved handling and malleability, are less well characterized. We hypothesized that DBM with and without carrier would have equivalent safety profiles and sought to investigate any difference in pyrogenicity, drainage volume, and hospitalization. A retrospective cohort study was conducted for patients who received DBM allograft as part of cranioplasty for sagittal craniosynostosis. Cases using DBM with inert carrier were designated group I and those utilizing carrier-free "pure" DBM were designated group II. Primary outcome variables were maximum daily inpatient temperature (Tmax), postoperative drain output, and total drain duration. Thirteen patients were included. Demineralized bone matrix with carrier was used in 61.5% of patients (group I) and carrier-free DBM in 38.5% of patients (group II). Twenty-four hours postoperative group I had a mean Tmax of 37°C (36.6-37.4°C) versus 36.4°C (36.2-36.6°C) for group II (P=0.02). Mean total postoperative drain output was 437.9mL (307.5-568.2mL) for group I compared with 436.3mL (261.4-611.1mL) for group II (P=0.9). The median time until drain removal was POD 3.5 for group I compared with POD 3 for group II (P=0.05). Admission duration was 4.75 days for group I and 4 days for group II (P=0.03). Pure demineralized bone matrix allograft in cranial vault reconstruction for sagittal craniosynostosis results in improved handling with similar postoperative drain outputs when compared with DBM with carrier, with both groups remaining afebrile in the postoperative period.

The clinical repair of bone defects is hindered by limitations in donor material and complications arising from autologous bone grafting. Consequently, the development of efficient bone regeneration materials is of great clinical importance. The present study investigated a three-dimensional microporous demineralized bone matrix (DBM) combined with bone marrow mesenchymal stem cells (BMSCs) to enhance the outcomes of bone defect repair. The DBM has been developed to enhance the collagen preparation process, with the aim of retaining the collagen fiber network of the natural bone matrix and forming a three-dimensional microporous structure with good mechanical property. In vitro experiments demonstrated that the biocompatibility of DBM was superior to that of traditional cancellous and cortical bone materials, and they promoted cell adhesion, proliferation, and osteogenic differentiation as well as osteogenesis-related genes. In vivo experimentation was conducted to verify the efficacy of the treatment on a critical-sized cranial bone defect in nude mice. Micro-CT and histological analysis showed more formation of bone at 4 weeks and 8 weeks postsurgery. The DBM with optimized pore structure, degradation rate, and bioactivity enhanced the efficiency of bone defect repair by synergizing the osteogenic activity of BMSCs. The DBM with a porous and cross-linked structure could provide BMSCs with more internal surface area for attachment space to promote cell adhesion and growth and create advantages for the bone formation. Moreover, the DBM contains multifarious osteoinductive growth factors such as transforming growth factor-β (TGF-β), fibroblast growth factors (FGFs), bone morphogenetic proteins (BMPs) and insulin growth factors (IGFs), which can enhance osteogenic differentiation of BMSCs. This study may provide an innovative strategy for bone regeneration and bone defect repair.

ABSTRACT Aim This study examined the effectiveness of human demineralized bone matrix (DBM) as a scaffold material in bone regenerative medicine using cultured periosteal cells (CPCs). Methods A bone defect created in the parietal region of eight‐week‐old nude rats served as the graft bed. A polylactic acid resin dish shell was used as a covering material, and DBM (with (+) or without (−) CPC) was grafted at the site. Deproteinized bovine bone (DBB) was used in the control group. Four weeks later, the grafted site was sampled for micro‐computed tomography and histological observations. The osteoblastic induction effect of DBM was evaluated by co‐culturing with CPCs. Results The DBM‐CPC (+) group demonstrated a significantly larger new bone volume than the DBM‐CPC (−) group. New bone formation with a distinct lining of alkaline phosphatase (ALP)‐positive cells was observed in the DBM graft area, regardless of cell administration. However, the staining intensity and thickness tended to be higher in the DBM‐CPC (+) group. Cells positive for tartrate‐resistant acid phosphatase were more concentrated in areas close to the existing bone in the DBM‐CPC (−) group and throughout the newly formed bone area in the DBM‐CPC (+) group. Only slight bone conduction was observed adjacent to existing bone in the DBB graft group, with no new bone formation. The emergence of ALP‐positive cells was confirmed in CPC co‐cultured with DBM. Conclusions These findings demonstrate the bone inductive effect of DBM and indicate the effectiveness of DBM as a cell transplantation carrier in bone regeneration cell therapy.

Background: Biportal endoscopic transforaminal lumbar interbody fusion (BESS-TLIF) is an emerging minimally invasive technique. This study aimed to evaluate the two-year radiological fusion outcomes of single-level BESS-TLIF using a specific banana-shaped, porous titanium interbody cage. Methods: This retrospective study reviewed 51 patients who underwent the specified procedure. The primary endpoint was the radiological fusion rate, assessed by computed tomography (CT) over 24 months using a three-grade system. Factors influencing fusion, particularly bone graft composition (demineralized bone matrix [DBM] only vs. DBM with I-factor), were also analyzed. Results: The final complete fusion rate at two years was 96.1% (49/51; 95% Confidence Interval (CI), 86.5–99.5%). Bony fusion occurred predominantly in the posterior and intracage regions. The only significant factor influencing fusion was the bone graft material. The ‘DBM with I-factor’ group achieved complete fusion significantly faster than the ‘DBM only’ group (log-rank test, p < 0.001), with a higher final fusion rate (100% vs. 83.3%, p = 0.045). Conclusions: Single-level BESS-TLIF using a banana-shaped, porous titanium cage provides favourable two-year radiological fusion rates. The selective addition of I-factor as an osteoinductive supplement can significantly accelerate the time to achieve solid arthrodesis.

This study aimed to histologically evaluate and compare the bone regenerative potential of two grafting materials, demineralized bone matrix (DBM) putty and nanocrystalline hydroxyapatite (ncHA) putty, applied to surgically created intrabony defects in a rat's model, in conjunction with the decortication technique. Thirty rats were included. A surgical bone defect measuring W × L × D; 2 × 2 × 1.5 mm with decortication was prepared by small round bur, and the rats were randomly divided into three groups (10 rats each), group I (control): Defect induction and decortication, group II: Defect induction and decortication then, ncHA putty insertion, group III: Defect induction and decortication then DBM allograft putty insertion. Five rats from each group were euthanized at 2 and 4 weeks, respectively. Maxilla excised for histological processing and evaluation using H&E stains to assess the percentage area of newly formed bone. Data were statistically analyzed by one-way ANOVA and post hoc test. The mean ± SD values at 2 and at 4 weeks were (1.05 ± 0.07, 1.25 ± 0.04) for groups I, group II (8.14 ± 0.16, 15.94 ± 0.21), and group III (8.20 ± 0.25, 13.40 ± 0.55), respectively. Both experimental groups showed significantly greater bone formation than the control at both intervals (p < 0.001). At 4 weeks, group II (ncHA) recorded higher bone regeneration compared to group III DBM (p < 0.001), while the control group showed only a slight increase. Both DBM and ncHA putties enhanced bone regeneration, with ncHA showing superior performance at 4 weeks. Intrabony defects are a clinical challenge, and selecting an effective graft material is crucial for achieving predictable periodontal regeneration. How to cite this article: Dao AM, Abdulrahman M, Mira ES, et al. Histological Comparison of Bone Regeneration Using Two Putty Bone Grafts in Surgically Created Intrabony Defect in Rats with Intramarrow Penetration. J Contemp Dent Pract 2025;26(10):938-944.

In vitro evaluation of 3D-printed PCL/forsterite scaffolds with aligned collagen and demineralized bone matrix for cranial bone regeneration

Rationale:Tendon adhesion is a relatively uncommon complication after distal radius fracture surgery.Patient concerns:A 51-year-old woman underwent open reduction and volar plate fixation for a distal radius fracture at another hospital approximately 4 weeks ago. Upon presentation to our hospital, active flexion of the thumb interphalangeal (IP) joint was preserved, but active extension was absent; additionally, passive extension of the thumb IP joint could not be achieved by the examiner.Diagnoses:Plain radiography and computed tomography demonstrated that 1 distal screw of the volar plate protruded beyond the dorsal cortex, with radiopaque material visible on the radial-volar aspect of the plate. Although rupture of the extensor pollicis longus tendon by the protruding screw was considered, passive extension of the thumb IP joint is generally preserved in such cases. Therefore, adhesion of the flexor pollicis longus tendon was considered more likely than extensor pollicis longus tendon rupture.Interventions:Surgical exploration confirmed severe adhesion of the flexor pollicis longus to the volar plate, which was released via adhesiolysis. And remnants of the demineralized bone matrix and hydroxyapatite complex previously applied were identified and removed.Outcomes:Early initiation of both active and passive rehabilitation was implemented postoperatively without immobilization. At 4 years postoperatively, the patient demonstrated full active extension of the thumb IP joint, with no evidence of recurrence.Lessons:When using bone graft substitutes containing demineralized bone matrix or bone morphogenetic proteins, measures should be taken to prevent leakage into adjacent soft tissues, particularly in regions containing multiple tendons. In addition, any leaked bone graft substitute should be removed using techniques such as irrigation at the surgical site.

Guided bone regeneration (GBR) is a key approach in oral and orthopedic reconstruction, relying on barrier membranes and graft materials to direct bone formation. While bovine and porcine xenografts dominate clinical use, caprine bone-derived biomaterials remain under-explored. This comprehensive review consolidates macroscopic and histological evidence on caprine bone-based grafts, focusing on demineralized bone matrix (DBM) and hydroxyapatite (HA) derivatives reported between 2019 and 2025. Database searches of PubMed, Scopus, and Web of Science identified relevant studies evaluating caprine materials’ physicochemical properties, in vitro biocompatibility, in vivo bone formation, and systemic responses. Results show that caprine DBM and HA exhibit favorable osteoconductivity and biocompatibility, producing progressive bone formation with histological features comparable to autograft under optimized processing. Variability in bone volume outcomes was linked to differences in material preparation and defect models. Transient hematological responses indicate the need for standardized sterilization and safety monitoring. The review highlights methodological gaps, including inconsistent histomorphometry, limited GBR-specific models, and lack of unified reporting. Standardized processing, combined imaging-histology protocols, and GBR-oriented large-animal studies are recommended to advance clinical translation of caprine xenografts as cost-effective alternatives to conventional grafts.

The study aimed to investigate the efficacy of autogenous iliac crest bone graft (ICBG) compared with other graft types in achieving successful fracture nonunion repair. An institutional review board-approved retrospective review of prospectively collected data was conducted on a consecutive series of patients surgically treated for fracture nonunions at an academic medical center between September 10, 2004, and August 20, 2023. Patients were analyzed based on which bone graft type-ICBG versus alternative graft types-used during their nonunion repair. Patient demographics, injury characteristics, and surgical history were compared. Outcomes included radiographic healing, time to union, postoperative complications, and revision rate. Cohorts were compared using an independent sample Student t-test for continuous variables and chi-square or Fisher exact tests for categorical variables. One-way analysis of variance with post hoc comparisons assessed differences across treatment strategy groups. Five hundred fifty-six patients were treated surgically for a fracture nonunion using standard internal fixation and a "bone graft" for biologic stimulation. 57.4% of these patients were treated with autogenous ICBG; 42.6% received alternative grafts (iliac crest aspirate, allograft, bone morphogenetic, reamer-irrigation aspirator, and/or demineralized bone matrix, without autogenous cancellous iliac crest). Compared with the alternative cohort, the ICBG cohort showed greater healing success after a single nonunion surgery (95.6% ICBG versus 86.9% alternative, P < 0.001) and faster healing times (4.8 ± 2.4 months versus 7.1 ± 4.9 months, P < 0.001). Complications at the ICBG harvest site included wound infections/hematomas and iliac wing fracture. No notable differences were found in positive cultures at the time of surgery, postoperative fracture-related infection, implant failure, or neurovascular injury. Using autogenous ICBG in the surgical repair of fracture nonunions was associated with higher healing rates compared with alternative graft types, supporting its continued role in enhancing bone healing outcomes, even in the face of infected nonunion.

Allograft bone and demineralized bone matrix (DBM) are important allogeneic sources of structural and biologic graft to support successful fusion in surgical correction of adult spinal deformity (ASD). Little is known about the contribution of graft type, volume, and ratio to successful fusion. A retrospective review of a single-institution database of ASD patients was reviewed to assess for postoperative pseudarthrosis, screw loosening, or rod breakage (PLB). Patients with ≥ 5 level fusion who had follow-up > 6 months were included in the analysis. Surgical records were reviewed to collect graft type and volume. Total allograft bone volume (TB), total DBM volume (DBM), and DBM: Bone ratio were assessed. TB and DBM per level were calculated. Univariate and multivariate analyses were performed. Receiver-operator curve (ROC) analysis was performed to identify cutoffs to minimize risk of mechanical complications. A total of 310 patients were included in the analysis, with 13 (4.2%) demonstrating PLB. Univariate analysis demonstrated several significant risk factors for the study complications, including ASA class, male sex, and history of smoking, as well as TAB and TAB: Level. Multivariate analysis identified smoking, male sex, TB: Level, and DBM: Bone ratio as significant risk factors. ROC analysis identified a cutoff of 10.3cc pf allograft bone per level, a DBM: bone ratio of 1.5, and a BMI of 25.1kg/m2 as risk factors for failure. In addition to demographic risk factors, total allograft bone per level and the ratio of DBM to allograft bone appear to be significant risk factors for pseudarthrosis after surgical correction of ASD. These values can be used to rationally select graft volume and graft composition in order to mitigate the risk of pseudarthrosis.

To determine if the use of autogenous bone graft is necessary for the treatment of humeral shaft nonunions after initial nonoperative management. Retrospective. Level 1 academic trauma center. All skeletally mature patients undergoing nonunion repair of a humeral shaft fracture (OTA/AO 12A, 12B, 12C) after initial nonoperative management of the acute fracture. The primary outcome was osseous union. Failure of nonunion repair was defined by lack of osseous union within 365 days from surgery and/or return to the operating room for additional attempts to promote union. Secondary outcomes included complications including infection, radial nerve palsy, and donor site morbidity. Seventy-two patients were included in the final cohort. Thirty-eight patients (53%) were female, and the average age was 51 (SD 18, range 17, 83). Two patients (3%) developed a recalcitrant nonunion, both of which healed after a second procedure consisting of revision compression plating. The use of bone autograft was uncommon overall in this cohort (4 patients, 6%). Bone morphogenic protein, bone allograft, or demineralized bone matrix was used in 12 patients (17%). The remaining 56 patients (78%) were treated with compression plating alone. Compression was generated through multiple techniques including use of the articulated tensioning device, a pull screw with a verbrugge clamp, lag screw application, and compression generated via eccentric drilling through the plate. There were no differences in terms of patient demographics, fracture, or injury characteristics between the groups that received autograft and those who did not ( P > 0.05). Use of autograft or other biologic supplementation was not associated with a statistically significant increase in union rate, 100% versus 97% ( P = 1.00). In the 4 patients who underwent autogenous bone grafting, there were no reported donor site complications. For humeral shaft fractures initially treated nonoperatively that went on to nonunion or anticipated nonunion, the union rate for compression plating alone was comparable with the union rate noted in the literature after treatment with bone autograft and compression plating. These results suggest that routine use of bone autograft may be unnecessary in the treatment of humeral shaft nonunions. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hip decompression effectively treats early-stage osteonecrosis of the femoral head (ONFH) by slowing disease progression and potentially delaying joint replacement. Biological adjuvants like bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) support bone regeneration and improve outcomes1-7. The present video article demonstrates a simple, coreless hip decompression technique with BMAC and PRP injection for early-stage ONFH. The procedure is performed in the same operating room setting as traditional core decompression, with the patient supine on a radiolucent table for fluoroscopic guidance. One or both legs are draped free for access to the iliac crests. Bone marrow is harvested percutaneously from the anterior superior iliac crest with a trocar needle kit, centrifuged, and prepared for injection. We recommend precoating needles and syringes with 1:1,000 heparin to prevent clotting. The BioCUE System (Zimmer Biomet) is typically utilized for centrifugation. Hip decompression is performed with use of a trocar and cannula (PerFuse System; Zimmer Biomet), with subsequent injection through the cannula into the femoral head. A 0.5-cm skin incision is made. The trocar is placed lateral to the femur and advanced percutaneously through the lateral femoral cortex, with a starting point proximal to the lesser trochanter. The trocar is then advanced along the femoral neck into the necrotic region by performing mallet strikes on the instrument's strike cap. Anteroposterior and frog-leg lateral views assist in positioning the trocar within the necrotic area. Internal leg rotation, which aligns the patella upward, helps position the trocar horizontally parallel to the floor. Positioning is adjusted using repeated imaging as needed. Once the patient is positioned, the trocar is removed, leaving the cannula in place. With the cannula retracted 1 cm, a 30-mL syringe is utilized to inject BMAC and PRP into the necrotic lesion. Because of sclerotic resistance, substantial pressure is needed, but retraction of the cannula helps. Following injection, the cannula is withdrawn another 1 cm, and demineralized bone matrix is injected to prevent escape of the BMAC. Alternative treatments for ONFH include traditional core decompression with a sliding hip screw drill or an X-REAM device (Stryker), both of which carry a higher risk of fracture because of the larger diameter of the tract and require limited weightbearing postoperatively. Bone-cement injection can stabilize the femoral head but lacks regenerative properties. Core decompression with either BMAC or PRP alone, rather than in combination, also serves as an alternative treatment strategy. Open approaches, like osteotomy, are more invasive, have longer recovery times, and may complicate future hip arthroplasty if unsuccessful. This technique enables minimally invasive hip decompression and delivery of adjuvant cell therapy or grafting, typically without the use of power instruments. This approach avoids the risk of injuring the bone due to the heat from power tools, protecting the BMAC injection site. Patients are generally discharged the same day and permitted full weight-bearing immediately, even in bilateral surgeries. Hip decompression for ONFH has shown variable rates of success8,9, but adding BMAC or PRP may improve outcomes1-3. Houdek et al. reported that among 35 hips treated with decompression plus BMAC and PRP for corticosteroid-induced ONFH, 88% avoided THA at 3 years2 and 70%, at 7 years3. Patients with grade-1 or 2 Kerboul angles had a 90% survivorship rate, underscoring the benefits of BMAC and PRP. Insert the trocar into the lateral cortex, positioned distal to the vastus ridge and proximal to the lesser trochanter, to reduce iatrogenic subtrochanteric fracture risk.Avoid advancing closer than 5 mm to the subchondral cortex to prevent joint-surface disruption or collapse, especially with eccentric lesions.If resistance occurs during injection, retract the cannula a few millimeters laterally to increase delivery space and reduce pressure. BMAC = bone marrow aspirate concentrateONFH = osteonecrosis of the femoral headPRP = platelet-rich plasmaAP = anteroposteriorTHA = total hip arthroplastyARCO = Association Research Circulation Osseous classificationMRI = magnetic resonance imaging.

Investigating the Effect of Combination between Demineralized Bone Matrix and Hydroxyapatite in Spinal Fusion: A Systematic Review and Meta Analysis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Minimally invasive or percutaneous surgery (MIS) for hallux valgus correction has demonstrated excellent clinical and radiographic outcomes. However there are rare occasions where there is limited bone formation and remodelling despite successful union. This study investigated whether prophylactic bone graft augmentation could improve bone formation compared to standard percutaneous technique. Methods: A retrospective comparative study of patients undergoing fourth-generation percutaneous hallux valgus correction with Bone Graft Augmentation (BGA group) or without (NBG group) demineralized bone fibre augmentation. Primary outcome was radiographic healing assessed at 6 weeks, 3 months, and 6 months using a validated classification system. Secondary outcomes included patient reported outcome measures (MOXFQ, EQ-5D-5L, VAS Pain), and radiographic parameters (intermetarsal angle, hallux valgus angle). Results: Between September 2022 and July 2024, 215 patients (191 female; 24 male; 316 feet) underwent fourth generation percutaneous metatarsal extra-capsular transverse osteotomy for hallux valgus correction. Patients were divided into bone graft augmentation (BGA; 222 feet) and non-bone graft (NBG; 94 feet) groups. Radiographic follow-up was available for 75.2% (167 feet) of BGA and 79.8% (75 feet) of NBG cases. The BGA group showed significantly improved radiographic union scores at 3 and 6 months (p=0.005-0.027) but not 6 weeks (p=0.06), with both groups achieving 100% union by 6 months. There were no significant differences between groups in terms of patient reported outcome measures or radiographic deformity correction (p&gt;0.05). The additional cost of bone graft augmentation was USD$1990 per procedure. Conclusion: The addition of demineralized bone matrix to the lateral healing zone, led to significantly improved radiographic healing rates at three and six months following percutaneous hallux valgus surgery. Future studies should investigate whether other biological adjuncts could further optimize healing in specific patient populations or identify those which may not demonstrate bony remodelling. Graph demonstrating mean bone healing classification score between the two groups at various time points following surgery. Error bars indicate 95% confidence intervals