Comparing the Rate of Dissolution of Two Commercially Available Synthetic Bone Graft Substitutes

Abstract

This study characterized the dissolution properties of two commercially available bone substitutes: (1) A calcium sulfate (CaS)/brushite/β-tricalcium phosphate (TCP) graft containing 75% CaS and 25% calcium phosphate; and (2) a CaS/hydroxyapatite (HA) bone graft substitute composed of 60% CaS and 40% HA. Graft material was cast into pellets (4.8 mm outer diameter × 3.2 mm). Each pellet was placed into a fritted thimble and weighed before being placed into 200 mL of deionized water. The pellets were removed from the water on days 1, 2, 3, 4, 6, 8, 14, 18, or until no longer visible. The mass and volume of each pellet were calculated at each timepoint to determine the rate of dissolution. Analysis of variance was performed on all data. Statistical significance was defined as p < 0.05. The CaS/HA pellets were completely dissolved after day 8, while the CaS/brushite/β-TCP pellets remained until day 18. The CaS/brushite/β-TCP pellets had significantly more mass and volume at days 1, 2, 3, 4, 6, and 8 timepoints. The CaS/brushite/β-TCP pellets lost 46% less mass and 53% less volume over the first 4 days as compared to CaS/HA pellets. The CaS/brushite/β-TCP pellets had a rough, porous texture, while the CaS/HA pellets had a smooth outer surface. Overall the CaS/brushite/β-TCP pellets dissolved approximately twice as slowly as the CaS/HA pellets in vitro. As these in vitro findings might have in vivo implications, further clinical data are required to further confirm and establish the optimal synthetic bone substitute strategy or antibiotic delivery carrier.

Keywords

bone graft substitute - dissolution - resorption

Authors' Contributions

K.M.: interpretation of data, drafting the paper and revising it critically, approval of the submitted and final versions

M.S.: research design, acquisition, analysis and interpretation of data, approval of the submitted and final versions

I.P.: interpretation of data, drafting the paper and revising it critically, approval of the submitted and final versions

P.J.R.: interpretation of data, drafting the paper and revising it critically, approval of the submitted and final versions

J.F.: research design, acquisition, analysis, and interpretation of data, approval of the submitted and final versions

N.S.P.: research design, critical manuscript revisions, supervision, approval of the submitted and final versions

All authors have read and approved the final submitted manuscript.

Publikationsverlauf

Eingereicht: 12. Mai 2023

Angenommen: 04. September 2024

Accepted Manuscript online:
05. September 2024

Artikel online veröffentlicht:
11. Oktober 2024

• References

• 1 Sohn HS, Oh JK. Review of bone graft and bone substitutes with an emphasis on fracture surgeries. Biomater Res 2019; 23 (01) 9
• 2 Wang W, Yeung KWK. Bone grafts and biomaterials substitutes for bone defect repair: a review. Bioact Mater 2017; 2 (04) 224-247
• 3 Tahmasebi Birgani Z, Malhotra A, Yang L, Harink B, Habibovic P. 1.19 Calcium phosphate ceramics with inorganic additives. Compr Biomater II 2017; 406-427
• 4 Bowles RD, Bonassar LJ. 7.15 Intervertebral disc. Compr Biomater II 2017; 265-277
• 5 Delloye C, Cornu O, Druez V, Barbier O. Bone allografts. 2007; 89 (05) 574-579
• 6 Roberts TT, Rosenbaum AJ. Bone grafts, bone substitutes and orthobiologics: the bridge between basic science and clinical advancements in fracture healing. Organogenesis 2012; 8 (04) 114-124
• 7 Gupta A, Kukkar N, Sharif K, Main BJ, Albers CE, El-Amin Iii SF. Bone graft substitutes for spine fusion: a brief review. World J Orthop 2015; 6 (06) 449-456
• 8 Campana V, Milano G, Pagano E. et al. Bone substitutes in orthopaedic surgery: from basic science to clinical practice. J Mater Sci Mater Med 2014; 25 (10) 2445-2461
• 9 Rupp M, Klute L, Baertl S. et al. The clinical use of bone graft substitutes in orthopedic surgery in Germany-A 10-years survey from 2008 to 2018 of 1,090,167 surgical interventions. J Biomed Mater Res B Appl Biomater 2022; 110 (02) 350-357
• 10 Bohner M. Resorbable biomaterials as bone graft substitutes. Mater Today 2010; 13 (1–2): 24-30
• 11 Fernandez de Grado G, Keller L, Idoux-Gillet Y. et al. Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management. J Tissue Eng 2018; 9: 2041731418776819
• 12 Faour O, Dimitriou R, Cousins CA, Giannoudis PV. The use of bone graft substitutes in large cancellous voids: any specific needs?. Injury 2011; 42 (Suppl. 02) S87-S90
• 13 Greenwald AS, Boden SD, Goldberg VM, Khan Y, Laurencin CT, Rosier RN. American Academy of Orthopaedic Surgeons. The Committee on Biological Implants. Bone-graft substitutes: facts, fictions, and applications. J Bone Joint Surg Am 2001; 83-A (Suppl 2 Pt 2): 98-103
• 14 Fillingham Y, Jacobs J. Bone grafts and their substitutes. Bone Joint J 2016; 98-B (1 Suppl A): 6-9
• 15 Gillman CE, Jayasuriya AC. FDA-approved bone grafts and bone graft substitute devices in bone regeneration. Mater Sci Eng C 2021; 130: 112466
• 16 Hak DJ. The use of osteoconductive bone graft substitutes in orthopaedic trauma. J Am Acad Orthop Surg 2007; 15 (09) 525-536
• 17 Galois L, Mainard D, Delagoutte JP. Beta-tricalcium phosphate ceramic as a bone substitute in orthopaedic surgery. Int Orthop 2002; 26 (02) 109-115
• 18 Chazono M, Tanaka T, Komaki H, Fujii K. Bone formation and bioresorption after implantation of injectable β-tricalcium phosphate granules-hyaluronate complex in rabbit bone defects. J Biomed Mater Res A 2004; 70 (04) 542-549
• 19 Kattimani VS, Kondaka S, Lingamaneni KP. Hydroxyapatite–past, present, and future in bone regeneration. Bone Tissue Regen Insights 2016; 7: BTRI.S36138
• 20 Saulacic N, Fujioka-Kobayashi M, Kimura Y, Bracher AI, Zihlmann C, Lang NP. The effect of synthetic bone graft substitutes on bone formation in rabbit calvarial defects. J Mater Sci Mater Med 2021; 32 (01) 14
• 21 Koshino T, Murase T, Takagi T, Saito T. New bone formation around porous hydroxyapatite wedge implanted in opening wedge high tibial osteotomy in patients with osteoarthritis. Biomaterials 2001; 22 (12) 1579-1582
• 22 Spivak JM, Hasharoni A. Use of hydroxyapatite in spine surgery. Eur Spine J 2001; 10 (Suppl. 02) S197-S204