Tibial segmental bone defect treated with bone plate and cage filled with either xenogeneic composite or autologous cortical bone graft

C. R. Teixeira; S. C. Rahal; R. S. Volpi; R. Taga; T. M. Cestari; J. M. Granjeiro; L. C. Vulcano; M. A. Correa

doi:10.1160/VCOT-06-12-0093

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2007; 20(04): 269-276
DOI: 10.1160/VCOT-06-12-0093

Original Research

Schattauer GmbH

Tibial segmental bone defect treated with bone plate and cage filled with either xenogeneic composite or autologous cortical bone graft

An experimental study in sheep

Authors

C. R. Teixeira

¹School of Veterinary Medicine and Animal Science, São Paulo State University, Dept. of Veterinary Surgery and Anesthesiology, São Paulo, Brazil
S. C. Rahal

¹School of Veterinary Medicine and Animal Science, São Paulo State University, Dept. of Veterinary Surgery and Anesthesiology, São Paulo, Brazil
R. S. Volpi

²School of Medicine, São Paulo State University, Dept. of Surgery and Orthopedics, São Paulo, Brazil
R. Taga

³School of Dentristy of Bauru, São Paulo University, Dept. of Biological Science, São Paulo, Brazil
T. M. Cestari

³School of Dentristy of Bauru, São Paulo University, Dept. of Biological Science, São Paulo, Brazil
J. M. Granjeiro

⁴Biology Institute, Fluminense Federal University, Dept. of Cell and Molecular Biology, São Paulo, Brazil
L. C. Vulcano

⁵School of Veterinary Medicine and Animal Science, São Paulo State University, Dept. of Animal Reproduction and Radiology, São Paulo, Brazil
M. A. Correa

¹School of Veterinary Medicine and Animal Science, São Paulo State University, Dept. of Veterinary Surgery and Anesthesiology, São Paulo, Brazil

Abstract

Summary

Tibia segmental defect healing in sheep were clinically, radiographically and histologically evaluated. Twelve young sheep aged four to five months were divided into two groups, G1 and G2. A 3.5 cm long segmental defect was created in the right tibial diaphysis with maintenance of the periosteum. The bone defects in both groups were stabilized with a bone plate combined with a titanium cage. In G1 the cage was filled with pieces of autologous cortical bone graft. In G2 it was filled with a composite biomaterial which consisted of inorganic bovine bone, demineralized bovine bone, a pool of bovine bone morphogenetic proteins bound to absorbable ultra-thin powdered hydroxyapatiteand bonederived denaturized collagen. Except for one G1 animal, all of them showed normal limb function 60 days after surgery. Radiographic examination showed initial formation of periosteal callus in both groups at osteotomy sites, over the plate or cage 15 days postoperatively. At 60 and 90 days callus remodeling occurred. Histological and morphometric analysis at 90 days after surgery showed that the quantity of implanted materials in G1 and G2 were similar, and the quantity of new bone formation was less (p=0.0048) and more immature in G1 than G2, occupying 51 ± 3.46% and 62 ± 6.26% of the cage space, respectively. These results suggest that the composite biomaterial tested was a good alternative to autologous cortical bone graft in this experimental ovine tibial defect. However, additional evaluation is warranted prior to its clinical usage.

Keywords

Bone defect - treatment - biomaterials - bone graft - sheep

Full Text

References

References
1 Einhorn TA. Enhancement of fracture-healing. J Bone J Surg Am 1995; 77: 940-956.
2 Wolfe MW, Salkeld SL, Cook S. Bone morphogenetic proteins in the treatment of non-unions and bone defects: historical perspective and current knowledge. Univ Penn Othop J 1999; 12: 1-6.
3 Keating Keating, McQueen MM. Substitutes for autologous bone graft in orthopaedic trauma. J Bone J Surg Br 2001; 83: 3-8.
4 Kirker-Head C A. Recombinant bone morphogenetic proteins: novels substances for enhancing bone healing. Vet Surg 1995; 24: 408-418.
5 Lane JM. BMPs: why are they not in everyday use?. J Bone J Surg Am 2001; 83: 161-163.
6 Sciadini MF, Dawson JM, Johnson KD. Bovine- derived bone protein as a bone graft substitute in a canine segmental defect model. J Orthop Trauma 1997; 11: 496-508.
7 Granjeiro JM, Oliveira RC, Bustos-Valenzuela JC. et al. Bone morphogenetic proteins: from structure to clinical use. Braz J Med Biol Res 2005; 38: 1463-1473.
8 Pou A. Update on new biomaterials and their use in reconstructive surgery. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 240-244.
9 Groeneveld Groeneveld, Burger EH. Bone morphogen- etic proteins in human bone regeneration. Eur J Endocrinol 2000; 142: 9-21.
10 McKee MD. Management of segmental bony defects: the role of osteoconductive orthobiologics. J Am Acad Orthop Surg 2006; 14: S163-167.
11 Benke D, Olah A, Mohler H. Protein-Chemical Analysis of Bio-Oss® Bone substitute and evidence on its carbonate content. Biomaterials 2001; 22: 1005-1012.
12 Gugala Gugala, Gogolewski S. Regeneration of segmental diaphyseal defects in sheep tibiae using resorbable polymeric membranes: a preliminary study. J Orthop Traumatol 1999; 13: 187-195.
13 Den BoerFC, Wippermann BW, Blokhuis TJetal. Healing of segmental bone defects with granular porous hydroxyapatite augmented with recom- binant human osteogenic protein-1 or autologous bone marrow. J Orthop Res 2003; 21: 521-528.
14 Elshahat A, Inoue N, Marti G. et al. Guided bone regeneration at the donor site of iliac bone grafts for future use as autogenous grafts. Plast Reconstr Surg 2005; 116: 1068-1075.
15 Weng D, Hurzeler MB, Quinones CR. et al. Contribution of the periosteum to bone formation in guided bone regeneration: A study in monkeys. Clin Oral Implants Res 2000; 11: 546-554.
16 Grob D, Daehn S, Mannion AF. Titanium mesh cages (TMC) in spine surgery. Eur Spine J 2004; 14: 211-221.
17 Zevgaridis D, Thome C, Krauss JK. Prospective controlled study of rectangular titanium cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy. Neurosurg Focus. 2002 12. E2.
18 Attias N, Lehman RE, Bodell LS. et al. Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: a case report. J Orthop Trauma 2005; 19: 211-216.
19 Cobos JA, Lindsey RW, Gugala Z. The cylindrical titanium mesh cage for treatment of a long bone segmental defect: description of a new technique and report of two cases. J Orthop Trauma 2000; 14: 54-59.
20 Fujibayashi S, Kim HM, Neo M. et al. Repair of segmental long bone defect in rabbit femur using bioactive titanium cylindrical mesh cage. Bio- materials 2003; 24: 3445-3451.
21 Gerhart TN, Kirker-Head CA, Kriz MJ. et al. Healing segmental femoral defects in sheep using rec- ombinant human bone morphogenetic protein. Clin Orthop 1993; 293: 317-326.
22 Morgan Morgan, Leighton RL. Radiographic appearance of fracture healing. In: Radiology of small animal fracture management. Philadelphia: WB. Saunders Co; 1995: 34-42.
23 Johnson KD, August A, Sciadini MF. et al. Evaluation of ground cortical autograft as a bone graft material in anew canine bilateral segmental long bone defect model. J Orthop Trauma 1996; 10: 28-36.
24 Genius [Internet homepage]. Mogi Mirim. Baumer: 2001 [Accessed 29 December, 2005]. Available at: http://www.genius.ind.br.
25 Ehrnberg A, De Pablos J, Martinez-Lotti G. et al. Comparison of demineralized allogeneic bone matrix grafting (the Urist procedure) and the Iliza- rov procedure in large diaphyseal defects in sheep. J Orthop Res 1993; 11: 438-447.
26 Forell Forell, Straw RC. Bone morphogenetic proteins and bone derived growth factors. Vet Comp Orthop Traumatol 1993; 6: 166-171.
27 Taga R, Cestari TM, Taga EM. et al. Histologic, radiographic and morphometric evaluation of the repair of guinea pig critical size cranial defect treated with amixture of Osseobond and Biohapa- tite and bioabsorbable membrane ofbovine cortical bone. J Bras Endo/Perio 2000; 1: 78-87.
28 Merkx MA, Maltha JC, Freihofer HP. et al. Incorporation of three types ofbone block implants in the facial skeleton. 1999 20. 639-645.
29 Lima AFM. Influence of bone morphogenetic proteins adsorbed to the hydroxyapatite and agglutinant of bovine collagen on consolidation of radius fracture in rabbits [Thesis]. Botucatu(SP): School of Veterinary Medicine and Animal Science, Unesp, Brazil; 2003
30 Costa Filho LC, Taga R, Taga EM. Rabbit bone marrow response to bovine osteoinductive proteins and anorganic bovine bone. Int J Oral Maxillofac Implant 2001; 16: 799-808.
31 Guimarães MCM, Passanezi E, Sant'ana ACP. et al. Pool of bovine morphogenetic proteins and guided tissue regeneration in the treatment of in- trabony periodontal defects. I-Clinical measurements. J Appl Oral Sci 2004; 12: 70-77.