According to 5- and 10-year clinical follow-up studies large-scale bone allografts have a high failure rate, largely due to poor allograft incorporation with adjacent bone and subsequent poor remodeling. The goal of this study was to develop a methodology to deliver growth factors from large-scale bone allografts in a temporally controlled manner. Intact long bone allografts were coated with a micron-scale thick layer of degradable polymer that maintained inherent pore structures and acted as a delivery vehicle for bone morphogenetic protein-2 and vascular endothelial growth factor. VEGF was loaded onto the surface of the polymer to produce rapid release, to encourage initial vascularization at the defect site, while BMP-2 was encapsulated within the polymer layer to promote a more sustained release, to encourage bone formation over time. Release kinetics from factor-loaded polymer-coated allografts show an early burst release of VEGF over the first 7 days followed by a more sustained release of BMP-2 over the second and third week. In vitro cell studies using human mesenchymal stem cells confirm the bioactivity of the released BMP-2. In-vivo results show robust bone formation over the first 8 weeks of healing in femoral segmental defects in rats implanted with BMP-2 loaded polymer-coated allografts. A microscale thin coating of degradable polymer on a large-scale bone allograft provides temporal control over the delivery of growth factor loaded onto one allograft, while maintaining its microscale pore structure. Enhancing the incorporation and subsequent remodeling of allografts would reduce the incidence of allograft failure over time, and potentially speed healing at the earliest stages after implantation.
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http://dx.doi.org/10.1002/jbm.a.35435 | DOI Listing |
Background: Kyphoplasty (KP) is a well-established procedure with a low complication risk, however, the procedure's safety in patients with comorbidities and in the setting of systemic infection remains uncertain with no clear guidelines. We present a unique case of KP in the setting of recurrent septicemia, which required subsequent salvage vertebrectomy.
Case Description: We present a clinical case of a 59-year-old diabetic male patient with a recent foot ulcer, positive for and .
J Spine Surg
December 2024
Orthopedic Associates of Hartford, Hartford Hospital Bone and Joint Institute, Hartford, CT, USA.
Background And Objective: As the global population ages, degenerative spinal disorders are on the rise, leading to an increased focus on optimizing spinal fusion therapies. Despite the high success rate of iliac crest bone autografts, their usage is hampered by donor site morbidity and limited supply. The objective of this review is to assess the viability of ceramic-based synthetic materials as alternatives in spinal fusion surgeries.
View Article and Find Full Text PDFJ Clin Orthop Trauma
February 2025
Orthopaedic and Trauma Surgery Department, Hospital de Alta Complejidad Cuenca Alta, RP6 Km 92.5 PC 1814, Cañuelas, Buenos Aires, Argentina.
Introduction: Aseptic recalcitrant nonunion (ARNU) of the femur and tibia is an entity in which the absence of bony union, misalignment, and limb length discrepancies (LLD) coexist. Currently, the management of these cases lacks consensus. This study aimed to describe the bone union rate and deformity correction outcomes in patients with ARNU of the femur or tibia treated with the Induced Membrane Technique (IMT).
View Article and Find Full Text PDFBMC Musculoskelet Disord
January 2025
Department of Clinical Sciences, College of Veterinary Medicine, Columbus, OH, USA.
Background: Rotator cuff repairs may fail because of compromised blood supply, suture anchor pullout, or poor fixation to bone. To augment the repairs and promote healing of the tears, orthobiologics, such a platelet-rich plasma (PRP), and biologic scaffolds have been applied with mixed results. Adipose allograft matrix (AAM), which recruits native cells to damaged tissues, may also be a potential treatment for rotator cuff tears.
View Article and Find Full Text PDFJ Bone Joint Surg Am
January 2025
Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
➢ Jehovah's Witnesses refuse allogeneic blood products based on religious beliefs that create clinical, ethical, and legal challenges in orthopaedic surgery, requiring detailed perioperative planning and specific graft selection.➢ Detailed perioperative planning is particularly important for procedures with high intraoperative blood loss.➢ Graft selection must align with Jehovah's Witnesses patients' religious beliefs, with options including autografts, allografts, and synthetic materials; this requires shared decision-making between the patient and surgeon.
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