Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study.

Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.

Development of an injectable bioactive bone filler cement with hydrogen orthophosphate incorporated calcium sulfate.

Calcium sulfate cement (CSC) has emerged as a potential bone filler material mainly because of the possibility of incorporating therapeutic agents. Delivery of the cement through a needle or cannula will make it more useful in clinical applications. However, it was not possible to make CSC injectable because of the inherent lack of viscosity. The present work demonstrates the design development of a viscous and fully-injectable CSC by incorporating hydrogen orthophosphate ions, which does not hamper the biocompatibility of the material. The effect of addition of hydrogen orthophosphate on the rheological properties of the CSC paste was studied using a custom made capillary rheometer. The physicochemical changes associated with cement setting process were examined using X-ray diffraction and Fourier transform infrared spectroscopy and the thermal changes were measured through isothermal differential scanning calorimetry. Micromorphological features of different compositions were observed in environmental scanning electron microscopy and the presence of phosphate ions was identified with energy dispersive X-ray spectroscopic analysis and inductively coupled plasma-optical emission spectroscopy. The results indicated that HPO4 (2-) ions have profound effects on the rheological properties and setting of the CSC paste. Significant finding is that the HPO4 (2-) ions are getting substituted in the calcium sulfate dihydrate crystals during setting. The variations of setting time and compressive strength of the cement with the additive concentration were investigated. An optimum concentration of 2.5 % w/w gave a fully-injectable cement with clinically relevant setting time (below 20 min) and compressive strength (12 MPa). It was possible to inject the optimised cement paste from a syringe through an 18-gauge needle with thumb pressure. This cement will be useful both as bone filler and as a local drug delivery medium and it allows minimally invasive bone defect management.

Preparation and analysis of chemically gradient functional bioceramic coating formed by pulsed laser deposition.

Bioactive ceramic coatings based on calcium phosphates yield better functionality in the human body for a variety of metallic implant devices including orthopaedic and dental prostheses. In the present study chemically and hence functionally gradient bioceramic coating was obtained by pulsed laser deposition method. Calcium phosphate bioactive ceramic coatings based on hydroxyapatite (HA) and tricalcium phosphate (TCP) were deposited over titanium substrate to produce gradation in physico-chemical characteristics and in vitro dissolution behaviour. Sintered targets of HA and α-TCP were deposited in a multi target laser deposition system. The obtained deposits were characterized by X-ray diffraction, fourier transform infrared spectroscopy, scanning electron microscopy and energy dispersive X-ray analysis. Inductively coupled plasma spectroscopy was used to estimate the in vitro dissolution behaviour of coatings. The variation in mechanical property of the gradient layer was evaluated through scratch test and micro-indentation hardness. The bioactivity was examined in vitro with respect to the ability of HA layer to form on the surface as a result of contact with simulated body fluid. It could be inferred that chemically gradient functional bioceramic coating can be produced by laser deposition of multiple sintered targets with variable chemical composition.

3D-bulk to nanoforms of modified hydroxyapatite: Characterization and osteogenic potency in an in vitro 3D bone model system.

Synthetic bioceramics are replacing conventional methods of treating bone defects with autografts owing to the high demand of bone substitutes, with their Surface topography and size contributing to favor cytocompatibility in tissue regeneration. This experimental study deals with the comparative evaluation of the physical characterizations of four different in-house synthesized bioceramics from 3D-bulk to nanoforms of hydroxyapatite (HA), Biphasic calcium phosphate (BCP), Strontium doped hydroxyapatite (SrHA) and Silica coated hydroxyapatite (HASi) and also simultaneously evaluates adhesion, proliferation and osteogenic differentiation of rabbit adipose derived mesenchymal stem cells (RADMSCs) on these biomimetic ceramic niches. The osteogenic induced cells grown on 3D scaffolds for a period of 7, 14, 21, and 28 days were analyzed for their viability (MTT, LDH, live-dead assays), morphology (SEM), proliferation (Cytox-Red) and osteogenic differentiation (ALP, osteocalcin expression). Cellular activities and differentiation of RADMSCs were significantly higher on SrHA indicating the role of strontium in the differentiation of mesenchymal stem cells on this ceramic platform to the bone lineage. In order to reinforce the materials for hard tissue implantation and drug delivery, nano-SrHA (nSrHA) became the nanoparticle of choice based on its non-toxicity, cytocompatibility and osteogenic properties (nSrHA > nHASi > nBCP > nHA).

Pulsed laser deposition of hydroxyapatite on titanium substrate with titania interlayer.

Pulsed laser deposition (PLD) has been used to deposit hydroxyapatite (HA) ceramic over titanium substrate with an interlayer of titania. PLD has been identified as a potential candidate for bioceramic coatings over metallic substrates to be used as orthopedic and dental implants because of better process control and preservation of phase identity of the coating component. However, direct deposition of hydroxyapatite on titanium at elevated temperature results in the formation of natural oxide layer along with some perovskites like calcium titanate at the interface. This leads to easy debonding of ceramic layer from the metal and thereby affecting the adhesion strength. In the present study, adherent and stable HA coating over Ti6Al4V was achieved with the help of an interlayer of titania. The interlayer was made to a submicron level and HA was deposited consecutively to a thickness of around one micron by exposing to laser ablation at a substrate temperature of 400°C. The deposited phase was identified to be phase pure HA by X-ray diffraction, scanning electron microscopy, energy dispersive X-ray analysis, and inductively coupled plasma spectrometry. The mechanical behavior of coating evaluated by scratch test indicates that the adhesion strength of HA coating was improved with the presence of titania interlayer.

Laser surface modification of titanium substrate for pulsed laser deposition of highly adherent hydroxyapatite.

Biomedical implant devices made out of titanium and its alloys are benefited by a modified surface or a bioactive coating to enhance bone bonding ability and to function effectively in vivo for the intended period of time. In this respect hydroxyapatite coating developed through pulsed laser deposition is a promising approach. Since the success of the bioactive ceramic coated implant depends mainly on the substrate-coating strength; an attempt has been made to produce micro patterned surface structure on titanium substrate for adherent hydroxyapatite coating. A pulsed Nd-YAG laser beam (355 nm) with 10 Hz repetition rate was used for surface treatment of titanium as well as hydroxyapatite deposition. The unfocussed laser beam was used to modify the substrate surface with 500-18,000 laser pulses while keeping the polished substrate in water. Hydroxyapatite deposition was done in a vacuum deposition chamber at 400 °C with the focused laser beam under 1 × 10⁻³ mbar oxygen pressure. Deposits were analyzed to understand the physico-chemical, morphological and mechanical characteristics. The obtained substrate and coating surface morphology indicates that laser treatment method can provide controlled micro-topography. Scratch test analysis and microindentation hardness values of coating on laser treated substrate indicate higher mechanical adhesion with respect to coatings on untreated substrates.

First Report of a Tissue-Engineered Graft for Proximal Humerus Gap Non-union After Chronic Pyogenic Osteomyelitis in a Child: A Case Report.

CASE: An 11-year-old child who presented with a postseptic gap nonunion of 4 cm in the proximal humerus was treated with a customized hydroxyapatite-tricalcium phosphate-tricalcium silicate composite (HASi) scaffold loaded with culture-expanded autologous bone marrow-derived mesenchymal stem cells (MSCs) primed into osteogenic lineage. Union occurred at 3 months, and at 3 years, the child had improved joint mobility, with radiographic and computed tomographic imaging evidence of incorporation of the graft. CONCLUSIONS: This case demonstrated the feasibility of MSC directed into osteogenic lineage on HASi to repair a long bone defect owing to postseptic osteomyelitis, a condition notorious for a high failure rate.

Hydroxyapatite carriers as drug eluting agents-An In Vitro analysis.

INTRODUCTION: Hydroxyapatite based drug carriers offer a customized alternative to the delivery of pharmacologic agents in the osseous skeleton. They have an added advantage of being biocompatible and osteoconductive. This in vitro study aims to quantify the drug eluting properties of HA granules by spectrophotometry. MATERIALS AND METHODS: HA and HASi beads were loaded with gentamicin/ amoxycillin- clavulanate/ vancomycin and grouped into 5. Drug elution was evaluated by means of UV spectrophotometry. RESULTS: Drug eluent levels were well above bactericidal levels in all 5 groups. CONCLUSION: HA and HASi are viable options for clinicians for targeted drug delivery.

Ceramic Bone Graft Substitutes do not reduce donor-site morbidity in ACL reconstruction surgeries: a pilot study.

INTRODUCTION: Anterior knee pain is a major problem following Bone-patellar-tendon-bone graft (BPTB) use in anterior cruciate ligament (ACL) reconstruction. We hypothesized that filling the donor defect sites with bone-graft substitute would reduce the anterior knee symptoms in ACL reconstruction surgeries. MATERIAL AND METHODS: Patients operated for ACL-deficient knee between March 2012 and August 2013 using BPTB graft were divided into two treatment groups. The patellar and tibial donor-site bony defects were filled-up with Hydroxyapatite-Bioglass (HAP:BG) blocks in the study group (n = 15) and no filler was used in the control group (n = 16). At 2 years, the clinical improvement was assessed using International Knee Documentation Committee (IKDC) score and donor-site morbidity was assessed by questionnaires and specific tests related to anterior knee pain symptoms. RESULTS: Donor-site tenderness was present in 40% patients in the study group and 37.5% patients in the control group (p = 0.59). Pain upon kneeling was present in 33.3% patients in the study group and 37.5% patients in the control group (p = 0.55). Walking in kneeling position elicited pain in 40% patients in the study group and 43.8% in the control group (p = 0.56). The mean visual analogue score for knee pain was 3.0 in the study group and 3.13 in the control group, with no statistically significant difference (p = 0.68). Unlike control group, where a persistent bony depression defect was observed at donor sites, no such defects were observed in the study group. CONCLUSION: Filling the defects of donor sites with HAP:BG blocks do not reduce the anterior knee symptoms in patients with ACL reconstruction using autogenous BPTB graft.

Preparation of hydroxyapatite porous scaffold from a 'coral-like' synthetic inorganic precursor for use as a bone substitute and a drug delivery vehicle.

A novel surfactant free hydrothermal method was developed for the preparation of large hydroxyapatite scaffolds. Synthetic calcium carbonate (calcite) was used as the starting material which when mixed with an inorganic setting solution containing phosphoric acid and sodium hydroxide forms the porous precursor body with pore size 20-700 µm. The porous precursor body was then hydrothermally converted to hydroxyapatite scaffolds when treated in basic phosphate solution of pH 10.5 at 150 °C and 15 bar pressure maintaining the structural stability and integrity. X-ray diffraction and the Fourier transform infrared spectroscopy confirmed that the developed material consist of single phase crystalline hydroxyapatite. Surface morphology and microstructures were studied using scanning electron microscopy and porosity was evaluated by micro CT analysis. The cell material interactions evaluated by cell viability assays and live cell staining methods confirmed the cell compatibility. The drug release study at physiological pH implied that the developed materials could be promising in sustained long-term release. The results emerged have shown that the hydrothermal conversion of inorganic coral-like precursor is effective to produce porous bioactive hydroxyapatite scaffolds for bone regeneration as well as drug delivery vehicles for the treatment of infectious bone diseases such as osteomyelitis.

Bioactive nano-fibrous scaffold for vascularized craniofacial bone regeneration.

There has been a growing demand for bone grafts for correction of bone defects in complicated fractures or tumours in the craniofacial region. Soft flexible membrane like material that could be inserted into defect by less invasive approaches; promote osteoconductivity and act as a barrier to soft tissue in growth while promoting bone formation is an attractive option for this region. Electrospinning has recently emerged as one of the most promising techniques for fabrication of extracellular matrix such as nano-fibrous scaffolds that can serve as a template for bone formation. To overcome the limitation of cell penetration of electrospun scaffolds and improve on its osteoconductive nature, in this study, we fabricated a novel electrospun composite scaffold of polyvinyl alcohol (PVA)-poly (ε) caprolactone (PCL)-Hydroxyapatite based bioceramic (HAB), namely, PVA-PCL-HAB. The scaffold prepared by dual electrospinning of PVA and PCL with HAB overcomes reduced cell attachment associated with hydrophobic PCL by combination with a hydrophilic PVA and the HAB can contribute to enhance osteoconductivity. We characterized the physicochemical and biocompatibility properties of the new scaffold material. Our results indicate PVA-PCL-HAB scaffolds support attachment and growth of stromal stem cells; [human bone marrow skeletal (mesenchymal) stem cells and dental pulp stem cells]. In addition, the scaffold supported in vitro osteogenic differentiation and in vivo vascularized bone formation. Thus, PVA-PCL-HAB scaffold is a suitable potential material for therapeutic bone regeneration in dentistry and orthopaedics.

Development, characterization and comparison of two strontium doped nano hydroxyapatite molecules for enamel repair/regeneration.

OBJECTIVES: Enamel damage resulting or arising from/associated with orthodontic treatment such as white spot lesions and surface deterioration after debonding brackets along with incipient carious lesions are considered problems not amenable for routine restorations due to its invasive nature. The present study was aimed at synthesizing and characterizing nHAp and 25 and 50 mol% strontium nHAp as a surface application modality for dental enamel remineralization/repair. METHODS: 25 and 50 mol% Sr nHAp was synthesized and characterized in comparison with custom made pure nHAp initially with the help of transmission and scanning electron microscopy as well as toxicological assessment. Further, comparative evaluation of these novel synthesized strontium substituted particles was assessed for its efficacy in repairing damaged enamel with the help of atomic force microscopy, scanning electron microscopy and micro indentation testing. RESULTS: There is increase in crystallinity and reduced particle size favoring dissolution and re-precipitation through small incipient carious lesions and soft white spot areas with 25% Sr-nHAp. Sr doped specimens showed more cell viability in comparison with pure nHAP make it less cytotoxic and hence a biologically friendly material which can be safely applied in patient's mouth. AFM images obtained from 25% and 50% Sr nHAp treated specimens clearly indicated increased roughness in surface topography and performed well with micro indentation test. SIGNIFICANCE: The novel synthesized Sr doped nHAp forms an improved treatment modality to tackle the long standing quest for solving the problem of enamel loss with incipient carious lesions and WSL from orthodontic procedures.

Combined Treatment Effects Using Bioactive-Coated Implants and Ceramic Granulate in a Rabbit Femoral Condyle Model.

BACKGROUND: Resolution of peri-implant defects resulting from implant placement in the freshly extracted site demands for a bone graft substitute that stimulates bone regeneration and hence facilitates implant integration. In view of this, the addition of silica to hydroxyapatite (HASi) could enhance the bioactive behavior of ceramic materials and implant surfaces coated with bioactive ceramics might benefit the interaction between bone and implant. PURPOSE: To evaluate the bone response to implants coated with hydroxyapatite-silica (HASi) or hydroxyapatite (HA) and either or not combined with HASi and HA ceramic bone substitute particles, respectively, on bone-to-implant contact (BIC) and bone formation using a rabbit femoral condyle implant model with a gap design. MATERIAL AND METHODS: A total of 32 custom-made, titanium implants (Ti: diameter 5 mm, length 8 mm) with two-sided gaps were fabricated and coated with either HASi or HA using pulsed laser deposition (PLD). The implants were installed bilaterally in the femoral condyles of 16 New Zealand white rabbits. According to a randomization protocol, one gap of HASi-coated and HA-coated implants was filled with HASi particles and HA particles, respectively, and the other gap was left empty. After an implantation period of 8 weeks, the retrieved specimens were analyzed via histology and histomorphometry (i.e., bone to implant contact [BIC] and bone volume [BV]). RESULTS: The BIC and BV around the implants were analysed for HASi- and HA-coated implants with and without the use of HASi and HA bone substitute material. Comparison of HASi- and HA-coated implants showed similar BIC for HASi- (55.7 + 11.0) and HA-coated implants (50.3 + 19.7). When coated implants were combined with bone substitute materials, HASi-coated and particle-filled implants showed higher BIC (64.3 ± 6.8%) compared with HA-coated and HA-filled implants (54.5 ± 10.9%). Similarly, the BV within the region of interest showed significantly higher values for the HASi-coated and HASi-filled implants (21.1 ± 1.7%) compared with HA-coated and HA-filled implants (12.8 ± 4.9%). CONCLUSIONS AND CLINICAL IMPLICATIONS: Within the limitations of this study, it can be concluded that silicon substitution in HA favors bone regeneration compared with HA, especially when used as bone substitute material. Further studies using different healing periods will elucidate the resorption pattern of HASi granules in comparison with HA.

Pulsed laser deposition and in vitro characteristics of triphasic - HASi composition on titanium.

Pulsed laser deposition was used to deposit bioactive triphasic glass-ceramic composition (HASi) over titanium substrate using dense HASi target. Bioactive glass compositions are considered the most useful synthetic materials for immediate bone attachment because of its bioresorption, osteoconduction and osteointegration characteristics under in vivo conditions. The disadvantage of its brittleness associated with bioactive glass-ceramics has prompted its coating over metallic implants for the combination of duo mechanical and bioactive properties. The hard HASi target was able to undergo laser ablation under ambient gas pressure without bulk erosion of the target. Laser deposition was found to be efficient in depositing triphasic composition for immediate bone integration. The target and deposits were analyzed for the phase, composition and microstructural characteristics by means of X-ray diffraction, Fourier transform infrared spectroscopy, energy-dispersive X-ray analysis and scanning electron microscopy. Simultaneously, the adherent nature and mechanical behaviour of deposits were confirmed by scratch test and micro-indentation methods. Further, the in vitro dissolution and bioactivity were assessed by soaking in simulated body fluid followed by elemental analysis using inductively coupled plasma spectroscopy. The deposits were found to be cell-friendly, which was indicated by the phenomenology of stem cells under in vitro conditions.

Triphasic ceramic scaffold in paediatric and adolescent bone defects.

We evaluated novel triphasic hydroxyapatite tricalcium phosphate calcium silicate scaffold (HASi) in the management of paediatric bone defects. Their main advantage is considered to be adequate strength and stimulation of bone formation without resorting to autograft. A total of 42 children younger than 16 years of age were recruited over a period of 1 year and were treated with this synthetic bone substitute as a stand-alone graft for pelvic, femur, calcaneal and ulnar osteotomies, cystic bone lesions, subtalar arthrodesis and segmental bone defects. Forty children, 22 boys and 18 girls, mean age 8.3 years and a mean follow-up of 18.51 months, were available for evaluation. Analysis showed that younger age, cancellous defects and no internal fixation were associated with significantly faster healing. Partial incorporation was observed in 22.5% and complete incorporation in 77.5% of cases at 18 months of follow-up. Sex, type of defect, BMI and the shape of the ceramic graft did not significantly affect the rate of healing. Complications attributable to HASi included four nonunions, three of which were diaphyseal. HASi was found to be safe in children with cancellous or benign cavitatory defects. It is not suitable for diaphyseal and segmental bone defects as a stand-alone graft.

Novel nanoporous bioceramic spheres for drug delivery application: a preliminary in vitro investigation.

BACKGROUND: Bioceramics and their composites have found myriad applications in medicine as superlative osteoalloplasts. Their potential to function as a biocompatible resorbable drug delivery system is being explored. The present study is a preliminary investigation into the efficacy of these indigenously developed nanoporous materials as vehicles for therapeutic agents. An in vitro experiment was conducted with the goal of assessing this material and comparing it with a commercially available gentamicin-loaded polymethylmethacrylate cement. STUDY DESIGN: The drug-eluting characteristics of gentamicin bone cement and indigenously designed nanoporous bioceramic granules were analyzed spectrophotometrically and compared. Regression analysis was done. RESULTS: The first 5 days saw the elute from both samples containing drug concentrations >100 µg/g. CONCLUSIONS: Both samples exhibit a high initial-burst release, which is ideal for prophylactic purposes. Drug eluent levels for both materials were >100 µg/g, which is sufficient for bactericidal activity.

Pulsed laser deposition of hydroxyapatite on nanostructured titanium towards drug eluting implants.

Titania nanotubes grown on titanium substrates by electrochemical anodization in glycerol-ammonium fluoride-water system were used to develop efficient drug carrying implants upon coating hydroxyapatite (HA) ceramic. The nanostructured surfaces achieved by anodization were caped with HA crystallites by pulsed laser deposition. The implant substrates were studied for their drug carrying capacity using gentamicin as a model. The nano-tubular surface with HA coating had better drug loading capacity of about 800 µg/cm(2) gentamicin while the bare anodized substrate carried less than 660 µg/cm(2). The HA coating alone stored as low as 68 µg/cm(2) and released the drug within the initial burst period itself. The ceramic coated anodized substrates were found to be more efficient in controlled delivery for longer than 160 h with a drug release of 0.5 µg/cm(2) even towards the end. The substrate with nanostructuring alone delivered the whole drug within 140 h. This study proposes the application of laser deposition of HA over nanostructured titanium, which proves to be promising towards controlled drug eluting bioceramic coated metallic prostheses.

Adipogenesis on biphasic calcium phosphate using rat adipose-derived mesenchymal stem cells: in vitro and in vivo.

Developing adipose tissue-engineered construct to mend soft tissue defects arising from traumatic injury, tumor resections, and maxillofacial abnormalities is of prime importance in plastic and reconstructive surgical procedures. It is apparent that the clinical outcome of classic techniques like adipose tissue transplantation is unpredictable, with graft resorption, lack of vascularization, and impaired functionality. In this prospective, the concept of tissue engineering was adopted to fabricate a combination product with biphasic calcium phosphate (BCP) and rat adipose-derived mesenchymal stem cells (ASCs) toward the development of an adipose tissue construct. BCP, a combination of hydroxyapatite and α-tricalcium phosphate, was characterized for its physiochemical properties, and ASCs were characterized for their stemness. The cell-ceramic interactions were demonstrated in vitro, whereas adipogenesis was picturesquely depicted by Nile red-stained multilocular adipocyte-like cells. Subsequently, the three-dimensional cell-ceramic-engineered construct was implanted in the rat dorsal muscle for a period of 3 weeks to demonstrate the efficacy of the tissue construct in vivo. Interestingly, the histology of the postimplanted tissue construct revealed the distribution of chicken wire net-like fat cells within the vicinity of the construct. The efficacy of cell transplantation via the scaffold was traced using fluorescent in situ hybridization by labeling the Y chromosome. Thus, the ceramic-based construct may be a good option for reconstruction therapies.

Treatment of goat femur segmental defects with silica-coated hydroxyapatite--one-year follow-up.

Segmental bone defects caused by tumor resections, trauma, and skeletal abnormalities such as osteomyelitis remain a major problem in orthopedics because of the lack of predictability in attaining functional bone after the treatment. The objective of this study was to propose an indigenous porous biodegradable triphasic ceramic (calcium silicate, tricalcium phosphate, and hydroxyapatite [HA])-coated HA (core) (HASi) for the repair of such segmental defects. With respect to the synthesis of HASi, HA blocks were prepared by wet precipitation, dipped in silica sol (sol gel method), sintered at 1200 degrees C, polished in the form of hollow cylinder (2 cm long with an outer and inner diameter of 2 cm and 7 mm, respectively), and implanted into a 2-cm segmental defect created in the goat femur diaphysis. This study prolonged for 12 uneventful months and thereafter neo-osteogenesis in par with material degradation was analyzed through radiography, histology, histomorphometry, scanning electron microscope (SEM)-energy dispersive spectrum, micro-computed tomography, and inductively coupled plasma spectrometry. HASi proved to be osteoconductive, osteointegrative, and degradative in nature, without the intervention of fibrous tissue formation at the defect site. Histologically, the newly formed bone reorganized, mineralized, and attained the appearance and contour of the original femoral diaphysis in 1 year. The interconnected porous structure with silica composition aided progressive bone regeneration and repair in par with degradation of the material. Thus the study proposed the possibility of using HASi as a suitable material in clinical orthopedic reconstructive surgery, which remains a formidable challenge.

Surface-phosphorylated copolymer promotes direct bone bonding.

The bone bonding potential of surface-phosphorylated poly (2-hydroxyethyl methacrylate-co-methyl methacrylate) [poly (HEMA-co-MMA)] has been investigated and compared with commercially available poly (methyl methacrylate) bone cement (CMW1 radiopaque, Depuy; Johnson & Johnson, Blackpool, Lancashire, England, United Kingdom) as control. Poly (HEMA-co-MMA) is synthesized by free radical-initiated copolymerization and surface functionalized by phosphorylation. The X-ray photoelectron spectroscopy confirms the presence of surface-bound phosphate groups on poly (HEMA-co-MMA). The surface-phosphorylated poly (HEMA-co-MMA) promotes in vitro biomineralization, cell viability, cell adhesion, and expression of bone-specific markers such as osteocalcin and alkaline phosphatase. The bone implantation study performed in rabbits as per ISO 10993-6; 1994 (E) shows that surface-phosphorylated poly (HEMA-co-MMA) elicits bone bonding and new bone formation. New woven bone trabeculae are formed at the defect site of surface-phosphorylated poly (HEMA-co-MMA) within 1 week, while for control sample, inflammatory cells--predominantly, macrophages, fibroblasts, and fibrocytes--are present at the cortical margins around the defect. The 4 and 12 weeks postimplantation results show that the major part of the defects around the surface-phosphorylated poly (HEMA-co-MMA) implant is bridged with new woven bone, with significant remodeling (evident from resorption bays) along both the margins of the defect, but for control implants, the defects are only partially closed, with slight remodeling along the margins, but most of them are separated by fibrous tissue.