Graphene-modified CePO4 nanorods effectively treat breast cancer-induced bone metastases and regulate macrophage polarization to improve osteo-inductive ability.

BACKGROUND: Breast cancer bone metastasis has become one of the most common complications; however, it may cause cancer recurrence and bone nonunion, as well as local bone defects. METHODS: Herein, In vitro, we verified the effect of bioscaffold materials on cell proliferation and apoptosis through a CCK8 trial, staining of live/dead cells, and flow cytometry. We used immunofluorescence technology and flow cytometry to verify whether bioscaffold materials regulate macrophage polarization, and we used ALP staining, alizarin red staining and PCR to verify whether bioscaffold material promotes bone regeneration. In vivo, we once again studied the effect of bioscaffold materials on tumors by measuring tumor volume in mice, Tunel staining, and caspase-3 immunofluorescence. We also constructed a mouse skull ultimate defect model to verify the effect on bone regeneration. RESULTS: Graphene oxide (GO) nanoparticles, hydrated CePO4 nanorods and bioactive chitosan (CS) are combined to form a bioactive multifunctional CePO4/CS/GO scaffold, with characteristics such as photothermal therapy to kill tumors, macrophage polarization to promote blood vessel formation, and induction of bone formation. CePO4/CS/GO scaffold activates the caspase-3 proteasein local tumor cells, thereby lysing the DNA between nucleosomes and causing apoptosis. On the one hand, the as-released Ce3+ ions promote M2 polarization of macrophages, which secretes vascular endothelial growth factor (VEGF) and Arginase-1 (Arg-1), which promotes angiogenesis. On the other hand, the as-released Ce3+ ions also activated the BMP-2/Smad signaling pathway which facilitated bone tissue regeneration. CONCLUSION: The multifunctional CePO4/CS/GO scaffolds may become a promising platform for therapy of breast cancer bone metastases.

Posterosuperior Placement of a Standard-Sized Cup at the True Acetabulum in Acetabular Reconstruction of Developmental Dysplasia of the Hip With High Dislocation.

BACKGROUND: We sought to evaluate posterosuperior placement of the acetabular component at the true acetabulum during acetabular reconstruction in patients with Crowe type-IV developmental dysplasia of the hip. METHODS: Using pelvic computed tomography and image processing, we developed a two-dimensional mapping technique to demonstrate the distribution of preoperative three-dimensional cup coverage at the true acetabulum, determined the postoperative location of the acetabular cup, and calculated postoperative three-dimensional coverage for 16 Crowe type-IV dysplastic hips in 14 patients with a mean age of 52 years (33-78 years) who underwent total hip arthroplasty. Mean follow-up was 6.3 years (5.5-7.3 years). RESULTS: On preoperative mapping, the maximum three-dimensional coverage using a 44-mm cup was 87.31% (77.36%-98.14%). Mapping enabled the successful replacement of 16 hips using a mean cup size of 44.13 mm (42-46 mm) with posterosuperior placement of the cup. Early weight-bearing and no prosthesis revision or loosening during follow-up were achieved in all patients. The postoperative two-dimensional coverage on anteroposterior radiographs and three-dimensional coverage were 96.15% (89.49%-100%) and 83.42% (71.81%-98.50%), respectively. CONCLUSION: This technique may improve long-term implant survival in patients with Crowe-IV developmental dysplasia of the hip undergoing total hip arthroplasty by allowing the use of durable bearings, increasing host bone coverage, ensuring initial stability, and restoring the normal hip center.

Nickel-Titanium Shape-Memory Sawtooth-Arm Embracing Clamp for Complex Femoral Revision Hip Arthroplasty.

PURPOSES: To examine the clinical outcomes of patients treated with a nickel-titanium shape-memory sawtooth-arm embracing clamp (Ni-Ti SSEC) in complex femoral revision surgery. METHODS: We retrospectively evaluated the outcomes for 21 complex femoral revision hip arthroplasties that we treated using an Ni-Ti SSEC. The Ni-Ti SSEC was used for various procedures, including the fixation of extremely long cortical windows (11 patients), femoral shaft osteotomy (4 patients), an extended trochanteric osteotomy (3 patients), and protection of a penetrated femoral cortex by a primary stem (3 patients). All patients received follow-up care for an average of 48.2 months. RESULTS: The mean time of Ni-Ti SSEC insertion intraoperatively was 6 minutes. The mean Harris Hip Score improved from 21.2 points before revision surgery to 83.1 points at the most recent examination. No implant failures or malunions occurred. Dislocation and deep infection occurred in 1 case during the follow-up period. CONCLUSIONS: Our results show that the embracing clamp is a simple and valid method for fixing osteotomies in treating complex femoral revision surgery.

Fabrication, characterization, and biocompatibility of ethyl cellulose/carbonated hydroxyapatite composite coatings on Ti6Al4V.

In order to improve the biocompatibility of metallic implants, bioactive components are often used as coatings so that a real bond with the surrounding bone tissue can be formed. We prepared ethyl cellulose/carbonated hydroxyapatite composite coatings (ECHCs) on Ti6Al4V substrates with carbonated hydroxyapatite coatings (CHACs) without ethyl cellulose as controls. The inorganic constituent on the CHACs and ECHCs is calcium-deficient carbonated hydroxyapatite with a flaky texture and a low degree of crystallinity. The flaky carbonated hydroxyapatite plates aggregate to form macropores with an aperture size of around 0.5-2.0 µm. The presence of ethyl cellulose provides superior morphology, contact angle, and biocompatibility characteristics. In comparison to CHACs, ECHCs exhibit a smoother, crack-free surface because the cracks are filled by ethyl cellulose. Moreover, the contact angle of ECHCs is 37.3°, greater than that of CHACs (13.0°). Surface biocompatibility was investigated by using human bone mesenchymal stem cells (hBMSCs). The attachment, spreadability, viability and proliferation of hBMSCs on ECHCs are superior to those on CHACs. Thus, the crack-free ECHCs have excellent biocompatibility and are appropriate for use as biological implants.

Calcineurin/NFAT pathway mediates wear particle-induced TNF-α release and osteoclastogenesis from mice bone marrow macrophages in vitro.

AIM: To investigate the roles of the calcineurin/nuclear factor of activated T cells (NFAT) pathway in regulation of wear particles-induced cytokine release and osteoclastogenesis from mouse bone marrow macrophages in vitro. METHODS: Osteoclasts were induced from mouse bone marrow macrophages (BMMs) in the presence of 100 ng/mL receptor activator of NF-κB ligand (RANKL). Acridine orange staining and MTT assay were used to detect the cell viability. Osteoclastogenesis was determined using TRAP staining and RT-PCR. Bone pit resorption assay was used to examine osteoclast phenotype. The expression and cellular localization of NFATc1 were examined using RT-PCR and immunofluorescent staining. The production of TNFα was analyzed with ELISA. RESULTS: Titanium (Ti) or polymethylmethacrylate (PMMA) particles (0.1 mg/mL) did not significantly change the viability of BMMs, but twice increased the differentiation of BMMs into mature osteoclasts, and markedly increased TNF-α production. The TNF-α level in the PMMA group was significantly higher than in the Ti group (96 h). The expression of NFATc1 was found in BMMs in the presence of the wear particles and RANKL. In bone pit resorption assay, the wear particles significantly increased the resorption area and total number of resorption pits in BMMs-seeded ivory slices. Addition of 11R-VIVIT peptide (a specific inhibitor of calcineurin-mediated NFAT activation, 2.0 µmol/L) did not significantly affect the viability of BMMs, but abolished almost all the wear particle-induced alterations in BMMs. Furthermore, VIVIT reduced TNF-α production much more efficiently in the PMMA group than in the Ti group (96 h). CONCLUSION: Calcineurin/NFAT pathway mediates wear particles-induced TNF-α release and osteoclastogenesis from BMMs. Blockade of this signaling pathway with VIVIT may provide a promising therapeutic modality for the treatment of periprosthetic osteolysis.

Acute single-stage reconstruction of multiligament knee injuries using the ligament advanced reinforcement system.

OBJECTIVE: The purpose of the study was to report our early outcome in the management of multiligament knee injuries with the ligament advanced reinforcement system (LARS). SUBJECTS AND METHODS: Between 2007 and 2010, 9 of 11 patients operated on for multiligament knee injuries were included in this study; 2 patients were excluded due to complicated neurovascular injuries, open knee dislocations and severe comorbidities. All patients were managed acutely (<3 weeks) by reconstructions of the cruciate and collateral ligaments with LARS ligament and were followed up for an average of 30 months (18-46 months). RESULTS: The mean Lysholm score of the 9 patients at final follow-up was around 90 (range 88-94) with an average Tegner activity score of 5.5. The postoperative function of 1 case of KD-11 and 2 cases of KD-111 was rated as 'A,' while the remaining cases were rated 'B'. At final follow-up, minor osteoarthritic degeneration was detected in 1 case of KD-III and 2 cases of KD-IV. Superficial infection developed in 1 case, and no cases of knee synovitis and premature osteoarthritis were recorded. CONCLUSION: A creditable outcome at mean of 30 months' follow-up was obtained in acute single-stage reconstruction of uncomplicated multiligament knee injuries with LARS ligament.

Berberine inhibits lipopolysaccharide- and polyethylene particle-induced mouse calvarial osteolysis in vivo.

BACKGROUND: Wear particle-induced osteolysis could lead to the aseptic loosening of implants. Studies have suggested that endotoxins, such as lipopolysaccharides (LPS), may be the primary causes of wear particle-mediated osteolysis, and that osteolysis may originate from subclinical levels of bacterial infection. However, effective therapies against wear particles and gram-negative bacterial or LPS-induced bone resorption are limited. MATERIALS AND METHODS: In the current study, the effect of berberine on LPS- and polyethylene (PE) particle-induced osteolysis in vivo was investigated using a mouse calvarial model. Osteoclast number per bone perimeter and eroded surface per bone surface were measured. RESULTS: Berberine (10 mg/kg), injected either simultaneously with LPS or 3 d after LPS (25 mg/kg) treatment, blocked LPS-induced osteoclast recruitment and bone resorption in the mouse calvarial model. A daily single-dose of berberine (10 mg/kg), injected either simultaneously with PE particles or 4 d after treatment with PE particles, blocked PE particle-induced osteoclast recruitment and bone resorption. Berberine treatment markedly decreased LPS and PE particle-induced osteoclast recruitment and bone resorption in the murine calvarial model. CONCLUSION: These results suggest that berberine may have therapeutic effect for osteolysis induced by wear particles and LPS in gram-negative bacteria.

Nickel-titanium shape-memory sawtooth-arm embracing fixator for periprosthetic femoral fractures.

PURPOSE: We reviewed data to determine outcomes for 21 consecutive Vancouver type B1 or type C periprosthetic fractures that we treated between 2001 and 2008 using a nickel-titanium shape-memory sawtooth-arm embracing fixator. METHODS: The study participants were 12 men and 9 women (mean age, 70.8 years; range, 42-85 years). The average duration of follow-up monitoring was 39.7 months (range, 1-78 months). In five cases, cables and screws were used for further stabilisation. No bone grafting was performed for any of the patients. RESULTS: Results were satisfactory, except for one patient who died one month after surgery from a cause unrelated to arthroplasty. Bone union was achieved in the remaining 20 cases within an average of 5.25 months. No implant failures or malunions occurred in any of the patients. The average Harris hip score at the final follow-up examination was 79.3 points. CONCLUSIONS: Our results show that the embracing fixator is a valid alternative treatment for Vancouver type B1 or type C periprosthetic femoral fractures.

Computer simulation of optimal lipped polyethylene liner orientation against prosthetic impingement.

BACKGROUND: Lipped or elevated acetabular liners are to improve posterior stability and are widely used in hip arthroplasty. However, concerns of increasing impingement exist when using such liners and optimal orientation of the elevated rim remains unknown. We aimed to identify the impact of lipped liner on the range of motion (ROM) before impingement and propose its optimal orientation. METHODS: An isochoric three-dimensional model of a general hip-replacement prosthesis was generated, and flex-extension, add-abduction and axial rotation were simulated on a computer. The maximum ROM of the hip was measured before the neck impinged on the liner. Different combinations of acetabular anteversion angles ranging from 5 to 30 degrees, and lipped liner orientations from posterior to anterior were tested. RESULTS: When acetabular anteversion was 10 or 15 degrees, placing the lip of the liner in the posterosuperior of the acetabulum allowed satisfactory ROM in all directions. When acetabular anteversion was 20 degrees, extension and external rotation were restricted. Adjusting the lip to the superior restored satisfactory ROM. When acetabular anteversion was 25 degrees, only placing the lip into the anterosuperior could increase extension and external rotation to maintain satisfactory ROM. CONCLUSIONS: This study showed that optimal lipped liner orientation should depend on acetabular anteversion. When acetabular anteversion was smaller than 20 degrees, placing lip in the posterior allowed an optimally ROM. When acetabular anteversion was greater than 20 degrees, adjusting lip to the anterior allowed a comprehensive larger ROM to avoid early impingement.

The clinical use of enriched bone marrow stem cells combined with porous beta-tricalcium phosphate in posterior spinal fusion.

Cytotherapy for bone regeneration has not been widely used clinically. A new method based on enriched bone-marrow-derived mesenchymal stem cells (MSCs) combined with porous beta-tricalcium phosphate (beta-TCP) was used for posterior spinal fusion in 41 patients. The aim of the present study was to assess the clinical feasibility of peri-operative bone marrow stem cell enrichment and their combination with tricalcium phosphate. About 252 ml marrow per patient was harvested from bilateral iliac crest, the enriched MSCs were produced by a cell processor peri-operatively, then combined with porous beta-TCP granules by a negative pressure and a short-time incubation in the meantime of conventional operation, which were finally implanted back into the patient. About 45 ml enriched MSC suspension was collected, and 78+/-16% of MSCs were recovered. By enrichment technique, the number of colony-forming units which expressed alkaline phosphatase (CFUs-ALP+, to estimate the prevalence of MSCs) was increased 4.3 times; the increasing folds of bone marrow nucleated cells (NCs) and MSCs had a positive correlation. The natural log (ln) of MSC number declined with age, and also, the MSC number of younger subjects (< or =40 years) was more than that of older ones (>40 years), but none for NCs. The number of NCs and MSCs was not different significantly between men and women. However, the patients with thoracolumbar fracture (TLF) had significantly more MSCs than those with degenerative disc disease (DDD), but not for NCs. On the other hand, enriched MSCs could adhere to the wall of porous beta-TCP within 2h combination, and proliferate well during culture in vitro. After 34.5 months, 95.1% cases had good spinal fusion results. None of the samples before grafting was positive in bacterial culture. Only four patients had a little exudation or moderate swelling in their wounds, and recovered with conservative treatment.

[Clinical study of lumbar fusion by hybrid construct of stem cells technique and biodegradable material].

OBJECTIVE: To explorer the effectiveness of enriched bone marrow stem cells technique for lumbar fusion. METHODS: With the randomization and control principles, 2 graft materials [Enrichment bone marrow mesenchymal stem cells hybridized with beta-tri calcium phosphate (composite graft group), autologous iliac crest bone graft (autograft group)] were compared in posterior lumbar fusion procedures. 56 patients with degenerative disc disease, lumbar instability or spinal stenosis, were included. The volume of cells suspension in pre- and post-enrichment and the number of nucleated cells (NCs) were identified. The number of osteoprogenitor cells was estimated by counting the colony-forming units which express alkaline phosphatase (CFUs/ALP+). Then the efficiency of the enrichment was evaluated. Clinical follow-up with roentgenogram and Oswestry scale scores was performed for outcome evaluation. RESULTS: (249 +/- 31) ml bone marrow per patient from bilateral iliac crests was aspirated peri-operatively. About (43 +/- 11) ml enriched bone marrow was collected. The number of NCs was concentrated from (15.9 +/- 3.3) x 10(6)/ml to (44.1 +/- 10.8) x 10(6)/ml, CFUs/ALP+ was significantly increased from (118 +/- 86)/ml to(486 +/- 305)/ml. The follow-up was about (26.3 +/- 7.5) months. There was no significant differences in age, gender, disease and fusion segments between the two groups. The fusion rate was 93.3% and 96.2% for composite graft group and autograft group, respectively (chi2 = 0.2146, P = 0.6432). There was no difference in operation time between the two group (t = 0.5243, P = 0.6022), but blood loss in composite graft group was more than that in autograft group (t = 6.4664, P < 0.01). Cell salvage for auto-transfusion could transfuse back half of the blood loss during operation. No hematoma or chronic soreness in the bone marrow donor sites of composite graft group occurred, but a little exudation or moderate swelling in the wound happened in 4 cases which disappeared under medical treatment. Meanwhile, 15.4% patients had hematoma in the iliac bone donor site and 26.9% patients had chronic soreness, but no case had wound problem in autograft group. As for Oswestry scale scores, there was no significant difference between the two groups. CONCLUSIONS: The enrichment technique of autologous bone marrow stem cells can greatly increase the concentration of MSCs. It is a rapid and safe method used peri-operatively. The composite material of enriched MSCs and porous beta-TCP is a good bone substitute in posterior spinal fusion.

Evaluation of the osteogenesis and biodegradation of porous biphasic ceramic in the human spine.

The histological reports on porous biphasic calcium phosphate ceramic (PBC) in human spine are limited. The osteogenesis and biodegradation of PBC are insufficiently known in human. In present study, the undecalcified histological study was carried out on 20 samples retrieved from posterior spinal fusion in order to reveal the osteogenesis and biodegradation of the PBC in human spine. The quantitative study was performed in 14 samples with sufficient size. Newly formed bone was found in all the samples. More new bone was formed in those samples closely in contact with autogenous bone. The PBC degradation particles were present both in the macrophages and around the tissue. However, those phenomena were highly variable among the samples. New bone formation increased with time and decreased with age. The PBC degradation decreased with age, but it did not differ greatly with time. New bone formation was higher and the residual material was lower in the fusion group than that in non-fusion group. The PBC is a kind of osteoconductive material and do not transform into new bone after a relatively long time. The PBC should be well mixed with the autogenous bone in order to achieve high new bone colonization. The PBC degradation particles and related active phagocytotic activity have been noted.

Three-dimensional flow perfusion culture system for stem cell proliferation inside the critical-size beta-tricalcium phosphate scaffold.

A 3-dimensional flow perfusion system has been created in our laboratory to provide continuous and homogeneous nutrient supply inside the critical-size beta-tricalcium phosphate (beta-TCP) scaffold and permit cell proliferation during long-term incubation. The critical-size porous cylindrical scaffold (14 mm in diameter, 30 mm in length) with a central tunnel was impregnated with sheep mesenchymal stem cells. In the flow perfusion group, the hybrid scaffolds were continuously perfused with complete alpha-minimum essential medium via a peristaltic pump for 7, 14, and 28 days. In the static culture group, the hybrid composites were immersed in the medium without perfusion for 14 and 28 days. The daily glucose consumption was much higher in the flow perfusion group than in the static group (p < 0.001). In the flow perfusion group, glucose consumption increased dramatically in the first 14 days, and the increase slowed in the last 14 days. In the static group, the increase occurred only in the first 14 days. Cell viability via MTT colorimetry increased with time, which coincided with the results of glucose consumption. Histological study showed that the cells proliferated through the whole scaffolds under the flow perfusion culture. While under the static culture, the cells survived and proliferated only inside the first to third rows of the macropores under the scaffold surface. The cell quantity increased with time under flow perfusion culture. The results suggest that flow perfusion culture is superior to static culture for mesenchymal stem cell proliferation in the critical-size porous scaffold. This perfusion culture system permits a constant nutrition supply into the center of a large-scale scaffold for at least 4 weeks. Determination of D-glucose in the culture medium is a noninvasive way to survey cell proliferation in this system.

[The effect of ultra high molecular weight polyethylene particles on macrophage].

OBJECTIVE: To study the effect of ultra high molecular weight polyethylene (UHMWPE) particles on macrophages and evaluate the expression of NFAT2, a key transcriptional factor for osteoclast differentiation. METHODS: From November 2004 to February 2005, macrophages were co-cultured with UHMWPE particles. When observed at different times, the proliferation activity of macrophages was analyzed by MTT and the expression of calcineurin (CaN) and NFAT2 by immunohistochemical and RT-PCR method respectively. RESULTS: The macrophages phagocytosed UHMWPE particles in an early time, the expression of CaN and NFAT2 was increased, while the proliferation activity was not enhanced. CONCLUSIONS: UHMWPE particles can stimulate macrophages to phagocytose significantly, and enhance the expression of the transcriptional factor NFAT2.

[VASCULARITY STUDY ON PERIPROSTHETIC TISSUES AROUND ASEPTIC LOOSENING AFTER TOTAL HIP ARTHROPLASTY].

OBJECTIVE: To observe the vascularity in periprosthetic tissues of aseptic loosening after total hip arthroplasty (THA) and to explore the relationship between expression of vascularity and osteolysis. METHODS: Between October 2009 and June 2012, interface tissues were obtained from 22 patients (22 hips) who underwent revision of THA because of prosthetic aseptic loosening, including 12 males and 10 females with the age range of 53-81 years and prosthesis survival range of 6-14 years. The interface tissues were divided into osteolysis group and non-osteolysis group based on preoperative X-ray findings and intraoperative observation. The synovial tissues were harvested from another 8 patients (3 males and 5 females, aged 58-72 years) with osteoarthritis undergoing THA as control group. HE stainging was used to observe the histological character, and low-wear or high-wear was identified according to metal or polyethylene particles amount in osteolysis group. The CD34 immunohistochemical staining was used to mark the blood vessels. Microvessel density and microvessel index were calculated with the use of image analysis software. RESULTS :Histological observation showed that wear particles and numerous macrophages/multinucleated giant cells accumulated in the membrane of osteolysis group, while many fibroblasts and synovial cells existed in non-osteolysis group. The microvessels density and microvessel index were significantly lower in non-osteolysis group than those in osteolysis group and control group (P < 0.05), and there was no significant difference in microvessel density and microvessel index between osteolysis group and control group (P > 0.05). There were less microvessel density and microvessel index in heavy-loaded metal or polyethylene wear particles areas than those in low-loaded metal or polyethylene wear particles areas (P < 0.05), and there for either polyethylene or metal particles (P > 0.05). CONCLUSION: The phagocytosis of macrophage in periprosthetic tissues need vicinal microvessels formation and blood supply to some extent. Vascular injury and decreased blood supply at the implant-bone interface seem to be one of the reasons for insufficient implant osseointegration and aseptic loosening.

Hydroxyapatite coatings with oriented nanoplate and nanorod arrays: Fabrication, morphology, cytocompatibility and osteogenic differentiation.

Hydroxyapatite (HA) crystals exhibit rod-like shape with c-axis orientation and plate-like shape with a(b)-axis orientation in vertebrate bones and tooth enamel surfaces, respectively. Herein, we report the synthesis of HA coatings with the oriented nanorod arrays (RHACs) and HA coatings with oriented nanoplate arrays (PHACs) by using bioglass coatings as sacrificial templates. After soaking in simulated body fluid (SBF) at 120°C, the bioglass coatings are hydrothermally converted into the HA coatings via a dissolution-precipitation reaction. If the Ca/P ratios in SBF are 2.50 and 1.25, the HA crystals on the coatings are oriented nanorod arrays and oriented nanoplate arrays, respectively. Moreover, the bioglass coatings are treated with SBF at 37°C, plate-like HA coatings with a low crystallinity (SHACs) are prepared. As compared with the Ti6Al4V and SHACs, the human bone marrow stromal cells (hBMSCs) on the RHACs and PHACs have better cell adhesion, spreading, proliferation and osteogenic differentiation because of their moderately hydrophilic surfaces and similar chemical composition, morphology and crystal orientation to human hard tissues. Notably, the morphologies of HA crystals have no obvious effects on cytocompatibility and osteogenic differentiation. Hence, the HA coatings with oriented nanoplate arrays or oriented nanorod arrays have a great potential for orthopedic applications.

Fabrication of silver nanoparticle-doped hydroxyapatite coatings with oriented block arrays for enhancing bactericidal effect and osteoinductivity.

Implant-associated infection is a common postoperative complication and remains a serious problem in orthopedic surgery. This work describes the synthesis of silver nanoparticle-doped hydroxyapatite coatings with oriented block arrays (AgNP-BHAC). The resulting nanostructure was investigated using scanning electron microscopy, energy-dispersive spectrometry, transmission electron microscopy, X-ray powder diffraction, and Fourier transform infrared spectroscopy. AgNP-BHAC exhibited excellent antimicrobial activity toward gram-negative Escherichia coli and gram-positive Staphylococcus aureus owing to the antibacterial effects of the silver nanoparticles. Human bone marrow stromal cells (hBMSC) culture revealed that the AgNP-BHAC exhibited better biocompatibility, and permitted improved cell proliferation, attachment, and osteoinductivity than uncoated Ti-6Al-4V titanium alloy, the favored material for biomedical applications. In summary, this study presents a convenient and effective method for the incorporation of silver into HA coatings with block morphology. This method can be utilized to modify a variety of metallic implant surfaces to improve their antimicrobial effects and reduce potential long-term cytotoxicity.

Biodegradable Mg-Cu alloy implants with antibacterial activity for the treatment of osteomyelitis: In vitro and in vivo evaluations.

Treatment of chronic osteomyelitis (bone infection) remains a clinical challenge; in particular, it requires an implantable material with improved antibacterial activity. Here, we prepared biodegradable magnesium (Mg)-copper (Cu) alloys with different Cu contents (0.05, 0.1, and 0.25 wt%) and assessed their potential for treating methicillin-resistant Staphylococcus aureus-induced osteomyelitis. We evaluated the microstructures, mechanical properties, corrosion behavior, and ion release of the alloys in vitro, and their biocompatibility and antibacterial activity in vitro and in vivo. The antibacterial activity of the Mg-Cu alloys in vitro was demonstrated by microbiological counting assays, bacterial viability assays, biofilm formation observations, and the expression of biofilm, virulence, and antibiotic-resistance associated genes. The antibacterial activity of Mg-Cu alloys in vivo was confirmed by imaging examination, microbiological cultures, and histopathology. The biocompatibility of Mg-Cu alloys was confirmed by cell proliferation, vitality, and morphology assays in vitro and Cu(2+) or Mg(2+) ion assays, blood biochemical tests, and histological evaluation in vivo. The alloy containing 0.25 wt% Cu exhibited the highest antibacterial activity among the tested alloys, with favorable biocompatibility. Collectively, our results indicate the potential utility of Mg-Cu alloy implants with 0.25 wt% Cu in treating orthopedic infections.

Fabrication of three-dimensional porous scaffold based on collagen fiber and bioglass for bone tissue engineering.

An ideal scaffold for bone tissue engineering should have interconnected porous structure, good biocompatibility, and mechanical properties well-matched with natural bones. Collagen is the key component in the extracellular matrix (ECM) of natural bones, and plays an important role in bone regeneration. The biological activity of collagen has promoted it to be an advantageous biomaterial for bone tissue engineering; however, the mechanical properties of these scaffolds are insufficient and the porous structures are not stable in the wet state. An effective strategy to solve this problem is to fabricate a hybrid scaffold of biologically derived and synthetic material, which have the necessary bioactivity and mechanical stability needed for bone synthesis. In this work, a three-dimensional macroporous bone scaffold based on collagen (CO) fiber and bioglass (BG) is fabricated by a slurry-dipping technique, and its relevant mechanical and biological properties are evaluated. The CO/BG scaffold is interconnected with a porosity of 81 ± 4.6% and pore size of 40-200 µm. Compared with CO scaffold, water absorption value of CO/BG scaffold decreases greatly from 889% to 52%, which significantly alleviates the swelling behavior of collagen and improves the stability of scaffold structure. The CO/BG scaffold has a compression strength of 5.8 ± 1.6 MPa and an elastic modulus of 0.35 ± 0.01 Gpa, which are well-matched with the mechanical properties of trabecular bones. In vitro cell assays demonstrate that the CO/BG scaffold has good biocompatibility to facilitate the spreading and proliferation of human bone marrow stromal cells. Hence, the CO/BG scaffold is promising for bone tissue engineering application.

The use of morselized allografts without impaction and cemented cage support in acetabular revision surgery: a 4- to 9-year follow-up.

BACKGROUND: Acetabular revision arthroplasty with major bone loss is one of the most difficult operations in orthopedic surgery. The goal of the study was to evaluate midterm clinical results of the use of morselized allografts with cemented cage support in revision total hip replacement. METHODS: We identified 28 patients (29 hips) at an average follow-up of 73 months. Harris Hip Scores (HHS) were assessed before and after surgery. Pre- and postoperative radiographs were evaluated for restoration of the center of rotation, component migration, and graft incorporation. RESULTS AND DISCUSSION: At follow-up, the mean HHS improved from 34 (range, 20-45) to 80 (range, 71-98) points. None of the components had been re-revised. On average, the revised hip center of rotation was improved significantly. Incorporation of the graft was complete in 23 hips. The midterm result of cage reconstruction with morselized bone allograft is relatively better than other studies using a similar cage construction. We believe we have three special modifications of this reconstruction technique that are beneficial for bone incorporation. CONCLUSIONS: These data confirm that acetabular reconstruction using morselized allografts and cemented acetabular cages is effective in the midterm as a treatment for acetabular loosening with massive bone deficiency.