Bone regeneration induced by a 3D architectured hydrogel in a rat critical-size calvarial defect.

Bone regeneration can be stimulated by implantation of biomaterials, which is especially important for larger bone defects. Here, healing potency of the porous ArcGel was evaluated in a critical-size calvarial bone defect in rats in comparison with clinical standard autologous bone and Bio-Oss® Collagen (BioOss), a bone graft material frequently used in clinics. Bone healing and metabolic processes involved were monitored longitudinally by [18F]-fluoride and [18F]-FDG µ-PET/CT 1d, 3d, 3w, 6w, and 12w post implantation. Differences in quality of bone healing were assessed by ex vivo µ-CT, mechanical tests and histomorphometry. The amount of bone formed after implantation of ArcGel was comparable to autologous bone and superior to BioOss (histomorphometry). Furthermore, microarchitecture of newly formed bone was more physiological and better functional in case of ArcGel (push-out tests). [18F]-FDG uptake increased until 3d after implantation, and decreased until 12w for both ArcGel and BioOss. [18F]-fluoride uptake increased until 3w post implantation for all materials, but persisted significantly longer at higher levels for BioOss, which indicates a prolonged remodelling phase. The study demonstrates the potential of ArcGel to induce restitutio ad integrum comparable with clinical standard autologous bone and better bone regeneration in large defects compared to a commercial state-of-the-art biomaterial.

Is biocompatibility affected by constant shear stress?--comparison of three commercially available meshes in a rabbit model.

Mesh implants as standard treatment for tissue defects can be adapted to patient's needs by specific bioactive coatings. The biophysical interaction with the surrounding tissue must be understood to describe the influence of coatings qualitatively and quantitatively. This study investigates the use of meshes to repair diaphragmatic defects. The physical stress in this tissue is high in comparison to other applications. Therefore, knowledge gained from this experimental model can be applied to other locations. Meshes were implanted on surgically created diaphragmatic defects in growing rabbits. A standardized load model was used to investigate 33 rabbits. The commercial products Ultrapro®, Surgisis®, and Proceed® were implanted. The adhesive properties of the meshes as well as the defect size were determined macroscopically at explantation after 4 months. Sections of the explanted meshes and diaphragms were examined histologically and immunohistochemically. The median defect size for all mesh groups decreased from the initial size of 10 mm down to 4.5 mm at explantation. No statistically significant differences were seen between the three mesh groups. Surgisis® was found to be completely disintegrated after 4 months. Ultrapro® and Proceed® showed no macroscopic differences compared to their original appearance. Both sealed the original diaphragmatic defect as tightly as at time of implantation. Histological and immunohistochemical analyses showed significant differences between the three mesh groups. Proceed® caused stronger inflammatory reaction in the surrounding tissue and inferior connective tissue formation. Regarding the composition of the newly generated tissue within the defect area, Ultrapro® and Surgisis® were found superior. This can sufficiently be explained by the different gradient of inflammatory reaction in the surrounding tissue. Because Surgisis® offers no sufficiently lasting support for the diaphragmatic defect, our future main focus for mesh modification is laid on Ultrapro®.

[Analysis of 18F-FDG uptake pattern in PET for diagnosis of aseptic loosening versus prosthesis infection after total knee arthroplasty. A prospective pilot study]. / Analyse des 18F-FDG-Speichermusters in der PET zur Differenzierung zwischen aseptischer Prothesenlockerung und Protheseninfektion - Eine prospektive Pilotstudie.

UNLABELLED: The AIM of this prospective study was to identify a typical pattern for fluorodeoxyglucose (18F-FDG) uptake in positron emission tomography (PET) to differentiate aseptic loosening (tibial and / or femoral component) from prosthesis infection in painful knee prosthesis. PATIENTS, METHODS: 20 patients with painful knee prosthesis underwent PET imaging to evaluate aseptic loosening / prosthesis infection of their knee prosthesis. The interface between bone and surrounding soft tissue or bone was divided into 3 segments each for both the femur and the tibia and in addition for 4 segments reflecting the surrounding periprosthetic soft tissue. FDG uptake in each of the segments was scored (0-3) by two independent observers. The final diagnosis was based on operative findings with subsequent microbiological culture and histological examination. RESULTS: After surgical revision 6 femoral components and 5 tibial components were found to be loose and prosthetic infection was present in 9 prostheses. In 8 of 9 infected prostheses loosening of the femoral und tibial component occurred. There was no statistically significant correlation between the standardised uptake within each of the segments and the diagnosis of aseptic loosening or prosthesis infection. A differentiated qualitative and quantitative FDG-PET result interpretation divided into five categories was developed. Specificity / sensitivity / positive predictive value / negative predictive value were 93% / 83% / 83% / 93% for aseptic loosening of the femoral component, 87% / 80% / 67% / 93% for aseptic loosening of the tibial component and 82% / 89% / 80% / 90% for infection. CONCLUSION: This pilot study shows that FDG-PET is a promising diagnostic tool for patients with painful knee prostheses. There is a good correlation between PET images and the intraoperative and pathology findings. Its clinical value, however, warrants further evaluation in a larger patient population.

Biomimetic modification of the TiO(2)/glass composite Ecopore with heparinized collagen and the osteoinductive factor BMP-2.

The porous TiO(2)/glass composite Ecopore has potential applications in hard tissue replacement. We describe the modification of Ecopore with the growth factor bone morphogenetic protein-2 (BMP-2) to add osteoinductive properties. Ecopore covalently coated with BMP-2 caused a weak induction of alkaline phosphatase in murine embryonal fibroblasts. In a rabbit bone defect model, BMP-2-coated Ecopore had moderately higher bone apposition rates and ingrown bone quantities at 6 weeks after implantation. To overcome loss of function due to chemical surface coupling, we filled the pore system of Ecopore with heparinized collagen sponge and loaded this secondary matrix with BMP-2. Heparinization of collagen filling increased the BMP-2 loading capacity of the matrix approximately 1.28-fold. Within 96 h, 17.0+/-0.1 and 10.1+/-0.2% of the used BMP-2 was released from non-modified and heparinized Ecopore/collagen, respectively, indicating that the heparin modification retarded BMP-2 release. Revealed by energy-dispersive X-ray spectroscopy analysis of implant cross-sectional areas, BMP-2-loaded Ecopore/collagen had significantly higher bony ingrowth quantities in rabbits, with the heparinized modification yielding the highest value (16.09+/-3.51%, p<0.005) compared with the non-heparinized matrix (10.72+/-4.07%, p<0.05) and the BMP-2-free controls (5.60+/-1.47%). This suggested a beneficial effect of the biomimetic modification of Ecopore with heparinized collagen for bone healing and integration.

[Application of an amphiphilic bonder in a goat model to increase the femoral cement-bone adhesion in cemented hip arthroplasty]. / Einsatz eines amphiphilen Haftvermittlers im Schafsmodell zur Verbesserung der femoralen Knochenzement-Knochen-Verbundfestigkeit in der zementierten Hüftendoprothetik.

AIM: Cemented revision of femoral components in total hip arthroplasty has shown high rates of early loosening due to reduced micro- and macroretention of the cement to the endostal bone stock. Enhanced stability can be reached by an amphiphilic bonder, which offers a covalent bonding of the hydrophobic cement to the hydrophilic bone. The aim of this study is to evaluate the biocompatibility of such a bonder and its effects on the mechanical stability of cemented hip arthroplasty stems in vivo. METHODS: Total cemented hip arthroplasties were performed in 20 sheep. In the verum group (n = 10) the implant bed was preconditioned by application of the bonder prior to femoral stem implantation. To study the biocompatibility around the bone-cement interface fluorescent marking of osteoblasts was applied in vivo throughout the observation period of 9 months. Native X-rays of the hip joints were obtained immediately after implantation and after euthanasia. The bone-cement interface was examined histologically. RESULTS: All stems of the verum group showed firm bonding of cement to bone in manual testing, while in 7 of the 10 controls the stems with adherent cement could be easily pulled out off the bony implant bed. This was coherent with significantly higher rates of progredient radiolucent lines and soft-tissue interpositions between bone and cement in the control group. The bonder was biocompatible. CONCLUSION: When preconditioned with an amphiphilic bonder, cemented stems showed a markedly higher adhesive strength to the cancellous bone without signs of inflammation or neoplasia. This procedure might offer enhanced longevity of cemented femoral revision stems in hip arthroplasty.

[Bilateral tumor of the nasal vestibule--a case report]. / Bilaterale Raumforderung des Naseneingangs--ein Fallbericht.

The authors report a case of a bilateral tumor of the nasal vestibule with a six-year history of progressive impairment of nasal breathing. After microsurgical transnasal excision, the finding was diagnosed as bilateral nasolabial cyst.