TY - JOUR
T1 - Extracortical bone-bridging fixation with use of cortical allograft and recombinant human osteogenic protein-1
AU - Fukuroku, Jun
AU - Inoue, Nozomu
AU - Rafiee, Bahman
AU - Sim, Franklin H.
AU - Frassica, Frank J.
AU - Chao, Edmund Y.S.
N1 - Funding Information:
In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from National Institutes of Health-National Cancer Institute Merit Grant CA-23751 and Stryker Orthopaedics. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker Orthopaedics). F.J. Frassica is a consultant for Stryker Orthopaedics. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
PY - 2007/7
Y1 - 2007/7
N2 - Background: Prosthetic reconstruction with extracortical bone-bridging fixation is an effective method for the treatment of massive bone loss. We evaluated the effect of the use of recombinant human osteogenic protein-1 (rhOP-1) combined with allogenic cortical bone strips as a substitute for an autogenous bone graft for extracortical bone-bridging. Methods: Eight skeletally mature adult male dogs underwent a bilateral resection of a 6-cm segment of the femoral diaphysis and reconstruction with a porous segmental prosthesis. On the experimental side, an allogenic cortical onlay graft in the form of bone strips combined with rhOP-1 mixed with bovine type-I-collagen putty (OP-1 putty) was applied. On the control side, allogenic cortical bone strips augmented with autogenous cancellous bone chips and bone marrow were used. The reconstructions were followed for twelve weeks with biweekly evaluations of load-bearing gait and radiographs. The animals were killed twelve weeks after the surgery, and the reconstructed femora were studied biomechanically, histologically, and with microradiographs. Results: One animal was excluded from the analysis because a fracture of the proximal part of the femur on the control side was observed radiographically twelve weeks after the surgery. There were no significant differences in load-bearing gait between the experimental and control sides throughout the experimental period. Serial radiographs revealed a 1.9-fold (p < 0.04), 2.7-fold (p < 0.01), and 2.4-fold (p < 0.03) increase in mineralized area on the experimental side at two, four, and six weeks, respectively. The torsional stiffness and strength of the fixation attributed to the extracortical bridging bone alone were 2.3-fold (p < 0.03) and 2.2-fold (p = 0.058) greater on the experimental side, respectively. The allograft porosity on the experimental side was 3.8-fold (p < 0.02) greater than that on the control side. With the number of samples available, there was no significant difference in mineral apposition rate between the experimental and control sides. Conclusions: In an animal model of segmental bone-replacement prosthetic fixation with use of the extracortical bone-bridging principle, an allogenic onlay cortical graft combined with rhOP-1 was an effective substitute for autogenous bone graft. Clinical Relevance: The allogenic onlay cortical graft combined with rhOP-1 may be useful for fixation of segmental bone and joint prostheses implanted for the treatment of massive defects of long bones.
AB - Background: Prosthetic reconstruction with extracortical bone-bridging fixation is an effective method for the treatment of massive bone loss. We evaluated the effect of the use of recombinant human osteogenic protein-1 (rhOP-1) combined with allogenic cortical bone strips as a substitute for an autogenous bone graft for extracortical bone-bridging. Methods: Eight skeletally mature adult male dogs underwent a bilateral resection of a 6-cm segment of the femoral diaphysis and reconstruction with a porous segmental prosthesis. On the experimental side, an allogenic cortical onlay graft in the form of bone strips combined with rhOP-1 mixed with bovine type-I-collagen putty (OP-1 putty) was applied. On the control side, allogenic cortical bone strips augmented with autogenous cancellous bone chips and bone marrow were used. The reconstructions were followed for twelve weeks with biweekly evaluations of load-bearing gait and radiographs. The animals were killed twelve weeks after the surgery, and the reconstructed femora were studied biomechanically, histologically, and with microradiographs. Results: One animal was excluded from the analysis because a fracture of the proximal part of the femur on the control side was observed radiographically twelve weeks after the surgery. There were no significant differences in load-bearing gait between the experimental and control sides throughout the experimental period. Serial radiographs revealed a 1.9-fold (p < 0.04), 2.7-fold (p < 0.01), and 2.4-fold (p < 0.03) increase in mineralized area on the experimental side at two, four, and six weeks, respectively. The torsional stiffness and strength of the fixation attributed to the extracortical bridging bone alone were 2.3-fold (p < 0.03) and 2.2-fold (p = 0.058) greater on the experimental side, respectively. The allograft porosity on the experimental side was 3.8-fold (p < 0.02) greater than that on the control side. With the number of samples available, there was no significant difference in mineral apposition rate between the experimental and control sides. Conclusions: In an animal model of segmental bone-replacement prosthetic fixation with use of the extracortical bone-bridging principle, an allogenic onlay cortical graft combined with rhOP-1 was an effective substitute for autogenous bone graft. Clinical Relevance: The allogenic onlay cortical graft combined with rhOP-1 may be useful for fixation of segmental bone and joint prostheses implanted for the treatment of massive defects of long bones.
UR - http://www.scopus.com/inward/record.url?scp=34447260487&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34447260487&partnerID=8YFLogxK
U2 - 10.2106/JBJS.F.00290
DO - 10.2106/JBJS.F.00290
M3 - Article
C2 - 17606787
AN - SCOPUS:34447260487
SN - 0021-9355
VL - 89
SP - 1486
EP - 1496
JO - Journal of Bone and Joint Surgery
JF - Journal of Bone and Joint Surgery
IS - 7
ER -