Ferdiansyah Mahyudin

Biomaterials in Orthopaedics

In general knowledge, orthopaedic surgery treats the disease and injuries of musculoskeletal system including bone fractures, anomalies, degenerative disease, tumor, and infection. Significant difference in orthopaedic cases occurs between developed and developing countries. In the latter, the majority of cases are caused by injury and infection. Most surgical treatment needs the use of implants for both traumatic and reconstructive procedures. Orthopedic implants can be selected from metals, polymers and ceramics or their combination. In Indonesia, certain type of orthopaedic implants have been produced locally but still cannot fulfill the high demand. The current technology used by local manufacturers has some limitations in production capacity and product variety mainly for complex implants like arthroplasty. Collaboration in R&D activities on orthopaedic implants is on-going between local manufacturers with universities and government institutions under the assistance of orthopaedic surgeons. This collaboration receives a full support from the Indonesian Government as it aligns with the national programme on supporting local products and the new general health insurance programme which covers every citizen of Indonesia.

Comparative Effectiveness of Bone Grafting Using Xenograft Freeze-Dried Cortical Bovine, Allograft Freeze-Dried Cortical New Zealand White Rabbit, Xenograft Hydroxyapatite Bovine, and Xenograft Demineralized Bone Matrix Bovine in Bone Defect of Femoral Diaphysis of White Rabbit: Experimental Study In Vivo

Autogenous bone graft is gold standard in treating bone defects, but it might have difficulty in corporation and rejection reaction. This study is to compare the effectiveness among freeze-dried xenograft, freeze-dried allograft, hydroxyapatite xenograft, and demineralized bone matrix xenograft as bone graft to fill bone defect in femoral diaphysis of white rabbit. Thirty male New Zealand white rabbits were distributed into five groups. Bone defect was filled correspondingly with xenograft freeze-dried cortical bovine, allograft freeze-dried cortical New Zealand white rabbit, xenograft hydroxyapatite bovine, and xenograft demineralized bone matrix bovine. No graft was used in control group. VEGF, osteoblast, and woven bone were higher in allograft freeze-dried cortical New Zealand white rabbit (mean 5.6625 (p < 0.05)) and xenograft demineralized bone matrix bovine (mean 5.2475 (p < 0.05)) with calcification of woven bone was already seen in week 2 in the latter group. There was a decrease of woven bone (mean 4.685 (p < 0.05)) fibrous tissue (mean 41.07 (p < 0.05)) in xenograft demineralized bone matrix bovine. The Immunoglobulin-G was elevated in control and all study groups but not significantly (p = 0.07855). Bone healing process in xenograft demineralized bone matrix bovine is more effective than in xenograft hydroxyapatite bovine, allograft freeze-dried New Zealand white rabbit, xenograft freeze-dried cortical bovine, and control.

Proximal fibula osteotomy as an alternative to TKA and HTO in late-stage varus type of knee osteoarthritis

Background Knee osteoarthritis has a high prevalence in Indonesia. Aim of this research is knowing the outcome of knee osteoarthritis patient after PFO procedure. Methods Data collected and analyzed in hospitals in Surabaya from July to December 2017. This study compares preoperative and postoperative outcome on radiological evaluation, patient satisfaction, and clinical function. Results The study includes 15 patients. Radiological evaluation on Tibiofemoral Angle and Joint Space Ratio increases significantly. Patient satisfaction evaluation using SF12 significantly improve. Evaluation using KOOS and Oxford Knee Score also increase significantly. Conclusion PFO could become an alternative treatment for last stage knee osteoarthritis.

In Vitro Comparative Study of Osteogenic Differentiation Ability between Adipose and Bone Marrow Mesenchymal Stem Cell Applied to Bovine Demineralized Bone Matrix

Ideal bone graft must possess the desirable trait such as osteoconductive, osteoinductive and osteogenesis. Demineralized Bone Matrix (DBM) provides both osteoconductive and osteoinductive trait. Referring to the tissue engineering principle, the addition of mesenchymal stem cell would add the osteogenic trait to this procedure. The design of this study is experimental using Bovine DBM. Bone Marrow Mesenchymal Stem Cell (BMSCs) and Adipose Mesenchymal Stem Cells (ASCs) were taken from New Zealand white rabbit. There are two groups of treatment, divided into DBM implanted with BMSCs and DBM implanted with ASCs. Each BMSCs and ASCs groups is incubated in the normal and osteogenic culture plate. Evaluation is performed by counting the osteoblast and immunohistochemistry stain using Alkaline Phosphate and Osteocalcin. After 4 weeks of incubation, we found that the osteoblast count in BMSCs groups is higher compared to the ASCs groups in both culture condition (p<0.01) along with Alkaline Phosphate staining (p<0.05), while the Osteocalcin staining showed insignificant differences (p>0.05). This study revealed that xenogenic bovine DBM can act as the potential osteoinductive scaffold for the MSCs to differentiate. The tissue engineering application by combining MSCs and Bovine DBM can be considered as an alternative in managing bone defect cases.

Effect of Decellularized Cartilage Bovine Scaffold and Hypoxic Condition on Stem Cell Differentiation to Chondrocyte: An In Vitro Study

Autologous Chondrocyte Implantation (ACI) has been established for years to treat cartilage defect. Application of tissue engineering has advantages over ACI as tissue engineering requires simpler procedures without leaving morbidity at the donor site. Decellularized bovine cartilage scaffold and hypoxic stem cell differentiation were used in this in vitro experimental study. Comparative test was done between three study groups using bone marrow mesenchymal stem cells treated in three different conditions: growth factor-rich chondrogenic medium, scaffold without growth factor, and combination of both. Each group was given two oxygen tension conditions of normoxia and hypoxic within phase of stem cell differentiation. Immunohistochemical examinations on SOX9, RUNX2, and collagen type II were done for evaluation. After 5-week treatment, the result showed that the highest expression SOX9 and collagen type II were found within the group that used the combination of both scaffold and chondrogenic medium in hypoxic condition. Collagen type II expression in scaffold without additional growth factor showed no statistically significant difference compared with the combination group in hypoxic condition. Cartilage tissue engineering has proven its effectiveness for cartilage regeneration. Decellularized biomaterial scaffold limited the use of growth factor resulting in better cost and resource efficiency.

Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up

Object: Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients. Method: This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed. Result: The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation. Conclusion: Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect.

Tissue Bank and Tissue Engineering

Permanent damage on the tissue or organ are still a major problem and chalenge to be solved in the world of medicine. Humankind has tried to solve the problem using technologies available in their respective era since long time ago. We can read from various literature about the efforts already made to replace and consequently heal the damaged tissue or organ. Tissue or organ damage caused by war and many other causes became the main reason of the tissue banks estabilishment in many parts of the earth. Tissue bank strife to provide safe and high quality products to be used as natural biomaterial for damaged tissue reconstruction in patients. Several processes started from procurement, processing, and finally sterilization has been done to guarantee safe and useful products for the patients in need. In line with the recent technological advancement, especially with the introduction of stem cell usage, tissue and organ reconstruction has entered a new era that will bring greater hope for patients. If the previous methods that used biomaterial only employ dead tissue in the reconstruction procedures, tissue engineering will make the combination between stem cell and biomaterial as scaffold possible, thus enabling the living tissue to be used in reconstruction. This method, albeit still in the process of research, is expected to yield better results.

Indonesian Perspective on Biomaterials and Medical Devices

Indonesia is an emerging country with population about 255 million in 2015 and 40 % of this population is in their productive age. The country’s nominal GDP for 2015 is about 900 billion USD with 5 % annual growth and general government debt stays at 26 % of GDP. The government has put healthcare service as one of the strategic program in the 2015–2019 National Development Plan along with a new effective national healthcare financing scheme. Indonesia is a big market for medical products with a market value about 800 million USD in 2015 and estimated to reach 1.2 billion USD in 2019. The government has set policies and a clear roadmap for assuring the availability and distribution of medical devices by fostering local production, improving the quality of local products and tightening the surveillance to the pre- and post-market devices. The challenge lies on unifying the country’s experts to mutually collaborate under a strong leadership on the same interest toward the national independency in producing effective yet low cost medical devices.