John Ricci

A 1-year study of osteoinduction in hydroxyapatite-derived biomaterials in an adult sheep model: part I.

The study presented here investigated hydroxyapatite biomaterials implanted in soft-tissue sites in adult sheep to determine whether these materials are osteoinductive and whether the rate of osteoinduction can be increased by manipulating the composition and porosity of the implants. For the study, 16.8-mm x 5-mm discs were prepared from mixtures of hydroxyapatite and beta-tricalcium phosphate. Five mixtures of hydroxyapatite-ceramic and hydroxyapatite-cement paste forms were studied: 100 percent hydroxyapatite-ceramic (Interpore), 60 percent hydroxyapatite-ceramic, 100 percent hydroxyapatite-cement paste, 60 percent hydroxyapatite-cement paste, and 20 percent hydroxyapatite-cement paste. Biomaterials were implanted in subcutaneous and intramuscular soft-tissue pockets in 10 adult sheep. Cranial bone grafts of equal dimension were implanted as controls. One year after implantation, the volume of all biomaterials and bone grafts was determined from a computed tomographic scan, and porosity and bone formation were determined using backscatter electron microscopy. Cranial bone and the 20 percent hydroxyapatite-cement paste implants demonstrated significant volume reduction in all sites after 1 year (p < 0.001). No significant difference in volume of the remaining four biomaterials was found. There was no significant change in pore size in the ceramic implants (range, 200 to 300 micro) and in the cement-paste implants containing 60 percent hydroxyapatite or more (range, 3 to 5 nm). Pore size in the cement-paste implants containing 20 percent hydroxyapatite increased significantly with resorption of the tricalcium-phosphate component, reaching a maximum of 200 to 300 micro in the periphery, where the greatest tricalcium-phosphate resorption had occurred. Both ceramic biomaterials demonstrated lamellar bone deposition within well-formed haversian systems through the entire depth of the implants, ranging from a mean of 6.6 percent to 11.7 percent. There was minimal bone formation in the cement-paste implants containing 60 percent hydroxyapatite or more. In contrast, cement-paste implants containing 20 percent hydroxyapatite demonstrated up to 10 percent bone replacement, which was greatest in the periphery of the implants where the greatest tricalcium-phosphate resorption had occurred. This study confirms the occurrence of true osteoinduction within hydroxyapatite-derived biomaterials, when examined using backscatter techniques. In this study, the rate of osteoinduction was greatest when a porous architecture was maintained, which was best achieved in ceramic rather than cement-paste forms of hydroxyapatite. Porosity and resultant bone formation in cement-paste implants can be improved by combining hydroxyapatite with a rapidly resorbing component, such as tricalcium phosphate.

Osteoconductive Composite Grouts for Orthopedic Use

A composite of HA particulate and calcium sulfate hemihydrate has been developed. When this dry material is mixed with either sterile saline or water, the resulting mixture begins to gel. While in the gel or dough state, the composite can be manually inserted or injected under pressure into a bone defect where it sets in situ. The calcium sulfate acts as a binder to hold the HA particles in place. The subsequent resorption of the calcium sulfate leaves controlled porosity for bone ingrowth and attachment to the nonresorbable HA particulate. The combination of calcium sulfate and HA results in a composite with handling properties superior to those of HA alone. Calcium sulfate has a long history of medical use as an implant material. The biocompatibility of the material has been clearly established. The combination of HA and calcium sulfate is likewise extremely compatible as demonstrated in the present studies. Bone ingrowth concomitant with resorption occurs rapidly with efficient conduction of bone from particle to particle. Based on the experiments presented herein, the composite of HA and calcium sulfate may be a useful alternative or adjunct to autogenous bone grafting. Many questions, however, remain regarding long-term tissue response and bone remodeling as well as the efficacy of this material relative to bone grafting.

EFFECT OF MECHANICAL LOAD ON HEALING INCISIONS

ABSTRACT Full thickness skin incisions were made on the back of a young domestic pig. During the period of fibroplasia, the incisions were mechanically loaded with a subcutaneous tissue expander. Mechanical and histological evaluation of mechanically loaded and control incision areas indicated that the mechanical stress encouraged healing and remodeling of dermal tissue.