Jouni Heikkilä

Polymethylmethacrylate composites: disturbed bone formation at the surface of bioactive glass and hydroxyapatite.

The effects of polymethylmethacrylate on bone formation were studied alone and as composites in combination with hydroxyapatite and bioactive glass in the rabbit subchondral femur. Radiographs, histology, computer assisted histomorphometry, scanning electron microscopy and energy dispersive X-ray analysis were used for evaluation. A total of 60 cones were implanted for 3, 6 and 12 weeks. The composite cones consisted of granules of bioactive glass (S56.5P4) or hydroxyapatite embedded in polymethylmethacrylate. Pure polymethylmethacrylate cones served as controls. At the interface of the cones, bone contact was observed only when bioactive glass or hydroxyapatite was present at the cone surface. Fibrous tissue was always found at the polymethylmethacrylate-tissue interface. The osteoconductive bone formation at the surface of bioactive glass and hydroxyapatite was disturbed by polymethylmethacrylate. It seemed to resist bone formation at the interface of both bioactive glass and hydroxyapatite. However, bioactive glass was better able to withstand the detrimental effect of polymethylmethacrylate than hydroxyapatite.

Histomorphometric and molecular biologic comparison of bioactive glass granules and autogenous bone grafts in augmentation of bone defect healing

The applicability of bioactive glass (BG) granules as a substitute for bone grafts was tested by comparing the histologic, histomorphometric, and molecular biologic healing patterns to those of bone autografts and ungrafted bone defects in a rat model. The cellular response in defects filled with BG granules was characterized by continuous overexpression of type III collagen. Osteogenic mesenchymal cells, prior to their differentiation to osteoblasts, organized as a dense periosteumlike layer on the surface of the BG granules. By day 14 new bone formation was more extensive in autografted defects than in BG filled defects (p = 0.039). No cartilage-specific type II collagen mRNA was detectable, confirming the uniformity of intramembranous bone formation. The difference in the initiation of new bone formation was further confirmed by the mRNA analyses of the de novo production of TGF-beta 1 and type I collagen. Autografted defects demonstrated the highest levels of TGF-beta 1 and type I collagen mRNAs during the first 2 weeks of healing, whereas BG-filled defects showed biphasic expression patterns of the same genes. Spontaneous new bone formation in ungrafted bone defects was also characterized by biphasic expression of type I collagen gene. Osteonectin mRNA declined gradually over time in autografted and BG filled defects, whereas unfilled defects showed a gradual increase of osteonectin mRNA during healing. By 8 weeks, about 70% of the BG surface showed evidence of direct new bone contact. Energy-dispersing X-ray analyses confirmed the presence of silica-rich and CaP-rich zones at the bonding interface. In conclusion, the osteoconductive surface of bioactive glass granules efficiently bonds to ongrowing new bone but the material does not reach the capacity of autogenous bone graft in promotion of osteogenesis.

Bone bank service in Finland: Experience of bacteriologic, serologic and clinical results of the Turku Bone Bank 1972–1995

560 bones were harvested by The Turku Bone Bank between 1972-1995. It was started with massive allografts for bone tumor surgery, but today most are femoral heads for hip revision surgery. The increase in harvested bones nearly trebled from 1984-1989 to 1990-1995. Only 1 positive hepatitis C test was found. There were no hepatitis B or HIV positive donors. The incidence of discarding after screening was 24%, with positive bacterial growth (8%, usually Staphylococcus epidermidis) as the commonest reason. 2 massive grafts with negative cultures when harvesting were positive after thawing and resulted in deep infection. 369 allografts were transplanted. The infection rate of massive allografts for bone tumor surgery was 5/63 in 1973-1995, and 2/52 in 1985-1995. The infection rate for hip revision surgery was 3.4%. The clinical functional results correspond to those reported in larger international series.

Bioactive glass granules: a suitable bone substitute material in the operative treatment of depressed lateral tibial plateau fractures: a prospective, randomized 1 year follow-up study.

Purpose of this study was to compare bioactive glass and autogenous bone as a bone substitute material in tibial plateau fractures. We designed a prospective, randomized study consisting of 25 consecutive operatively treated patients with depressed unilateral tibial comminuted plateau fracture (AO classification 41 B2 and B3).14 patients (7 females, 7 males, mean age 57xa0years, range 25–82) were randomized in the bioglass group (BG) and 11 patients (6 females, 5 males, mean age 50xa0years, range 31–82) served as autogenous bone control group (AB). Clinical examination of the patients was performed at 3 and 12 months, patients’ subjective and functional results were evaluated at 12 months. Radiological analysis was performed preoperatively, immediately postoperatively and at 3 and 12 months. The postoperative redepression for both studied groups was 1xa0mm until 3 months and remained unchanged at 12 months. No differences were identified in the subjective evaluation, functional tests and clinical examination between the two groups during 1 year follow-up. We conclude that bioactive glass granules can be clinically used as filler material instead of autogenous bone in the lateral tibial plateau compression fractures.

Bioactive glass versus hydroxylapatite in reconstruction of osteochondral defects in the rabbit

We studied osseointegration of a bioactive glass (BG) and hydroxylapatite (HA) in rabbit femur epiphyseal and metaphyseal regions. 17 BG and 24 HA cones implanted in defects through arthrotomy were analyzed. The holes for implants were drilled through distal femur joint surfaces. The cartilage wound repaired generally by fibrous tissue. Histomorphometry showed that 61, 78, and 79 percent of BG surface was covered by bone at 3, 6, and 12 weeks, respectively. The corresponding figures for HA were 47, 67, and 78 percent. Chemical bonding between bone and implants of both types was confirmed by scanning electron microscopy (SEM) and energy-dispersive x-ray analysis (EDXA). Formation of a calcium phosphate-rich layer on the surface BG implant was demonstrated by EDXA. Our results indicate that the osseointegration rate of bioactive glass does not differ from that of hydroxylapatite.

Dynamic contrast-enhanced MR imaging and MR-guided bone biopsy on a 0.23 T open imager

Objective: To assess the feasibility of MR (magnetic resonance)-guided bone biopsies. Design and patients: Thirty-six consecutive patients with known or suspected benign or malignant bone lesions underwent comprehensive MR imaging. A dynamic contrast-enhanced sequence followed by stationary T1-weighted sequences were obtained and MR-guided bone biopsy of the tumor at the site with fastest enhancement was performed using an open 0.23 T MR imager. Results: All MR-guided bone biopsies samples were estimated to be sufficient by the pathologists. The biopsy specimens were diagnostic in 34 of 36 cases. Conclusion: MR-guided bone biopsies combined with dynamic contrast-enhanced imaging are feasible and safe for the diagnostic investigation of equivocal bone lesions.