impregnation of bone chips with alendronate and cefazolin ... fileimpregnation of bone chips with...
TRANSCRIPT
Impregnation of bone chips with alendronate and cefazolin,
combined with demineralized bone matrix: a bone chamber study in
goats
N.M.C. Mathijssen, G.Hannink, P.Pilot, R.M.
Bloem, B.W. Schreurs, P. Buma
Hip revision surgery
15-18
augustus 2011
Summerclass
Orthopedie
Allograft bone for bone impaction
15-18
augustus 2011
Summerclass
Orthopedie
Bone impaction grafting
15-18
augustus 2011
Summerclass
Orthopedie
“Scaffold”
15-18
augustus 2011
Summerclass
Orthopedie
Osteoclasts and osteoblasts
Loosening
Infection (4-6%)
How can we improve the outcome after hip
revision surgery with BIG and prevent
complications?
15-18
augustus 2011
Summerclass
Orthopedie
Loosening
Solution: Local application of bisphosphonates
?? What dose?
?? Do growthfactors in DBM enhance bone formation?
Infection
Solution: local application of antibiocs
?? Influence of local application of cefazolin?
Methods
Bone chamber study in 25 goats
Group Cefazolin Demineralized bone Alendronate
1 - - -
2 200 μg/ml - -
3 200 μg/ml - 0,5 mg/ml
4 200 μg/ml - 1 mg/ml
5 200 μg/ml - 2 mg/ml
6 200 μg/ml - 10 mg/ml
7 - 50% Demin 50% allograftbone -
8 - 50% Demin 50% allograftbone 1 mg/ml
Methods
- Bone impregnated and rinsed - Impacted bone - 8 bone chambers in each goat - Ingrowth opening in bone chamber - 12 weeks
- Histology:
- HE coupes - Old and new bone same color pointcounting
Methods
Results
Results
Control Bisphosphonate group
% Graft bone of total volume
% New bone of total volume
Discussion
Bone chambermodel is simplified situation
No cementation
No access to joint
Small surface area
12 weeks
Ideal circumstances
Careful with extrapolation to clinical situation
Allograft bone was fresh frozen
Conclusion
Local application of bisphosphonates decreases bone resorption and might be used with allograft bone chips
Optimum dose of 1 mg/ml in this study
Too much alendronate results in decreased bone formation
No effect of demineralized bone on bone formation
Local application of cefazolin (200 µg/mL) has no effect on bone remodelling
