Polymeric additives to enhance the functional properties of calcium phosphate cements

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Abstract

The vast majority of materials used in bone tissue engineering and regenerative medicine are based on calcium phosphates due to their similarity with the mineral phase of natural bone. Among them, calcium phosphate cements, which are composed of a powder and a liquid that are mixed to obtain a moldable paste, are widely used. These calcium phosphate cement pastes can be injected using minimally invasive surgery and adapt to the shape of the defect, resulting in an entangled network of calcium phosphate crystals. Adding an organic phase to the calcium phosphate cement formulation is a very powerful strategy to enhance some of the properties of these materials. Adding some water-soluble biocompatible polymers in the calcium phosphate cement liquid or powder phase improves physicochemical and mechanical properties, such as injectability, cohesion, and toughness. Moreover, adding specific polymers can enhance the biological response and the resorption rate of the material. The goal of this study is to overview the most relevant advances in this field, focusing on the different types of polymers that have been used to enhance specific calcium phosphate cement properties.

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Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.

Linda Asher, J C Banwart, R Hassanein (1995)

This study analyzed the cause, rate, and risk factors of iliac crest bone graft donor site morbidity. All complications or problems, no matter how small, were sought to develop strategies of prevention. A wide range of major, 0.76% (Keller et al) to 25% (Summers et al) and minor complications, 9.4% (Keller et al) to 24% (Summers et al) has been reported. A consecutive series of 261 patients, whose bone graft harvest was done by one surgeon, was studied by chart review and a mail survey that was not conducted by the operating surgeon. The survey presented specific open-ended questions designed to uncover any complication/problem, no matter how small. Complications then were categorized as major or minor and subcategorized as acute or chronic. Statistical analysis was done using chi-squared and multiple logistical regression. None of the 261 patients had a severe perioperative complication--e.g., superior gluteal artery injury, sciatic nerve injury, or deep wound infection. None of the 225 patients with long term follow-up (average, 66 months; range, 32-105 months) had a severe late complication--e.g., donor site herniation, meralgia paresthetica, pelvic instability, or fracture. Of the 180 patients meeting the qualifications for statistical analysis, major complications occurred in 18 (10%), only three of which affected function (pain). Minor complications occurred in 70 (39%). The results indicated that severe complications from iliac crest bone graft harvest can be avoided and major complications affecting functioning are uncommon, but minor complications are common. The findings suggest that procedural refinements of limiting subcutaneous dissection and providing layered tension-free incision closure may improve results.

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An injectable calcium phosphate-alginate hydrogel-umbilical cord mesenchymal stem cell paste for bone tissue engineering.

Liang Zhao, Michael Weir, Hockin Xu (2010)

The need for bone repair has increased as the population ages. Stem cell-scaffold approaches hold immense promise for bone tissue engineering. However, currently, preformed scaffolds for cell delivery have drawbacks including the difficulty to seed cells deep into the scaffold, and inability for injection in minimally-invasive surgeries. Current injectable polymeric carriers and hydrogels are too weak for load-bearing orthopedic applications. The objective of this study was to develop an injectable and mechanically-strong stem cell construct for bone tissue engineering. Calcium phosphate cement (CPC) paste was combined with hydrogel microbeads encapsulating human umbilical cord mesenchymal stem cells (hUCMSCs). The hUCMSC-encapsulating composite paste was fully injectable under small injection forces. Cell viability after injection matched that in hydrogel without CPC and without injection. Mechanical properties of the construct matched the reported values of cancellous bone, and were much higher than previous injectable polymeric and hydrogel carriers. hUCMSCs in the injectable constructs osteodifferentiated, yielding high alkaline phosphatase, osteocalcin, collagen type I, and osterix gene expressions at 7 d, which were 50-70 fold higher than those at 1 d. Mineralization by the hUCMSCs at 14 d was 100-fold that at 1 d. In conclusion, a fully injectable, mechanically-strong, stem cell-CPC scaffold construct was developed. The encapsulated hUCMSCs remained viable, osteodifferentiated, and synthesized bone minerals. The new injectable stem cell construct with load-bearing capability may enhance bone regeneration in minimally-invasive and other orthopedic surgeries. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

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Complications of iliac crest bone graft harvesting.

E Arrington, W. J. Smith, H G Chambers … (1996)

Autologous bone grafts harvested from the iliac crest are commonly used in reconstructive orthopaedic surgery. Autologous bone is used to help promote bone healing in fractures and to provide structural support for reconstructive surgery. The results of autologous bone grafting are more predictable than the use of xenografts, cadaveric allografts, or synthetic bone substitutes because autologous bone grafts provide osteoinductive and osteoconductive properties, are not immunogenic, and are usually well incorporated into the graft site. In a retrospective review of 414 consecutive cases of iliac crest bone graft procedures performed at Brooke Army Medical Center from 1983 to 1993, 41 (10%) minor and 24 (5.8%) major complications were identified. Minor complications included superficial infections, superficial seromas, and minor hematomas. Major complications included herniation of abdominal contents through massive bone graft donor sites, vascular injuries, deep infections at the donor site, neurologic injuries, deep hematoma formation requiring surgical intervention, and iliac wing fractures. Harvesting of iliac crest bone graft can be associated with significant morbidity. However, with adequate preoperative planning and proper surgical technique, the incidence of these complications can be reduced.

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Author and article information

Journal

Journal ID (nlm-ta): J Tissue Eng

Journal ID (iso-abbrev): J Tissue Eng

Journal ID (publisher-id): TEJ

Journal ID (hwp): sptej

Title: Journal of Tissue Engineering

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 2041-7314

Publication date Collection: 2012

Publication date (Electronic): 20 March 2012

Volume: 3

Issue: 1

Electronic Location Identifier: 2041731412439555

Affiliations

[1 ]Biomaterials, Biomechanics, and Tissue Engineering Group, Department of Materials Science and Metallurgy, Technical University of Catalonia (UPC), Barcelona, Spain

[2 ]Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain

[3 ]Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, South Korea

[4 ]Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, South Korea

[5 ]Department of Nanobiomedical Science and WCU Research Center, Dankook University, Cheonan, South Korea

Author notes

[*]Maria-Pau Ginebra Biomaterials, Biomechanics, and Tissue Engineering Group Department of Materials Science and Metallurgy Technical University of Catalonia (UPC) Avenida Diagonal 647 E-08028 Barcelona Spain Email: maria.pau.ginebra@ 123456upc.edu

Article

Publisher ID: 10.1177_2041731412439555

DOI: 10.1177/2041731412439555

PMC ID: 3324842

PubMed ID: 22511991

SO-VID: 9e8e03ab-6a57-4a9f-bdc6-a7f0284f1e84

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Polymeric additives to enhance the functional properties of calcium phosphate cements

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Most cited references 123

Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.

An injectable calcium phosphate-alginate hydrogel-umbilical cord mesenchymal stem cell paste for bone tissue engineering.

Complications of iliac crest bone graft harvesting.

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