Homologous morcelized defatted bone graft additionated with

antibiotic and PMMA “in vivo”: preliminary histologic evaluation.

G. Gualdrini.G. Gualdrini.Rizzoli InstituteRizzoli Institute

VII Department of Orthopaedic and TraumatologyVII Department of Orthopaedic and Traumatology

Orthopaedic Clinic - University of Bologna - ItalyOrthopaedic Clinic - University of Bologna - Italy

Director prof. Armando GiuntiDirector prof. Armando Giunti

1947 De Grood M.1947 De Grood M.

1980 McCollum D.E.1980 McCollum D.E.

1982 Roffmann M.1982 Roffmann M.

1984 Sloof T. 1984 Sloof T.

1985 Ling R.1985 Ling R.

1987 Oakeshott R.1987 Oakeshott R.

1991 Oliver H.1991 Oliver H.

1993 Gie GA.1993 Gie GA.

1994 Schreurs B.W.1994 Schreurs B.W.

1996 1996 Hovelius e UllmarkHovelius e Ullmark

““Impacted morselized allograft and cement for Impacted morselized allograft and cement for revision total knee arthroplasty” revision total knee arthroplasty”

Acta Orthop. Scand. 1996Acta Orthop. Scand. 1996

19981998Bone Bank Bone Bank

Rizzoli Institute Rizzoli Institute

Omologous morcelized Omologous morcelized defatted bone graftdefatted bone graft

Howex@Howex@

Chips 3 mmChips 3 mm

Thorèn K.: “Thorèn K.: “Lipid-extracted bone graft”, , 19941994..

• three sterile envelopsthree sterile envelops• 25 kGy, 25 kGy, • - 80° C,- 80° C,

4 weeks4 weeks

With G. Ullmark kind permitWith G. Ullmark kind permit

6 months6 months

With G. Ullmark kind permitWith G. Ullmark kind permit

4 years4 years

With G. Ullmark kind permitWith G. Ullmark kind permit

4 years4 years

With G. Ullmark kind permitWith G. Ullmark kind permit

82 hip p. revisions82 hip p. revisions6 knee p. revisions6 knee p. revisions13 post-trauma hip prosthesis13 post-trauma hip prosthesis51 spinal fusions51 spinal fusions50 bone lesions filling50 bone lesions filling47 long bone non-unions47 long bone non-unions

249 patients249 patients10/1998 -08/200210/1998 -08/2002

Paprosky 2BPaprosky 2B

Paprosky 2BPaprosky 2B

Paprosky 3B

3 months 2 years

GCTGCT

12 months

Bone cystBone cyst

1month p.o.

3 months 6 months

• High plastic properties High plastic properties

• Loss bone-stock recoveryLoss bone-stock recovery

• High resistance to septic risk High resistance to septic risk

• Low resistance to mechanical strenghtLow resistance to mechanical strenght

Remarks about “MOD-B”

““Adsorption and release of antibiotics Adsorption and release of antibiotics from morselized cancellous bone. from morselized cancellous bone. In vitro studies of 8 antibiotics.”In vitro studies of 8 antibiotics.”

Witso E., Persen L., Loseth K., Bergh K.Witso E., Persen L., Loseth K., Bergh K.

Acta Orthop. Scand. 1999 Jun; 70 (3): 298-304Acta Orthop. Scand. 1999 Jun; 70 (3): 298-304

“Vancomycin-Tobramycin composite grafts -a new treatment for chronic osteomyelytis of the neuropatic food.”

Winkler H., Berger C., Kristen K.H., Engel A.Annual Meeting EBJIS, May 25-27, 2000 Berlin.

inserire rx tappari, avambracci, Navacchia

Morcelized bone combined with Morcelized bone combined with acrylic cement enhances acrylic cement enhances in vitroin vitro

release of vancomycinrelease of vancomycin

VII Department Orthopaedic and TraumatologyVII Department Orthopaedic and Traumatology*Muscoloskeletal Tissue Bank*Muscoloskeletal Tissue BankRizzoli Orthopaedic Institute, Bologna. Rizzoli Orthopaedic Institute, Bologna.

G.Gualdrini, A.Bassi*, A. GiuntiG.Gualdrini, A.Bassi*, A. Giunti

in press

16 cylinders:16 cylinders:

10 C-A-MB : PMMA g 0.5 + 10 C-A-MB : PMMA g 0.5 + vancomycin g 0.1 + bone g 0.8 vancomycin g 0.1 + bone g 0.8

6 C-A : PMMA g 0.5 + 6 C-A : PMMA g 0.5 + vancomycin g 0.1 vancomycin g 0.1

Human plasmaHuman plasma Saline solution Saline solution

Four weeks 37°C Four weeks 37°C

AntibioticAntibiotic total release total releasebone pla bone pla vsvs cem pla cem pla

1447 719 128715150

200

400

600

800

1000

1200

1400

1600

bone pla bone sal cem pla cem sal

mg/ml

p=0.04p=0.04

Antibiotic releaseAntibiotic releasefirst weekfirst week

0

100

200

300

400

500

600

700

0 1 2 3 4 5 6 7days

m g/ml

bone plabone salcem placem sal

Antibiotic releaseAntibiotic releasesecond-fourth weeksecond-fourth week

0

200

400

600

800

1000

1200

1400

I II III IVweek

m g/ml

bone plabone salcem placem sal

““Mechanical characterization of an Mechanical characterization of an antibiotic cement-morcelized bone antibiotic cement-morcelized bone

graft composite”graft composite”

M.Baleani, R.Fognani, A.Toni, A.Bassi°, G.Gualdrini*

Medical Tecnology Lab.- I Orthopaedic Department°Muscoloskeletal Tissue Bank°Muscoloskeletal Tissue Bank*VII Orthopaedic Department *VII Orthopaedic Department Rizzoli Orthopaedic Institute, Bologna. In Rizzoli Orthopaedic Institute, Bologna. In press.press.

0

5

10

15

20

CO

MP

RE

SS

IVE

ST

RE

NG

TH

(M

Pa

)

02 DAYS 1 WEEK 4 WEEK

0

5

10

15

20

TE

NS

ILE

ST

RE

NG

TH

(M

Pa)

02 days 1week 4week

Homologous morcelized defatted bone graft additionated with

antibiotic and PMMA “in vivo”: preliminary histologic evaluation.

G.Gualdrini, A.Bassi, A.Giunti.G.Gualdrini, A.Bassi, A.Giunti.

• High plastic properties High plastic properties

• Loss bone-stock recoveryLoss bone-stock recovery

• Good antibiotic deliveryGood antibiotic delivery

• High resistance to mechanical loadingHigh resistance to mechanical loading

• Good “in vivo” biocompatibilityGood “in vivo” biocompatibility

Remarks about “CAMB”