Beta-tricalcium phosphate as a synthetic cancellous bone graft in veterinary orthopaedics

J. Franch; C. Díaz-Bertrana; P. Lafuente; P. Fontecha; I. Durall

doi:10.1055/s-0038-1633001

Veterinary and Comparative Orthopaedics and Traumatology, Inhaltsverzeichnis

Vet Comp Orthop Traumatol 2006; 19(04): 196-204
DOI: 10.1055/s-0038-1633001

Original Research

Schattauer GmbH

Beta-tricalcium phosphate as a synthetic cancellous bone graft in veterinary orthopaedics

A retrospective study of 13 clinical cases

J. Franch

¹Surgery Department, Veterinary School of Barcelona, Bellaterra, Barcelona, Spain

,

C. Díaz-Bertrana

¹Surgery Department, Veterinary School of Barcelona, Bellaterra, Barcelona, Spain

,

P. Lafuente

¹Surgery Department, Veterinary School of Barcelona, Bellaterra, Barcelona, Spain

,

P. Fontecha

¹Surgery Department, Veterinary School of Barcelona, Bellaterra, Barcelona, Spain

,

I. Durall

¹Surgery Department, Veterinary School of Barcelona, Bellaterra, Barcelona, Spain

› Institutsangaben

Abstract

Summary

The clinical use of β-tricalcium phosphate (β-TCP) as a synthetic cancellous bone graft in veterinary orthopaedics is herein reported. The retrospective study was based on 13 clinical cases belonging to 11 dogs and one cat. The weights of the dogs ranged from 3.4 to 48 kg. One female cat weighing 3.5 kg completed the study. The clinical cases were six arthrodeses (four carpal, two tarsal), one hypertrophic non-union (femur), one atrophic non-union (metacarpal bones) and five long-bone fractures (two femurs, one tibia, two radii) possessing subcritical-sized bone defects. The β-TCP used in this study was presented as irregular interconnected-porous granules and was placed in the bone defects after mixing it with fresh blood. Bone healing was achieved at between eight and 12 weeks in all clinical cases except for the case of the chronic atrophic nonunion in which only one of the four metacarpal bones healed. In the 12 successful cases, the bone defect grafted with β-TCP showed a radiological bone ingrowth of 100% (10 cases), 90% (one case) and 75% (one case). The complete lack of tissue adverse effects in our series, and the good defect healing, allows us to hypothesise that β-TCP can be successfully used as a synthetic bone graft in bone defects with good local biological conditions and where osteoconduction is especially needed for assuring a structural scaffold for newbone ingrowth. When, in addition to osteoconduction, osteoinduction and osteogenesis are necessary for defect healing, the fresh cancellous bone graft remains the gold standard in veterinary orthopaedics.

Keywords

β-tricalcium phosphate - bone grafting

Volltext

Referenzen

References
1 Kelly EB. New frontiers in Bone Grafting. Orthopaedic Technology Review 2000; 2: 28-35.
2 Vaccaro AR. The role of the osteoconductive scaffold in synthetic bone graft. Orthopaedics 2002; 25 (5 Suppl) s571-8.
3 Szpalski M, Gunzburg R. Applications of Calcium Phosphate-Based Cancellous Bone Void Fillers in Trauma Surgery. Orthopaedics 2002; 25 (5 Suppl) s601-12.
4 St John TA, Vaccaro AR, Sah AP. et al. Physical and monetary costs associated with autogenous bone graft harvesting. Am J Orthop 2003; 32: 18-23.
5 McLaughlin RM, Roush JK. Autogenous cancellous and corticocancellous bone grafting. Vet Med 1998; 93: 1071-4.
6 Sandhu HS, Grewal HS. The use of allograft bone in lumbar spine. Orthop Clin North Am 1999; 30: 685-98.
7 Kervin SC, Lewis DD, Elkins AD. Bone grafting andbanking. CompContEd 1991; 13: 1558-66.
8 Weigel JP. Bone Grafting. In: Disease Mechanisms in Small Animal Surgery. Bojrab MJ. (ed) Lippincott Williams & Wilkins; Philadelphia: 1993: 678-84.
9 Arts JJ, Gardeniers JW, Welten ML. et al. No negative effects of bone impaction grafting with bone and ceramic mixtures. Clin Orthop Rel Res 2005; 438: 239-47.
10 Anker CJ, Holdridge SP, Baird Betal. Ultraporous beta-tricalcium phosphate is well incorporated in small cavitary defects. Clin Orthop Rel Res 2005; 434: 251-7.
11 Galois L, Mainard D, Delagoutte JE. Beta-tricalcium phosphate ceramic as a bone substitute in orthopaedic surgery. Int Orthop 2002; 26: 109-15.
12 Hauschild G, Merten HA, Bader A. et al. Bioartificial bone grafting: tarsal joint fusion in a dog using abioartificial composite bone graft consisting of B-tricalcium phosphate and platelet rich plasma-A case report. Vet Comp Orthop Traumatol 2005; 18: 52-4.
13 Boudrieau RJ, Mitchell SL, Seeherman H. Mandibular reconstruction of a partial hemimandibulectomy in a dog with severe malocclusion. Vet Surg 2004; 33: 119-30.
14 Kervin SC, Lewis DD, Elkins AD. et al. Deep-frozen allogeneic cancellous bone grafts in 10 dogs: A case series. Vet Surg 1996; 25: 18-28.
15 Dorea HC, McLaughlin RM, Cantwell HD. et al. Evaluation of healing in feline femoral defects filled cancellous autograft, cancellous allograft or Bioglass. Vet Comp Orthop Traumatol 2005; 18: 157-68.
16 Younger EM, Chapman MW. Morbidity at bone graft donor sites. JOrthop Trauma 1989; 3: 192-5.
17 Skaggs DL, Samuelson MA, Hale JM. et al. Complications of posterior iliac crest bone grafting in spine surgery in children. Spine 2000; 25: 2400-02.
18 Fergurson JF. Fracture of the humerus after cancellous bone graft harvesting in a dog. J Small Anim Pract 1996; 37: 513-5.
19 Palmisano MP, Schrader SC. Premature closure of the proximal physis of the humerus in a dog as a result of harvesting a cancellous bone graft. J Am VetMed Assoc 1999; 215: 1460-62.
20 Johnson KA. Cancellous bone graft collection from the tibia in dogs. Vet Surg 1986; 15: 334-8.
21 Martinez SA, Walker T. Bone Grafts. Vet Clin North Am Small Anim Pract 1999; 29: 1207-19.
22 Moore WR, Graves SE, Bain GI. Synthetic bone graft substitutes. ANZ J Surg 2001; 71: 354-61.
23 Trevor PB, Stevenson S, Carrig CB. et al. Evaluation of biocompatible osteoconductive polymer as an orthopaedic implant in dogs. JAmVet Med Assoc 1992; 200: 1651-60.
24 Elkins AD, Jones LP. The effects of plaster of Paris and autogenous cancellous bone on the healing of cortical defects in the femurs of dogs. Vet Surg 1988; 17: 71-6.
25 Wheeler DL, Cross AR, Eschbach EJ. et al. Grafting of massive tibial subchondral bone defects in a caprine model using [beta]-tricalcium phosphate versus autograft. J Orthop Trauma 2005; 19: 85-91.
26 Soost F, Koch S, Stoll C. et al. Validation of bone conversion in osteoconductive and osteoinductive bone substitutes. Cell and Tiss Bank 2001; 2: 77-86.
27 Blokhuis TJ, Termaat MF, den Boer FC. et al. Properties of calcium phosphate ceramics in relation to their invivo behavior. J Trauma 2000; 48: 179-86.
28 Yamada S, Heymann D, Bouler JM. et al. Osteoclastic resorption of calcium phosphate ceramics with different hydroxyapatite-tricalcim phosphate ratios. Biomaterials 1997; 18: 1037-41.