Segmental Bone Defects: Use of Custom-Designed Trabecular Titanium Implants
Article Sidebar
Published:
Apr 18, 2022
Keywords:
Trabecular titanium, scaffold, segmental bone defect
Main Article Content
Abstract
Introduction: There is a wide variety of therapeutic options for the reconstruction of segmental bone defects caused by fractures, tumors, or infections, but it continues to be a challenge in orthopedic surgery.
Materials and Methods: The present work presents six (6) cases of patients with massive bone loss treated by means of what we call a “synergistic combination” of an induced membrane, to provide biological benefits, plus a trabecular titanium scaffold designed for each patient to provide stability and structure.
Results: Five men and one woman with an average age of 30 years were operated on by this technique.The average follow-up was 24 months. In the immediate postoperative period, the axis, length, and sufficient mechanical stability to initiate partial weight-bearing were reestablished. Full weight-bearing according to the patients’ conditions (pain, muscle strength) required an average of 25 to 30 days.
Conclusion: We propose a rare treatment option in our field with sufficient biomechanical stability to tolerate early weight-bearing, recovering the entire length of the defect in a single stage with excellent functional outcomes, understanding these as an advantage over traditional therapeutic options such as bone transport or the Masquelet technique.
Materials and Methods: The present work presents six (6) cases of patients with massive bone loss treated by means of what we call a “synergistic combination” of an induced membrane, to provide biological benefits, plus a trabecular titanium scaffold designed for each patient to provide stability and structure.
Results: Five men and one woman with an average age of 30 years were operated on by this technique.The average follow-up was 24 months. In the immediate postoperative period, the axis, length, and sufficient mechanical stability to initiate partial weight-bearing were reestablished. Full weight-bearing according to the patients’ conditions (pain, muscle strength) required an average of 25 to 30 days.
Conclusion: We propose a rare treatment option in our field with sufficient biomechanical stability to tolerate early weight-bearing, recovering the entire length of the defect in a single stage with excellent functional outcomes, understanding these as an advantage over traditional therapeutic options such as bone transport or the Masquelet technique.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Beatti, M. A., Zublin Guerra , C. M., Guichet , D. M., & Pellecchia , T. S. (2022). Segmental Bone Defects: Use of Custom-Designed Trabecular Titanium Implants. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(2), 219-237. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1436
Section
Clinical Research
Copyright (c) 2022 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Fillingham Y, Jacobs J. Bone grafts and their substitutes. Bone Joint J 2016; 98-B(1 Suppl A):6-9.
https://doi.org/10.1302/0311-620x.98b-.36350
2. Solomon LB, Callary SA, Boopalan PRJVC, Chakrabarty A, Costi JL, Howie DW. Impaction bone grafting of
segmental bone defects in femoral non-unions. Acta Orthop Belg 2013;79:64-70. PMID: 23547518
3. Keating J. The management of fractures with bone loss. J Bone Joint Surg Br 2005;87(2):142-50.
https://doi.org/ 10.1302/0301-620x.87b2.15874
4. Masquelet A, Fitoussi F, Begue T, Muller G. Reconstruction of the long bones by induced membrane and spongy autograft. Ann Chir Plast Esthet 2000;45:346-53. PMID: 10929461
5. Pelissier P, Masquelet A, Bareille R, Pelissier S, Amedee J. Induced membranes secrete growth factors including
vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22(1):73-9.
https://doi.org/10.1016/S0736-0266(03)00165-7
6. Masquelet A, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin
North Am 2010;41(1):27-37. https://doi.org/10.1016/j.ocl-2009.07.011
7. Giannoudis P, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects: Tips-tricks and future directions. Injury 2011;42(6):591-8. https://doi.org/10.1016/j.injury.2011.03.036
8. Pelissier P, Martin D, Baudet J, Lepreux S, Masquelet A. Behaviour of cancellous bone graft placed in induced
membranes. Br J Plast Surg 2002;55(7):596-8. https://doi.org/10.1054/bjps.2002.3936
9. Obert L, Giannoudis P, Masquelet A, Stafford P. International perspectives on the Masquelet technique for the
treatment of segmental defects in bone. Lecture presented at; 2016; Orlando, Florida.
10. Wang Y, Shen Y, Wang Z, Yang J, Liu N, Huang W. Development of highly porous titanium scaffolds by selective laser melting. Mat Lett 2010;64(6):674-6. https://doi.org/10.1016/j.matlet.2009.12.035
11. Alvarez K, Nakajima H. Metallic scaffolds for bone regeneration. Materials 2009;2(3):790-832. https://doi.org/10.3390/ma2030790
12. Dabrowski B, Swieszkowski W, Godlinski D, Kurzydlowski KJ. Highly porous titanium scaffolds for orthopaedic
applications. J Biomed Mater Res B Appl Biomat 2010;95(1):53-61. https://doi.org/10.1002/jbm.b.31682
13. Mullen L, Stamp RC, Brooks WK, Jones E, Sutcliffe CJ. Selective laser melting: a regular unit cell approach for the manufacture of porous, titanium, bone in-growth constructs, suitable for orthopedic applications. J Biomed Mater Res B Appl Biomat 2009;89(2):325-34. https://doi.org/10.1002/jbm.b.31219
14. Rochford ETJ, Richards RG, Moriarty TF. Influence of material on the development of device-associated infections. Clin Microbiol Infect 2012;18(12):1162-7. https://doi.org/10.1111/j.1469-0691.2012.04002.x
15. Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hans M. Influence of materials for fixation implants on
local infection, An experimental study of steel versus titanium dc in rabbits. J Bone Joint Surg Br 1996;78(4):647-
51. PMID: 8682836
16. Solomin L, Slongo T. Long bone defect classification: what it should be? J Bone Res Rep Recommendations
2016;2(1):2. https://doi.org/10.4172/2469-6684.100016
17. Attias N, Lehman RE, Bodell LS, Lindsey RW. Surgical management of a long segmental defect of the humerus
using a cilindrical titanium mesh cage and plates. J Orthop Trauma 2005;19(3):211-6.
https://doi.org/ 10.1097/00005131-200503000-00011
18. Sewell MD, Hanna SA, McGrath A, Aston WJS, Blunn GW, et al. Intercalary diaphyseal endoprosthetic
reconstruction for malignant tibial bone tumours. J Bone Joint Surg Br 2011;93(8):1111-7.
https://doi.org/10.1302/0301-620X.93B8.25750
19. Van der Stok J, De Haas MFP, Van der Jagt OP, Van Lieshout, EMM, Patka P, et al. Porous titanium as treatment for large segmental bone defects. Poster 1611. ORS Annual Meeting, 2012.
20. Wieding J, Lindner T, Bergschmidt P, Badern R. Biomechanical stability of novel mechanically adapted openporous titanium scaffolds in metatarsal bone defects of sheep. Biomaterials 2015;46:35-47.
https://doi.org/10.1016/j.biomaterials.2014.12.010
https://doi.org/10.1302/0311-620x.98b-.36350
2. Solomon LB, Callary SA, Boopalan PRJVC, Chakrabarty A, Costi JL, Howie DW. Impaction bone grafting of
segmental bone defects in femoral non-unions. Acta Orthop Belg 2013;79:64-70. PMID: 23547518
3. Keating J. The management of fractures with bone loss. J Bone Joint Surg Br 2005;87(2):142-50.
https://doi.org/ 10.1302/0301-620x.87b2.15874
4. Masquelet A, Fitoussi F, Begue T, Muller G. Reconstruction of the long bones by induced membrane and spongy autograft. Ann Chir Plast Esthet 2000;45:346-53. PMID: 10929461
5. Pelissier P, Masquelet A, Bareille R, Pelissier S, Amedee J. Induced membranes secrete growth factors including
vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22(1):73-9.
https://doi.org/10.1016/S0736-0266(03)00165-7
6. Masquelet A, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin
North Am 2010;41(1):27-37. https://doi.org/10.1016/j.ocl-2009.07.011
7. Giannoudis P, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects: Tips-tricks and future directions. Injury 2011;42(6):591-8. https://doi.org/10.1016/j.injury.2011.03.036
8. Pelissier P, Martin D, Baudet J, Lepreux S, Masquelet A. Behaviour of cancellous bone graft placed in induced
membranes. Br J Plast Surg 2002;55(7):596-8. https://doi.org/10.1054/bjps.2002.3936
9. Obert L, Giannoudis P, Masquelet A, Stafford P. International perspectives on the Masquelet technique for the
treatment of segmental defects in bone. Lecture presented at; 2016; Orlando, Florida.
10. Wang Y, Shen Y, Wang Z, Yang J, Liu N, Huang W. Development of highly porous titanium scaffolds by selective laser melting. Mat Lett 2010;64(6):674-6. https://doi.org/10.1016/j.matlet.2009.12.035
11. Alvarez K, Nakajima H. Metallic scaffolds for bone regeneration. Materials 2009;2(3):790-832. https://doi.org/10.3390/ma2030790
12. Dabrowski B, Swieszkowski W, Godlinski D, Kurzydlowski KJ. Highly porous titanium scaffolds for orthopaedic
applications. J Biomed Mater Res B Appl Biomat 2010;95(1):53-61. https://doi.org/10.1002/jbm.b.31682
13. Mullen L, Stamp RC, Brooks WK, Jones E, Sutcliffe CJ. Selective laser melting: a regular unit cell approach for the manufacture of porous, titanium, bone in-growth constructs, suitable for orthopedic applications. J Biomed Mater Res B Appl Biomat 2009;89(2):325-34. https://doi.org/10.1002/jbm.b.31219
14. Rochford ETJ, Richards RG, Moriarty TF. Influence of material on the development of device-associated infections. Clin Microbiol Infect 2012;18(12):1162-7. https://doi.org/10.1111/j.1469-0691.2012.04002.x
15. Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hans M. Influence of materials for fixation implants on
local infection, An experimental study of steel versus titanium dc in rabbits. J Bone Joint Surg Br 1996;78(4):647-
51. PMID: 8682836
16. Solomin L, Slongo T. Long bone defect classification: what it should be? J Bone Res Rep Recommendations
2016;2(1):2. https://doi.org/10.4172/2469-6684.100016
17. Attias N, Lehman RE, Bodell LS, Lindsey RW. Surgical management of a long segmental defect of the humerus
using a cilindrical titanium mesh cage and plates. J Orthop Trauma 2005;19(3):211-6.
https://doi.org/ 10.1097/00005131-200503000-00011
18. Sewell MD, Hanna SA, McGrath A, Aston WJS, Blunn GW, et al. Intercalary diaphyseal endoprosthetic
reconstruction for malignant tibial bone tumours. J Bone Joint Surg Br 2011;93(8):1111-7.
https://doi.org/10.1302/0301-620X.93B8.25750
19. Van der Stok J, De Haas MFP, Van der Jagt OP, Van Lieshout, EMM, Patka P, et al. Porous titanium as treatment for large segmental bone defects. Poster 1611. ORS Annual Meeting, 2012.
20. Wieding J, Lindner T, Bergschmidt P, Badern R. Biomechanical stability of novel mechanically adapted openporous titanium scaffolds in metatarsal bone defects of sheep. Biomaterials 2015;46:35-47.
https://doi.org/10.1016/j.biomaterials.2014.12.010