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Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery.

Van Lieshout EM, Van Kralingen GH, El-Massoudi Y, Weinans H, Patka P - BMC Musculoskelet Disord (2011)

Bottom Line: Young's Modulus was highest in Calcibon® (790 MPa) and lowest in Ostim® (6 MPa).The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications.The data outlined here will help surgeons to select the most suitable products currently available for specific clinical indications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. e.vanlieshout@erasmusmc.nl

ABSTRACT

Background: Many (artificial) bone substitute materials are currently available for use in orthopaedic trauma surgery. Objective data on their biological and biomechanical characteristics, which determine their clinical application, is mostly lacking. The aim of this study was to investigate structural and in vitro mechanical properties of nine bone substitute cements registered for use in orthopaedic trauma surgery in the Netherlands.

Methods: Seven calcium phosphate cements (BoneSource®, Calcibon®, ChronOS®, Eurobone®, HydroSet™, Norian SRS®, and Ostim®), one calcium sulphate cement (MIIG® X3), and one bioactive glass cement (Cortoss®) were tested. Structural characteristics were measured by micro-CT scanning. Compression strength and stiffness were determined following unconfined compression tests.

Results: Each bone substitute had unique characteristics. Mean total porosity ranged from 53% (Ostim®) to 0.5% (Norian SRS®). Mean pore size exceeded 100 μm only in Eurobone® and Cortoss® (162.2 ± 107.1 μm and 148.4 ± 70.6 μm, respectively). However, 230 μm pores were found in Calcibon®, Norian SRS®, HydroSet™, and MIIG® X3. Connectivity density ranged from 27/cm3 for HydroSet™ to 0.03/cm3 for Calcibon®. The ultimate compression strength was highest in Cortoss® (47.32 MPa) and lowest in Ostim® (0.24 MPa). Young's Modulus was highest in Calcibon® (790 MPa) and lowest in Ostim® (6 MPa).

Conclusions: The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications. The data outlined here will help surgeons to select the most suitable products currently available for specific clinical indications.

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Related in: MedlinePlus

Porosity of bone substitutes Porosity of individual test samples was determined upon Micro-CT-scanning as described in the Materials and Methods. The total porosity (A), open porosity (B) and closed porosity (C) were determined. Each dot represents an individual test sample, and lines indicate the average value. The table below the figure shows the outcome of the pairwise comparisons (Student's T-test with Bonferroni correction). *, p < 0.05; **, p < 0.01; ***, p < 0.005; ns, not statistically significantly different. Grey boxes represent the self-self combinations, which could not be tested.
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Figure 3: Porosity of bone substitutes Porosity of individual test samples was determined upon Micro-CT-scanning as described in the Materials and Methods. The total porosity (A), open porosity (B) and closed porosity (C) were determined. Each dot represents an individual test sample, and lines indicate the average value. The table below the figure shows the outcome of the pairwise comparisons (Student's T-test with Bonferroni correction). *, p < 0.05; **, p < 0.01; ***, p < 0.005; ns, not statistically significantly different. Grey boxes represent the self-self combinations, which could not be tested.

Mentions: In order to gain insight into the porous structure of the bone substitute materials, the porosity and pore sizes were calculated from micro-CT images. Ostim® was the only product that had a clear porous structure. The total porosity (52.66 ± 10.14%) was significantly higher than the porosity of all other products (Figure 3A). The porosity of the other products diminished from 6.93 ± 1.32% (ChronOS®) to 0.48 ± 0.15% for Norian SRS®. As total porosity is dictated by open as well as closed pores, the open porosity and closed porosity were also determined. Open porosity was evident for Ostim® (50.52 ± 4.49%; Figure 3B), and diminished from 2.86 ± 0.92% (ChronOS®) to 0.22 ± 0.75% for Calcibon®. Closed porosity exceeded was highest for ChronOS® (3.59 ± 0.41%) and HydroSet™ (2.66 ± 0.49%), and lowest for Ostim® (0.43 ± 0.32%), Norian SRS® (0.33 ± 0.13%), and MIIG® X3 (0.29 ± 0.07%; Figure 3C).


Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery.

Van Lieshout EM, Van Kralingen GH, El-Massoudi Y, Weinans H, Patka P - BMC Musculoskelet Disord (2011)

Porosity of bone substitutes Porosity of individual test samples was determined upon Micro-CT-scanning as described in the Materials and Methods. The total porosity (A), open porosity (B) and closed porosity (C) were determined. Each dot represents an individual test sample, and lines indicate the average value. The table below the figure shows the outcome of the pairwise comparisons (Student's T-test with Bonferroni correction). *, p < 0.05; **, p < 0.01; ***, p < 0.005; ns, not statistically significantly different. Grey boxes represent the self-self combinations, which could not be tested.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040718&req=5

Figure 3: Porosity of bone substitutes Porosity of individual test samples was determined upon Micro-CT-scanning as described in the Materials and Methods. The total porosity (A), open porosity (B) and closed porosity (C) were determined. Each dot represents an individual test sample, and lines indicate the average value. The table below the figure shows the outcome of the pairwise comparisons (Student's T-test with Bonferroni correction). *, p < 0.05; **, p < 0.01; ***, p < 0.005; ns, not statistically significantly different. Grey boxes represent the self-self combinations, which could not be tested.
Mentions: In order to gain insight into the porous structure of the bone substitute materials, the porosity and pore sizes were calculated from micro-CT images. Ostim® was the only product that had a clear porous structure. The total porosity (52.66 ± 10.14%) was significantly higher than the porosity of all other products (Figure 3A). The porosity of the other products diminished from 6.93 ± 1.32% (ChronOS®) to 0.48 ± 0.15% for Norian SRS®. As total porosity is dictated by open as well as closed pores, the open porosity and closed porosity were also determined. Open porosity was evident for Ostim® (50.52 ± 4.49%; Figure 3B), and diminished from 2.86 ± 0.92% (ChronOS®) to 0.22 ± 0.75% for Calcibon®. Closed porosity exceeded was highest for ChronOS® (3.59 ± 0.41%) and HydroSet™ (2.66 ± 0.49%), and lowest for Ostim® (0.43 ± 0.32%), Norian SRS® (0.33 ± 0.13%), and MIIG® X3 (0.29 ± 0.07%; Figure 3C).

Bottom Line: Young's Modulus was highest in Calcibon® (790 MPa) and lowest in Ostim® (6 MPa).The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications.The data outlined here will help surgeons to select the most suitable products currently available for specific clinical indications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. e.vanlieshout@erasmusmc.nl

ABSTRACT

Background: Many (artificial) bone substitute materials are currently available for use in orthopaedic trauma surgery. Objective data on their biological and biomechanical characteristics, which determine their clinical application, is mostly lacking. The aim of this study was to investigate structural and in vitro mechanical properties of nine bone substitute cements registered for use in orthopaedic trauma surgery in the Netherlands.

Methods: Seven calcium phosphate cements (BoneSource®, Calcibon®, ChronOS®, Eurobone®, HydroSet™, Norian SRS®, and Ostim®), one calcium sulphate cement (MIIG® X3), and one bioactive glass cement (Cortoss®) were tested. Structural characteristics were measured by micro-CT scanning. Compression strength and stiffness were determined following unconfined compression tests.

Results: Each bone substitute had unique characteristics. Mean total porosity ranged from 53% (Ostim®) to 0.5% (Norian SRS®). Mean pore size exceeded 100 μm only in Eurobone® and Cortoss® (162.2 ± 107.1 μm and 148.4 ± 70.6 μm, respectively). However, 230 μm pores were found in Calcibon®, Norian SRS®, HydroSet™, and MIIG® X3. Connectivity density ranged from 27/cm3 for HydroSet™ to 0.03/cm3 for Calcibon®. The ultimate compression strength was highest in Cortoss® (47.32 MPa) and lowest in Ostim® (0.24 MPa). Young's Modulus was highest in Calcibon® (790 MPa) and lowest in Ostim® (6 MPa).

Conclusions: The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications. The data outlined here will help surgeons to select the most suitable products currently available for specific clinical indications.

Show MeSH
Related in: MedlinePlus