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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

Distribution of pore sizes of bone substitutes The frequency of pore sizes varying from 10 to 500 μm are shown. Bars indicate the mean ± SD of the individual test samples (N = 9 to 12 per product). For each product, a typical example is given in the upper right corner of the panel.
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Figure 5: Distribution of pore sizes of bone substitutes The frequency of pore sizes varying from 10 to 500 μm are shown. Bars indicate the mean ± SD of the individual test samples (N = 9 to 12 per product). For each product, a typical example is given in the upper right corner of the panel.

Mentions: For each product the range in pore sizes is shown in Figures 5. Of all products, BoneSource® had the smallest pores. Over 95% of pores were smaller than 60 μm, of which approximately half were < 26.7 μm. No pores > 100 μm were found. This was also seen in Ostim®, of which 95% of pores were smaller than 85 μm. Calcibon®, Norian SRS® and HydroSet™ incidentally showed pores up to 230 μm, however 95% were smaller than 125 μm. Of the CaPO4 products, ChronOS® and Eurobone® were the only two that contained pores up to 500 μm, with 95% of pores being smaller than 250 μm and 330 μm, respectively. The distribution of pore sizes of the CaSO4 MIIG® X3 appeared similar as that of Norian SRS® and, to a lesser extent, Calcibon®. However, with a maximum pore size of 250 μm and 90% of pores being < 190 μm, pores of MIIG® X3 were relatively larger. The pore size frequency of Cortoss® deviated from that of the other products tested, as a large range of pore sizes (25 to 300 μm) were approximately equally present. In this bioactive glass 95% of pores had sizes up to 390 μm, although pores of 500 μm were also found. Combining the data of total porosity and average pore size implied that bone substitute materials provide a wide range of products. Some had a high porosity with small pores (e.g., Ostim®), and at the other side of the spectrum products had a low porosity with large pores (e.g., Eurobone®).


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)

Distribution of pore sizes of bone substitutes The frequency of pore sizes varying from 10 to 500 μm are shown. Bars indicate the mean ± SD of the individual test samples (N = 9 to 12 per product). For each product, a typical example is given in the upper right corner of the panel.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Distribution of pore sizes of bone substitutes The frequency of pore sizes varying from 10 to 500 μm are shown. Bars indicate the mean ± SD of the individual test samples (N = 9 to 12 per product). For each product, a typical example is given in the upper right corner of the panel.
Mentions: For each product the range in pore sizes is shown in Figures 5. Of all products, BoneSource® had the smallest pores. Over 95% of pores were smaller than 60 μm, of which approximately half were < 26.7 μm. No pores > 100 μm were found. This was also seen in Ostim®, of which 95% of pores were smaller than 85 μm. Calcibon®, Norian SRS® and HydroSet™ incidentally showed pores up to 230 μm, however 95% were smaller than 125 μm. Of the CaPO4 products, ChronOS® and Eurobone® were the only two that contained pores up to 500 μm, with 95% of pores being smaller than 250 μm and 330 μm, respectively. The distribution of pore sizes of the CaSO4 MIIG® X3 appeared similar as that of Norian SRS® and, to a lesser extent, Calcibon®. However, with a maximum pore size of 250 μm and 90% of pores being < 190 μm, pores of MIIG® X3 were relatively larger. The pore size frequency of Cortoss® deviated from that of the other products tested, as a large range of pore sizes (25 to 300 μm) were approximately equally present. In this bioactive glass 95% of pores had sizes up to 390 μm, although pores of 500 μm were also found. Combining the data of total porosity and average pore size implied that bone substitute materials provide a wide range of products. Some had a high porosity with small pores (e.g., Ostim®), and at the other side of the spectrum products had a low porosity with large pores (e.g., Eurobone®).

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