Abstract
Bone replacement and the use of bone supplementary biological substances have become widespread in clinical practice. Although autografts have excellent properties, their limited availability, difficulties with shaping and donor site morbidity have made allografts a viable and increasingly preferred alternative. The main drawback of allografts is that the preparation destroys osteogenic cells and results in denaturation of osteoinductive proteins. Serum albumin is a well-known constituent of stem cell culture media and we found that lyophilizing albumin onto bone allografts markedly improves stem-cell attachment and bone healing in animal models thus replacing some of the osteoinductive potential. As a first step in the clinical introduction of albumin coated grafts, we aimed to test surgical handling and early incorporation in aseptic revision arthroplasty in humans. We selected patients who needed large structural allografts and the current operation was the last attempt at preserving a moving joint. In a series of 10 cases of hip and knee revision surgery we did not experience any drawbacks of the albumin-coated grafts during handling and implantation. Twelve months radiographic and SPECT-CT follow-up showed that the graft was well received by the host and active remodelling was observed. The lack of graft-related complications and the good 1-year results indicate that controlled trials may be initiated in more common bone grafting indications where long-term effectiveness can be evaluated.
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References
Atala A (2012) Regenerative medicine strategies. J Pediatr Surg 47:17–28
Babis GC, Sakellariou VI, O’Connor MI, Hanssen AD, Sim FH (2010) Proximal femoral allograft-prosthesis composites in revision hip replacement: a 12-year follow-up study. J Bone Joint Surg Br 92:349–355
Blackley HR, Davis AM, Hutchison CR, Gross AE (2001) Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up. J Bone Joint Surg Am 83(A):346–354
Brindley DA, Davie NL, Culme-Seymour EJ, Mason C, Smith DW, Rowley JA (2012) Peak serum: implications of serum supply for cell therapy manufacturing. Regen Med 7:7–13
Enneking WF, Campanacci DA (2001) Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am 83(A):971–986
Enneking WF, Mindell ER (1991) Observations on massive retrieved human allografts. J Bone Joint Surg Am 73:1123–1142
Haddad FS, Spangehl MJ, Masri BA, Garbuz DS, Duncan CP (2000) Circumferential allograft replacement of the proximal femur. A critical analysis. Clin Orthop Relat Res 371:98–107
Harris WH (2001) Wear and periprosthetic osteolysis: the problem. Clin Orthop Relat Res 393:66–70
Hawe A, Friess W (2006) Physico-chemical lyophilization behavior of mannitol, human serum albumin formulations. Eur J Pharm Sci 28:224–232
Head WC, Emerson RHJ, Malinin TI (1999) Structural bone grafting for femoral reconstruction. Clin Orthop Relat Res 369:223–229
Horváthy DB, Vácz G, Cselenyák A, Weszl M, Kiss L, Lacza Z (2012) Albumin-coated bioactive suture for cell transplantation. Surg Innov. doi:10.1177/1553350612451353
Intini G (2009) The use of platelet-rich plasma in bone reconstruction therapy. Biomaterials 30:4956–4966
Lee PT, Clayton RA, Safir OA, Backstein DJ, Gross AE (2011) Structural allograft as an option for treating infected hip arthroplasty with massive bone loss. Clin Orthop Relat Res 469:1016–1023
Lindahl H (2007) Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury 38:651–654
Malchau H, Bragdon CR, Muratoglu OK (2011) The stepwise introduction of innovation into orthopedic surgery: the next level of dilemmas. J Arthroplast 26:825–831
Richards CJ, Garbuz DS, Pugh L, Masri BA (2011) Revision total knee arthroplasty: clinical outcome comparison with and without the use of femoral head structural allograft. J Arthroplast 26:1299–1304
Rust PA, Kalsi P, Briggs TW, Cannon SR, Blunn GW (2007) Will mesenchymal stem cells differentiate into osteoblasts on allograft? Clin Orthop Relat Res 457:220–226
Ryser MF, Thieme S, Bornhauser M, Lehmann R, Brenner S (2009) Serum albumin strongly influences SDF-1 dependent migration. Int J Hematol 89:269–275
Urist MR (1965) Bone: formation by autoinduction. Science 150:893–899
Wehling P, Moser C, Frisbie D, McIlwraith CW, Kawcak CE, Krauspe R, Reinecke JA (2007) Autologous conditioned serum in the treatment of orthopedic diseases: the orthokine therapy. BioDrugs 21:323–332
Weszl M, Skaliczki G, Cselenyak A, Kiss L, Major T, Schandl K, Bognar E, Stadler G, Peterbauer A, Csonge L, Lacza Z (2012) Freeze-dried human serum albumin improves the adherence and proliferation of mesenchymal stem cells on mineralized human bone allografts. J Orthop Res 30:489–496
Acknowledgments
We are thankful for Lacerta Technologies Inc. for providing the albumin coating technology. The authors wish to thank Dr. Andrea Radácsi for her expert advice with SPECT-CT images. The present work was funded by Grants from TÉT-SIN-CELLTHER, TÁMOP-4.2.1/B09/1/KMR-2010-0001, OTKA 83803.
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Klára, T., Csönge, L., Janositz, G. et al. Albumin-coated structural lyophilized bone allografts: a clinical report of 10 cases. Cell Tissue Bank 15, 89–97 (2014). https://doi.org/10.1007/s10561-013-9379-8
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DOI: https://doi.org/10.1007/s10561-013-9379-8