Recommendations and considerations for the use of biologics in orthopedic surgery.
Reconstruction of extensive bone defects remains technically challenging and has considerable medical and financial impact on our society. Surgical procedures often require a bone/substitute graft to enhance and accelerate bone repair. Bone autografts are associated with morbidity related to bone harvesting and are limited in quantity. Alternatively, bone allografts expose the patient to the risk of transmission of infectious disease. Synthetic bone graft substitutes, such as calcium sulfates, hydroxyapatite, tricalcium phosphate, and combinations, circumvent some of the disadvantages of auto- and allografts, but have limited indications. Biomedical research has made possible the stimulation of the body's own healing mechanisms, either by delivering exogenous growth factors locally, or by stimulating their local production by gene transfer. Among all known factors having osteoinductive properties, only two bone morphogenetic proteins (for specific indications) and demineralized bone matrix have been approved for clinical use. In addition, ongoing research is exploring the efficacy of cell therapy and tissue engineering. The present report examines the composition, biological properties, indications, clinical experience and regulations of several of the biotherapeutics employed for bone reconstruction.
Department of Orthopaedic Surgery, Stanford University School of Medicine, CA, USA.
Stefan
S
Zwingenberger
Christophe
C
Nich
Roberto D
RD
Valladares
Zhenyu
Z
Yao
Maik
M
Stiehler
Stuart B
SB
Goodman
D001688:Biological Products / Q000008:administration & dosage / Q000627:therapeutic use*; D040761:Biomimetic Materials / Q000008:administration & dosage / Q000627:therapeutic use; D001843:Bone Cements / Q000627:therapeutic use; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage / Q000235:genetics / Q000627:therapeutic use*; D001861:Bone Regeneration / Q000187:drug effects*; D018786:Bone Substitutes / Q000008:administration & dosage / Q000627:therapeutic use*; D016025:Bone Transplantation; D002516:Ceramics / Q000627:therapeutic use; D019902:Chondrocytes / Q000637:transplantation; D015316:Genetic Therapy; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000008:administration & dosage / Q000235:genetics / Q000627:therapeutic use*; D019637:Orthopedic Procedures / Q000379:methods*; D017410:Practice Guidelines as Topic
C022107:Bioglass; D001688:Biological Products; D001843:Bone Cements; D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D036341:Intercellular Signaling Peptides and Proteins