Bioabsorbable Barrier Membrane Combined with rhBMP-2 Improved Bone Formation in an Experimental Model of Compromised Healing But Was Not Superior to rhBMP-2 Alone
Objective: Bioabsorbable barrier membranes placed
over alveolar ridge bone defects are routinely used in dental surgery to
promote bone formation. Combining these osteoconductive membranes with
osteoinductive Bone Morphogenetic Proteins could prove useful in long bone
fracture treatment. The hypothesis was tested in a clinically relevant model of
compromised healing. Methods: Four groups of 8 rabbits underwent unilateral
mid-tibial osteotomy, excision of periosteum and endosteum, and plate fixation.
One group had rhBMP-2 deposited between the bone ends and Membrane wrapped
around the osteotomy, the second group had Membrane wrapped around the
osteotomy, the third group had rhBMP-2 placed between the bone ends, and the
fourth group received no additional treatment. Results: After 7 weeks, callus size and blood flow were significantly
higher in the Membrane+rhBMP-2 group than in the rhBMP-2 treated group, but
torsion to failure test showed no significant difference. Membrane treatment
and no treatment led to non-union. Conclusion: Absorbable barrier membrane
combined with rhBMP-2 enhances bone formation, but has no advantage to rhBMP-2
alone. Membrane alone wrapped around the osteotomy was unable to prevent
non-union formation.
References
[1]
G. E. Friedlaender, C. R. Perry, J. D. Cole, S. D. Cook, G. Cierny, G. F. Muschler, et al., “Osteogenic Protein-1 (Bone Morphogenetic Protein-7) in the Treatment of Tibial Nonunions,” The Journal of Bone & Joint Surgery, Vol. 83-A, Suppl. 1(Pt 2): 2001, pp. S151-S158.
[2]
S. Govender, C. Csimma, H. K. Genant, A. Valentin-Opran, Y. Amit, R. Arbel, et al., “Recombinant Human Bone Morphogenetic Protein-2 for Treatment of Open Tibial Fractures: A Prospective, Controlled, Randomized Study of Four Hundred and Fifty Patients,” The Journal of Bone & Joint Surgery, Vol. 84-A, No. 12, 2002, pp. 2123-2134.
[3]
T. Sibai and E. F. Morgan, T. A. Einhorn, “Anabolic Agents and Bone Quality,” Clinical Orthopaedics and Related Research, Vol. 469, No. 8, 2011, pp. 2215-2224. http://dx.doi.org/10.1007/s11999-010-1722-9
[4]
A. Linde, P. Alberius, C. Dahlin, K. Bjurstam and Y. Sundin, “Osteopromotion: A Soft-Tissue Exclusion Principle Using a Membrane for Bone Healing and Bone Neogenesis,” Journal of Periodontology, Vol. 64, Suppl. 11, 1993, pp. 1116-1128. http://dx.doi.org/10.1902/jop.1993.64.11s.1116
[5]
R. P. Meinig, “Clinical Use of Resorbable Polymeric Membranes in Bone Defects,” Orthopedic Clinics of North America, Vol. 41, No. 1, 2010, pp. 39-47. http://dx.doi.org/10.1016/j.ocl.2009.07.012
[6]
H. C. Brownlow and A. H. Simpson, “Metabolic Activity of a New Atrophic Nonunion Model in Rabbits,” Journal of Orthopaedic Research, Vol. 18, No. 3, 2000, pp. 438-442. http://dx.doi.org/10.1002/jor.1100180316
[7]
A. A. Reed, C. J. Joyner, H. C. Brownlow and A. H. Simpson, “Human Atrophic Fracture Non-Unions Are Not Avascular,” Journal of Orthopaedic Research, Vol. 20, No. 3, 2002, pp. 593-599. http://dx.doi.org/10.1016/S0736-0266(01)00142-5
[8]
H. Eckardt, K. S. Christensen, M. Lind, E. S. Hansen, D. W. Hall and I Hvid, “Recombinant Human Bone Morphogenetic Protein 2 Enhances Bone Healing in an Experimental Model of Fractures at Risk of Non-Union,” Injury, Vol. 36, No. 4, 2005, pp. 489-494. http://dx.doi.org/10.1016/j.injury.2004.10.019
[9]
M. L. Radomsky, A. Y. Thompson, R. C. Spiro and J. W. Poser, “Potential Role of Fibroblast Growth Factor in Enhancement of Fracture Healing,” Clinical Orthopaedics and Related Research, Suppl. 355, 1998, pp. S283-S293. http://dx.doi.org/10.1097/00003086-199810001-00029
[10]
J. R. S. Hales, “Radioactive Microsphere Techniques for Studies of the Circulation,” Clinical and experimental pharmacology & physiology. Supplement, Vol. 1, 1974, pp. 31-46.
[11]
H. E. Stender, S. Z. He, V. E. Hjortdal, D. Kjolseth and K. Soballe, “Distribution of Blood Flow in Normal and Arthritic Joints. Role of Arteriovenous Shunting Studied in Growing Dogs,” American Journal of Physiology—Heart and Circulatory Physiology, Vol.262(1 Part 2), 1992, pp. H38-H46.
[12]
P. Ruegsegger, B. Koller and R. Muller, “A Microtomographic System for the Nondestructive Evaluation of Bone Architecture,” Calcified Tissue International, Vol. 58, No. 1, 1996, pp. 24-29. http://dx.doi.org/10.1007/BF02509542
[13]
M. S. Tonetti, P. Cortellini, J. E. Suvan, P. Adriaens, C. Baldi, D. Dubravec, et al., “Generalizability of the Added Benefits of Guided Tissue Regeneration in the Treatment of Deep Intrabony Defects. Evaluation in a Multi-Center Randomized Controlled Clinical Trial,” Journal of Periodontology, Vol. 69, No. 11, 1998, pp. 1183-1192. http://dx.doi.org/10.1902/jop.1998.69.11.1183
[14]
R. Dimitriou, G. I. Mataliotakis, G. M. Calori and P. V. Giannoudis, “The Role of Barrier Membranes for Guided Bone Regeneration and Restoration of Large Bone Defects: Current Experimental and Clinical Evidence,” BMC Medicine, Vol. 10, 2012, p. 81. http://dx.doi.org/10.1186/1741-7015-10-81
[15]
G. Zellin and A. Linde, “Treatment of Segmental Defects in Long Bones Using Osteopromotive Membranes and Recombinant Human Bone Morphogenetic Protein-2. An Experimental Study in Rabbits,” Journal of Plastic Surgery and Hand Surgery, Vol. 31, No. 2, 1997, pp. 97-104. http://dx.doi.org/10.3109/02844319709085475
[16]
A. Linde and E. Hedner, “Recombinant Bone Morphogenetic Protein-2 Enhances Bone Healing, Guided by Osteopromotive e-PTFE Membranes: An Experimental Study in Rats,” Calcified Tissue International, Vol. 56, No. 6, 1995, pp. 549-553. http://dx.doi.org/10.1007/BF00298588
[17]
N. F. Farso, “Guided Bone Induction—A Method in the Treatment of Diaphyseal Long Bone Defects,” 1992.
