Summary
Biocompatible calcium phosphate ceramics has been used for several years in orthopeadic surgery. We have been using two new synthetic biphasic calcium phosphate ceramics (BCP) since September 1996 for bone defect filling in any orthopaedic or trauma operation where autograft use was not possible or even wanted. The first, Eurocer 400® has 300 to 500 micron wide macropores with a totally interconnected porosity. This salt seed like product can be used in bone defect filling, when solidity is not a major concern. The second, Eurocer 200® has not totally interconnected 200 micron large pores. Its main characteristic is a mechanical resistance up to 30 Mpa. We use it in any case of weight-bearing surgery. Different sizes and presentation forms are available and will be chosen according to the recipient site shape. We report one hundred and fifty cases with a six to thirty month follow-up. In one third of the patients hip revision surgery was addressed. Another third concerned recent trauma or sequelae cases,.whereas the last third involved cold orthopaedic procedures. General principles are the need of a living and non-infected site after thorough debridement if necessary. Osteocompatibility of calcium phosphate ceramic is confirmed by our results. We report no mechanical failure. In all cases X-rays show a progressive integration, with new bone formation. Our substitutes have been histologically studied in nine cases, four to fifteen months after implantation. New bone formation around and in the substitute is impressive. Indeed, their good mechanical properties without loss of biological quality is the most relevant feature of these BCPs, leading to a wider indication field; therefore we have now abandoned the use of any bony auto, allo or xenograft.
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References
Basle MF, Rebel A, Grizon F, Daculsi G, Passuti N, Filmon R (1993) Cellular response to calcium phosphate ceramics implanted in rabbit bone. J Mater Sci 4: 273–280
Bucholz RW, Carlton A, Holmes RE (1987) Hydroxyapatite and tricalcium phosphate bone graft substitutes. Orthop Clin North Am 18: 323–324
Cazeau C, Doursounian L, Thouzard RC (1995) Utilisation de céramiques de phosphate tricalcique dans la réparation des fractures du plateau tibial. Rev Chir Orthop suppl II: 190–191
Cheung K, Haak MH (1989) Growth of osteoblasts on porous calcium phosphate ceramic: an in vitro model for biocompatibility study. Biomaterials 10: 724–736
Daculsi D, Legeros RZ, Mitre D (1990) Crystal dissolution of biological and ceramic apatites. Calcif Tissue Int 46: 20–27
Daculsi G, Passuti N (1990) Effect of the macroporosity for osseous substitution of calcium phosphate ceramics. Biomaterials 11: 86–87
Daculsi G, Passuti N, Delecrin J, Kerebel B (1989) Etude comparative de céramiques bioactives en phosphate de calcium après implantation en site osseux chez le chien. Rev Chir Orthop 75: 65–71
De Bruijn JD (1998) Calcium phosphates and other bone substitutes in tissue engeneering. North Sea Biomaterials, 14th ESB Conference The Hague. Dutch Society for Biomaterials, Bilthoven
De Bruijn JD, Klein CPAT, De Groot K, Van Blitterswik CA (1993) Influence of crystal structure on the establishment of the bonecalcium interface in vitro. Cells Materials 3: 407–417
De Groot K (1980) Bioceramics of calcium phosphates. Biomaterials 1: 47
Eggli PS, Muller W, Schenk RK (1988) Porous hydroxyapatite and tricalcium phosphate cylinders with two pore size ranges implanted in the cancellous bone of rabbits. Clin Orthop 232:127–138
Flatey TJ, Lynch KL, Benson M (1983) Tissus response to implants of calcium phosphate ceramics in the rabbit spine. Clin Orthop 17: 256–252
Frayssinet P, Trouillet JL, Rouquet N, Azimus E, Autefage A (1993) Osteointegration of macroporous calcium phosphate ceramics having a different chemical compsition. Biomaterials 14: 423–429
Galois L, Mainard D, Bordji K, Clement D, Delagoutte JP (1996) Influence de la taille des pores sur la réhabitation osseuse de 2 céramiques phosphocalciques. Actualités en Biomatériaux (vol III). Romillat, Paris: 361–380
Gao TJ, Lindholm TS, Kommonen B, Ragm P, Paronzin A, Lindholm TC (1995) Microscopic evaluation of bone-implant contact between hydroxyapatite bioactive glass and tricalcium phosphate implanted in sheep. Biomaterials 16:1175–1179
Gouin F, Passuti N, Delecrin J, Bainvel JV (1993) Utilisation d'une céramique poreuse biphasique dans le comblement des tumeurs bénignes. Rev Chir Orthop 79: 554
Husson JL, Poncer R, Chatelier P, Morel G, Polard JL, Lancien G (1995) Phosphates tricalciques et arthrodèses lombaires: résultats cliniques, radiographiques et histologiques. Rev Chir Orthop 81 (suppl II): 158
Jarcho M (1981) Calcium phosphate ceramics as hard tissue prosthetics. Clin Orthop 157:259–278
Jasty V, Jarcho M, Gumaer KL, Sauerschell R, Drobeck HP (1978) Bone tissue response to dense hydroxyapatite discs implants in mongrel dogs. 9th Congr Electron microsc 2: 274
Kitsugi T, Yamamuro T, Nakamura T, Oka M (1995) Transmission electron microscopy observations at the interface of bone and four types of calcium phosphate ceramics. Biomaterials 16:1101–1107
Klein CPAT, Abe Y, Hosono H, De Groot K (1984) Different calcium phosphates bioglass ceramic implanted in rabbit cortical bone. Biomaterials 5: 362–364
Klein CPAT, Parka P, Den Hollander W (1989) Macroporous calcium phosphate bioceramics in dog femora: histological study of interface and biodegradation. Biomaterials 10:59–63
Kotani S, Fujita Y, Kitsugi T, Nakamura T, Yamamuro Y (1991) Bone bonding mechanism of beta-tricalcium phosphate. J Biomed Mat Res 12:1303–1315
Lascart T, Favard L, Burdin P, Traore O (1998) Utilisation du phosphate tricalcique dans les ostéotomies tibiales d'addition interne. Ann Orthop Ouest 30:137–141
Le Huec JC, Clement D (1998) Evolution of the local calcium content around irradiated beta-tricalcium phosphate ceramic implants: in vivo study in the rabbit. Biomaterials 19: 733–738
Le Huec JC, Lesprit C, Clément D, Chanveaux A, Le Rebeller A (1997) Tricalcium phosphate ceramics and allografts as bone substitutes for spinal fusion in idiopathic scoliosis. Acta Orthop Belgica 63: 202–211
Le Huec JC, Schaeverbeke T, Clément D, Faber J, Le Rebeller A (1995) Influence of porosity on the mechanical resistance of hydroxyapatite ceramics under compressive stress. Biomaterials 16:113–117
Meyrueis JP, Cazenave A, Sohier-Meyrueis A (1996) Substituts osseux: critères de choix. Maitrise Orthopédique 57
Nasca RJ, Lemons JE, Montgomery R (1991) Evaluation of cryopreserved bone and synthetic biomaterials in promoting spinal fusion. Spine 16: 330–333
Neo M, Kotani S, Fujita Y, Nakamura T, Yamamuro Y (1992) Differences in ceramicbone interface between surface-active ceramics and resorbable ceramics. J Biomed Mat Res 26: 255–267
Oonishi H, Iwaki Y, Kin N, Kushitani S (1997) Hydroxyapatite in revision of total hip replacements with massive acetabular defects. J Bone Joint Surg 7913: 87–92
Passutu N, Daculsi G, Rogez JM, Martin S, Bainvel JV (1989) Macroporous calcium phosphate ceramics performance in human spine fusion. Clin Orthop 248:169–176
Pollo C, De Coexe B, Collard A, Gilliard C (1997) Discectomie cervicale antérieure et fusion intersomatique par greffons d'hydroxyapatite et vis plaque. Rachis 9: 39–46
Ripamonti U (1996) Osteoinduction in porous hydroxyapatite implanted in heterotopic sites of different animal models. Biomaterials 17: 31–35
Ripamonti U, Duneas N (1996) Tissue engineering of bone by osteoinductive biomaterials. MRS Bulletin 21: 36–43
Schwartz C, Lecestre P (1997) First clinical results of new synthetic biphasic ceramics for use as bone substitute.13th ESB Conference, Gteborg.
Schwartz C, Lecestre P (1997) Résultats préliminaires de l'utilisation de céramiques biphasées de synthèse comme substituts osseux en chirurgie orthopédique et traumatologique. GECO, Les Arcs.
Senter HJ, Koryna R, Kemp WR (1989) Anterior cervical discectomy with hydroxyapatite fusion. Neurosurg 25: 39–43
Shimazaki K, Mooney V (1985) Comparative study of porous hydroxyapatite and tricalcium phosphate as bone substitute. J Orthopaedics Research 3: 301–305
Trecant M, Delecrin J, Royer J, Goyenvalle E, Daculsi G (1994) Mechanical changes in macroporous calcium phosphate ceramics after implantation in bone. Clin Mat 15: 233–240
Uchida A, Araki N, Shinto Y, Yoshikawa H, Kurisaki E, Ono K (1990) The use of calcium hydroxyapatite ceramic in bone tumour surgery. J Bone Joint Surg 72B: 298–302
Uchida A, Nade S, Mc Cartney E, Ching W (1984) The use of ceramics for bone replacement. A comparative study of three porous ceramics. J Bone Joint Surg 66B: 269–275
Van Blitterswijk CA, Kuijpers W, Daems WT, De Groot K (1985) Macropore tissue ingrowth: a quantitative and qualitative study on hydroxyapatite ceramic. Biomaterials 7: 137–143
Winter M, Griss P, De Groot K, Taga H, Heimke G, Sawai K (1981) Comparative histocompatibility testing of seven calcium phosphate ceramics. Biomaterials 2: 159–161
Yang Z, Yan H, Tong W, Zou P, Chen W, Zhang X (1996) Osteogenesisin extraskeletal implanted porous calcium phosphate ceramics: variability among different kinds of animals. Biomaterials 17: 2131–2137
Yokozeki H, Hayashi T, Nakagawa T, Kurosawa H, Shibuya K, Ioku K (1998) Influence of surface microstructure on the reaction of the active ceramics in vivo. J Mater Sci 9: 381–384
Yoshii S, Kakutani Y, Yamamuro T, Nakamura T, Kitsugi T, Oka M (1988) Strength of bonding between a glass-ceramic and the surface of bone cortex. J Biomed Mat Res 22: 327–338
Yuan H, De Bruijn JD, Yang Z, Li Y, De Groot K, Zhang X (1998) Osteoinduction by calcium phosphate biomaterials North Sea Biomaterials, 14th ESB Conference The Hague. Dutch Society for Biomaterials, Bilthoven
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Paper presented at the 1998 meeting of GECO (Arc 1800, Bourg-Saint-Maurice, France)
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Schwartz, C., Lecestre, P., Fraysinet, P. et al. Bone substitutes. Eur J Orthop Surg Traumatol 9, 161–165 (1999). https://doi.org/10.1007/BF00542583
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DOI: https://doi.org/10.1007/BF00542583