Homologous morcelized defatted bone graft additionated with antibiotic and PMMA “in vivo”: preliminary histologic evaluation. G. Gualdrini. Rizzoli Institute VII Department of Orthopaedic and Traumatology Orthopaedic Clinic - University of Bologna - Italy Director prof. Armando Giunti

1947 De Grood M. 1980 McCollum D.E. 1982 Roffmann M. 1984 Sloof T. 1985 Ling R. 1987 Oakeshott R. 1991 Oliver H. 1993 Gie GA. 1994 Schreurs B.W.

1996 Hovelius e Ullmark “Impacted morselized allograft and cement for revision total knee arthroplasty” Acta Orthop. Scand. 1996 l’osso spongioso per la sua architettura può essere più facilmente penetrato dai vasi che apportano osteoblasti e depositano osteoide direttamente sulle trabecole senza che queste vengano riassorbite (GOLDBERG E STEVENSON 1987).

1998 Bone Bank Rizzoli Institute Omologous morcelized defatted bone graft

Howex@ Chips 3 mm

Thorèn K.: “Lipid-extracted bone graft”, 1994. 2.5 MRad

three sterile envelops 25 kGy, - 80° C,

4 weeks With G. Ullmark kind permit 1 MESE: OSTEOCITI NELLE LACUNE DELL’INNESTO, NEOAPPOSIZIONE OSSEA (in rosa + chiaro) ATTORNO TESSUTO FIBROSO CON NEOANGIOGENESI 3-4 MESI: TESS. FIBROSO ED OSTEOIDE INTORNO ALLE TRABCOLE DI TESSUTO NECROTICO 6-12 MESI: NEOFORMAZIONE OSSEA (FLUORESCENZA) 48 MESI: TESSUTO OSSEO VITALE (FOCOLAI DI EMOPOIESI) 1 MESE: OSTEOCITI NELLE LACUNE DELL’INNESTO With G. Ullmark kind permit

6 months With G. Ullmark kind permit Assenza osteociti nell’innesto (+ scuro); più chiaro osseo neoformato con osteociti e lacune vascolari With G. Ullmark kind permit

4 years With G. Ullmark kind permit

4 years With G. Ullmark kind permit Lacune con tessuto emopoietico, non si distingue tessuto neoformato ed innestato With G. Ullmark kind permit

10/1998 -08/2002 249 patients 82 hip p. revisions 6 knee p. revisions 13 post-trauma hip prosthesis 51 spinal fusions 50 bone lesions filling 47 long bone non-unions

Paprosky 2B

Paprosky 2B

Paprosky 3B P.G., femmina 75 aa Mobilizzazione bilaterale protesi anca

3 months 2 years

GCT

12 months

Bone cyst 1month p.o.

3 months 6 months

Remarks about “MOD-B” High plastic properties Loss bone-stock recovery High resistance to septic risk Low resistance to mechanical strenght

“Adsorption and release of antibiotics from morselized cancellous bone “Adsorption and release of antibiotics from morselized cancellous bone. In vitro studies of 8 antibiotics.” Witso E., Persen L., Loseth K., Bergh K. Acta Orthop. Scand. 1999 Jun; 70 (3): 298-304 “Vancomycin-Tobramycin composite grafts -a new treatment for chronic osteomyelytis of the neuropatic food.” Winkler H., Berger C., Kristen K.H., Engel A. Annual Meeting EBJIS, May 25-27, 2000 Berlin.

inserire rx tappari, avambracci, Navacchia

G.Gualdrini, A.Bassi*, A. Giunti Morcelized bone combined with acrylic cement enhances in vitro release of vancomycin G.Gualdrini, A.Bassi*, A. Giunti VII Department Orthopaedic and Traumatology *Muscoloskeletal Tissue Bank Rizzoli Orthopaedic Institute, Bologna. in press

16 cylinders: 10 C-A-MB : PMMA g 0. 5 + vancomycin g 0. 1 + bone g 0 16 cylinders: 10 C-A-MB : PMMA g 0.5 + vancomycin g 0.1 + bone g 0.8 6 C-A : PMMA g 0.5 + vancomycin g 0.1

Human plasma Saline solution Four weeks 37°C

Antibiotic total release bone pla vs cem pla

Antibiotic release first week

Antibiotic release second-fourth week

“Mechanical characterization of an antibiotic cement-morcelized bone graft composite” M.Baleani, R.Fognani, A.Toni, A.Bassi°, G.Gualdrini* Medical Tecnology Lab.- I Orthopaedic Department °Muscoloskeletal Tissue Bank *VII Orthopaedic Department Rizzoli Orthopaedic Institute, Bologna. In press.

G.Gualdrini, A.Bassi, A.Giunti. Homologous morcelized defatted bone graft additionated with antibiotic and PMMA “in vivo”: preliminary histologic evaluation. G.Gualdrini, A.Bassi, A.Giunti.

Remarks about “CAMB” High plastic properties Loss bone-stock recovery Good antibiotic delivery High resistance to mechanical loading Good “in vivo” biocompatibility