Clin Orthop Surg.  2018 Jun;10(2):253-259. 10.4055/cios.2018.10.2.253.

Unsintered Hydroxyapatite and Poly-L-Lactide Composite Screws/Plates for Stabilizing β-Tricalcium Phosphate Bone Implants

• Sakamoto A
• Okamoto T
• Matsuda S

• KMID: 2411753
• DOI: http://doi.org/10.4055/cios.2018.10.2.253

Abstract

Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.

Keyword

Bone neoplasms; Beta-tricalcium phosphate; Hydroxyapatites; Hydroxyapatite-polylactide; Reconstructive surgical procedures

MeSH Terms

Bone Neoplasms
Chondroblastoma
Chondrosarcoma
Durapatite*
Epiphyses
Femur
Giant Cell Tumors
Humans
Hydroxyapatites
Methods
Osteosarcoma
Reconstructive Surgical Procedures
Recurrence
Tibia
Durapatite
Hydroxyapatites

Figure

• 

  Fig. 1 Unsintered hydroxyapatite and poly-L-lactide composite (u-HA/PLLA) components for use in bone reconstruction after tumor curettage or resection. (A) Mesh plate and screws. (B) The β-tricalcium phosphate block is stabilized by u-HA/PLLA components.

• 

  Fig. 2 Chondrosarcoma in the ilium of a 41-year-old male. (A) After en -bloc resection of the lesion, hard-type β-tricalcium phosphate (β-TCP) blocks were implanted and stabilized with the unsintered hydroxyapatite and poly-L-lactide composite plates and screws. Plain radiographs were taken at various times: preoperatively, postoperatively (B), and 16 months after the surgery (C). (D) A computed tomography (CT) scan taken preoperatively shows an irregular calcified lesion at the left posterior ilium. (E, F) At 4 months after surgery, the CT scans show no evidence of dislocation of the implanted β-TCP blocks.

• 

  Fig. 3 Parosteal osteosarcoma in the distal femur of a 19-year-old female. (A) Plain radiographs. (B) Computed tomography scans show ossified bony protuberances from the posterior surface of the femur. (C) En-bloc resection was performed and the reconstruction method involved the use of hard-type β-tricalcium phosphate (β-TCP) blocks and the unsintered hydroxyapatite and poly-L-lactide composites. (D) No displacement of the β-TCP blocks was observed and the β-TCP blocks were incorporated into the host bone 21 months after the surgery.

• 

  Fig. 4 Giant-cell tumor of bone in the proximal tibia of a 36-year-old male. (A) Plain radiographs. (B) Computed tomography scans show an osteolytic and expansile lesion. (C) Immediate postoperative plain radiographs show reconstruction with a hard-type β-tricalcium phosphate (β-TCP) block. (D) Bone incorporation at the periphery of the β-TCP block is seen 3 months after the operation.

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  Fig. 5 Chondroblastoma in the proximal tibia of a 16-year-old male. (A) Plain radiographs. (B) Computed tomography scans show an osteolytic lesion with calcification. (C) After curettage, reconstruction was performed with a β-tricalcium phosphate block and unsintered hydroxyapatite and poly-L-lactide composites.

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