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Effects of Setting Bone Cement on Tissue-Engineered Bone Graft: a Potential Barrier to Clinical Translation?
Edward R. Tayton, MBBS, MRCS, MSc1; James O. Smith, BSc, BM, MRCS1; Nicholas Evans, BSc, MBBS, MSc, MRCS1; Alex Dickinson, PhD2; Alexander Aarvold, BSc, MBChB, MRCS, MD1; Spandan Kalra, MSc1; Matthew Purcell, MEng3; Steven Howdle, PhD3; Douglas G. Dunlop, MBChB, FRCS, MD1; Richard O.C. Oreffo, DPhil1
1 Bone and Joint Research Group, Human Development and Health, University of Southampton Medical School, Tremona Road, Southampton SO16 6YD, United Kingdom. E-mail address for E.R. Tayton: edwardtayton@hotmail.com. E-mail address for J.O. Smith: jsmith@doctors.org.uk. E-mail address for N. Evans: nick.evans@doctors.org.uk. E-mail address for A. Aarvold: alexaarvold@doctors.org.uk. E-mail address for S. Kalra: spandan.kalra@gmail.com. E-mail address for D.G. Dunlop: Doug.Dunlop@SUHT.SWEST.NHS.UK. E-mail address for R.O.C. Oreffo: roco@soton.ac.uk
2 Bioengineering Sciences Research Group, University of Southampton, Highfield, Southampton SO17 1BJ, United Kingdom. E-mail address: alex.dickinson@soton.ac.uk
3 School of Chemistry, University Park, University of Nottingham, Nottingham NG7 2RD, United Kingdom. E-mail address for M. Purcell: pcxmp@nottingham.ac.uk. E-mail address for S. Howdle: Steve.Howdle@nottingham.ac.uk
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Investigation performed at the University of Southampton, Southampton, United Kingdom

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 17;95(8):736-743. doi: 10.2106/JBJS.L.00164
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Strategies to improve mechanical strength, neovascularization, and the regenerative capacity of allograft include both the addition of skeletal stem cells and the investigation of novel biomaterials to reduce and ultimately obviate the need for allograft altogether. Use of bone cement is a common method of stabilizing implants in conjunction with impacted allograft. Curing cement, however, can reach temperatures in excess of 70°C, which is potentially harmful to skeletal stem cells. The aim of this study was to investigate the effects of setting bone cement on the survival of human adult skeletal stem cells within tissue-engineered allograft and a novel allograft substitute.


Milled allograft and a polymer graft substitute were seeded with skeletal stem cells, impacted into a graduated chamber, and exposed to curing bone cement. Sections were removed at 5-mm increments from the allograft-cement interface. A quantitative WST-1 assay was performed on each section as a measure of remaining cell viability. A second stage of the experiment involved assessment of methods to potentially enhance cell survival, including pretreating the allograft or polymer by either cooling to 5°C or coating with 1% Laponite, or both.


There was a significant drop in cellular activity in the sections taken from within 0.5 cm of the cement interface in both the allograft and the polymer (p < 0.05), although there was still measurable cellular activity. Pretreatment methods did not significantly improve cell survival in any group.


While the addition of bone cement reduced cellular viability of tissue-engineered constructs, this reduction occurred only in close proximity to the cement and measurable numbers of skeletal stem cells were observed, confirming the potential for cell population recovery.

Clinical Relevance: 

These studies highlight a potential pitfall when translating tissue-engineering strategies, but indicate that the use of bone cement should not necessarily be ruled out during the application of cell populations and biomaterials in tissue regeneration.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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