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Extracortical Bone-Bridging Fixation with Use of Cortical Allograft and Recombinant Human Osteogenic Protein-1
Jun Fukuroku, MD, PhD1; Nozomu Inoue, MD, PhD2; Bahman Rafiee, MD1; Franklin H. Sim, MD3; Frank J. Frassica, MD1; Edmund Y.S. Chao, PhD1
1 Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 5215 Johns Hopkins Outpatient Center, Baltimore, MD 21287
2 Department of Orthopedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, 1471 Jelke, Chicago, IL 60612-3833. E-mail address: nozomu_inoue@rush.edu
3 Department of Orthopedics, Mayo Clinic/Mayo Foundation, 200 First Street S.W., Rochester, MN 55902
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from National Institutes of Health-National Cancer Institute Merit Grant CA-23751 and Stryker Orthopaedics. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker Orthopaedics). F.J. Frassica is a consultant for Stryker Orthopaedics. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jul 01;89(7):1486-1496. doi: 10.2106/JBJS.F.00290
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Background: Prosthetic reconstruction with extracortical bone-bridging fixation is an effective method for the treatment of massive bone loss. We evaluated the effect of the use of recombinant human osteogenic protein-1 (rhOP-1) combined with allogenic cortical bone strips as a substitute for an autogenous bone graft for extracortical bone-bridging.

Methods: Eight skeletally mature adult male dogs underwent a bilateral resection of a 6-cm segment of the femoral diaphysis and reconstruction with a porous segmental prosthesis. On the experimental side, an allogenic cortical onlay graft in the form of bone strips combined with rhOP-1 mixed with bovine type-I-collagen putty (OP-1 putty) was applied. On the control side, allogenic cortical bone strips augmented with autogenous cancellous bone chips and bone marrow were used. The reconstructions were followed for twelve weeks with biweekly evaluations of load-bearing gait and radiographs. The animals were killed twelve weeks after the surgery, and the reconstructed femora were studied biomechanically, histologically, and with microradiographs.

Results: One animal was excluded from the analysis because a fracture of the proximal part of the femur on the control side was observed radiographically twelve weeks after the surgery. There were no significant differences in load-bearing gait between the experimental and control sides throughout the experimental period. Serial radiographs revealed a 1.9-fold (p < 0.04), 2.7-fold (p < 0.01), and 2.4-fold (p < 0.03) increase in mineralized area on the experimental side at two, four, and six weeks, respectively. The torsional stiffness and strength of the fixation attributed to the extracortical bridging bone alone were 2.3-fold (p < 0.03) and 2.2-fold (p = 0.058) greater on the experimental side, respectively. The allograft porosity on the experimental side was 3.8-fold (p < 0.02) greater than that on the control side. With the number of samples available, there was no significant difference in mineral apposition rate between the experimental and control sides.

Conclusions: In an animal model of segmental bone-replacement prosthetic fixation with use of the extracortical bone-bridging principle, an allogenic onlay cortical graft combined with rhOP-1 was an effective substitute for autogenous bone graft.

Clinical Relevance: The allogenic onlay cortical graft combined with rhOP-1 may be useful for fixation of segmental bone and joint prostheses implanted for the treatment of massive defects of long bones.

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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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