Improving the Function of Synthetic Bone Grafts by Patient Blood Mixing

A bone graft is defined as implanted material, used alone or in combination with other material(s), to promote bone healing through osteogenesis, osteoinduction, and osteoconduction[1-4].

Conventionally, during surgery it is very common for the bone
graft substitute particles to scatter around the soft tissue. The surgeon must then pick up every fragment of bone graft and insert it particle by particle into the area to be merged into the space to be filled. The bone graft material fragments which are dispersed around the soft tissue are difficult to contain and collecting
them is time-consuming during surgery[5].

During surgery, we have drawn blood from the patient and added it to the bone graft particles in order to contain these particles in the fusion area. The aim of this article is to describe this technique.

Hemostasis is the process of blood clot formation. When blood vessel walls are disrupted, the clotting process begins rapidly and is localized. The mechanism of coagulation starts with activation, adhesion, and aggregation of platelets with sequential activation of enzymes resulting in significant stepwise response amplification. The results of local generation of fibrin, enmeshes and reinforces the platelet plug. Clot formation is the initial response to stop bleeding, followed by clot lysis and tissue remodeling [6,7].

Features of PEEK Implants

For interference screws, the same technological drivers are present: metal screws can complicate revision surgeries and disrupt MRI scans [8], and bioabsorbables suffer
from inflammatory and strength limitations [8,9].

PEEK avoids stress shielding as its stiffness nearly matches that of healthy cortical
bone. PEEK implants are also resistant to heat and ionizing radiation, minimizing concerns with thermal conduction near the brain and toxicity. PEEK can be sterilized repeatedly by steam and gamma irradiation [10]. Finally, PEEK also facilitates critical postoperative diagnostic monitoring of oncologic and neurogical patients, because it is translucent to X-rays and is nonmagnetic, generating no artifacts in CT or MRI [10].

Osveh Asia Medical Instrument Co. is the first Iranian company to make implantable products using PEEK for the sports medicine industry. PEEK Interference Screw, PEEK Tendonitis Screw and PEEK Anchor Sutures is made of VESTAKEEP (by Evonik).

References

[1] M. Sabri, N. Meir, P. Ezequiel. Bone graft substitute prepared with the patient’s blood. Technical tip, The Foot 25 (2015) 277–279.

[2] Oryan A, Alidadi S, Moshiri A, Maffulli N. Bone regenerative medicine: classic options, novel strategies, and future directions. J Orthop Surg Res 2014.

[3] Elsalanty ME, Genecov DG. Bone grafts in craniofacial surgery. Craniomaxillofac Trauma Reconstr 2009;2:125–34.
[4] Albrektsson T, Johansson C. Osteoinduction, osteoconduction and osseointegration. Eur Spine J 2001;10:S96–101.

[5] Coughlin MJ, Grimes JS, Kennedy MP. Coralline hydroxyapatite bone graft substitute in hindfoot surgery. Foot Ankle Int 2006;27:19–22.

[6]Furie B, Furie BC. Mechanisms of thrombus formation. N Engl J Med, 2008, 938–49.

[7] Lillicrap D, Key N, Makris M, O’Shaughnessy D. Practical hemostasis and thrombosis. Wiley-Blackwell; 2009, ISBN 1-4051-8460-4. p. 1–5.

[8]S. Rupp, R. Seil, A. Schneider, D.M. Kohn, Ligament graft initial fixation strength using biodegradable interference screws, J Biomed. Mater. Res. 48 (1) (1999) 70e74.

[9]D.G. Nagarkatti, B.P. McKeon, B.S. Donahue, J.P. Fulkerson, Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation, Am. J. Sports Med. 29 (1) (2001) 67e71.

[10] M.M. Hanasono, N. Goel, F. DeMonte, Calvarial reconstruction with polyetheretherketone implants, Ann. Plast. Surg. 62 (6) (2009) 653e655.