Chapter 59 - Bone Grafts, Bone Morphogenic Proteins, and Bone Substitutes Flashcards
oteogenic materials
directly supply cells that are capable of in vivo bone formation
autograft, bmac, mscs
osteoinductive materials
contain factors capable of promoting progenitor cells down a bony lineage
eg BMPs, enhancing proteins
osteoconductive materials
form a scaffolding on which bone can be made
challenges with fresh allograft
potential for host immune response, disease transmission, host vs graft disease
fresh frozen allograft
requires thawing, if not thawed it has increased brittleness and can lead to longitudinal fractures
mechanical properties of freeze dried bone allograft
comparable compressive and tensile strength to fresh frozen, however very little torsional/bending strength -> NOT suitable for structural grafting
bioceramics are strong in ______ but weak in _______.
strong in compression; weak in tension
chemical compound of synthetic hydroxyapatite
Ca10(PO4)6(OH)2
BMPs are a member of what family?
TGFB superfamily
rhBMP2 is FDA approved for what uses?
- ALIF for degenerative disc disease or Grade 1 spondylolisthesis
- tibial non-union as a alternative for aurograft
rhBMP-7 is FDA approved for what uses?
recalcitrant long bone non-union
posterolateral lumbar fusion
recent lit regarding rhBMP2 in spine patients
overall increase in WOUND complications (epidural hematoma, wound dehiscence, postoperative fever, hemorrhage)
no increase in other complications (dysphagia, hoarseness, neurological complication)
rhBMP are contraindicated in which patients?
cancer patients - eg active disease, active treatment for disease, or near a previous cancer bed (eg where a met or a sarcoma was removed years prior)
2/2 TGFb dysregulation following bmp2 admin
