BoneAAOS_Review.pdf

BONE-GRAFT SUBSTITUTES: FACTS, FICTIONS APPLICATIONS AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 70th Annual Meeting February 5 - 9, 2003 New Orleans, Louisiana COMMITTEE ON BIOLOGICAL IMPLANTS Prepared by: Acknowledgements: A. Seth Greenwald, D.Phil.(Oxon) Exactech, Inc. GenSci OrthoBiologics, Inc. Interpore Cross International Medtronic Sofamor Danek Osteotech, Inc. Regeneration Technolgies, Inc. Stryker Biotech Synthes USA Wright Medical Technology, Inc. Zimmer, Inc. Scott D. Boden, M.D. Victor M. Goldberg, M.D. Yusuf Khan, M.S. Cato T. Laurencin, M.D., Ph.D. Randy N. Rosier, M.D. Presented with the permission of The Journal of Bone and Joint Surgery. This material was first published, in slightly different form, in J Bone Joint Surg Am 83(Suppl. 2):98-103, 2001. 0100 200 300 400 500 600 19982001 2002 Bone substitutes/ Platelet helpers Bone dowels Demineralized bone matrix products Allograft bone U.S. Sales ($millions) BMP 0 5000 10000 15000 20000 25000 1994 1995 1996 1997 1998 1999 2000 2001 Donors 5,188 6,142 10,004 12,000 (est) 14,030 (est) 16,692 (est) 21,000 (est) 22,000 (est) THE PHYSIOLOGY OF BONE GRAFTING The biology of bone grafts and their substitutes is appreciated from an understanding of the bone formation processes of Osteogenesis, Osteoinduction and Osteoconduction. Graft Osteogenesis: The cellular elements within a donor graft, which survive transplantation and synthesize new bone at the recipient site. Graft Osteoinduction: New bone realized through the active recruitment of host mesenchymal stem cells from the surrounding tissue, which differentiate into bone-forming osteoblasts. This process is facilitated by the presence of growth factors within the graft, principally bone morphogenetic proteins (BMPs). Graft Osteoconduction: The facilitation of blood-vessel incursion and new-bone formation into a defined passive trellis structure. All bone graft and bone-graft-substitute materials can be described through these pr