The Implantation of Bioactive Glass Granules Can Contribute the Load-Bearing Capacity of Bones Weakened by Large Cortical Defects

Nicole A P van Gestel; Floor Gabriels; Jan A P Geurts; Dennis J W Hulsen; Caroline E Wyers; Joop P van de Bergh; Keita Ito; Sandra Hofmann; Jacobus J Arts; Bert van Rietbergen

doi:10.3390/ma12213481

The Implantation of Bioactive Glass Granules Can Contribute the Load-Bearing Capacity of Bones Weakened by Large Cortical Defects

Materials (Basel). 2019 Oct 24;12(21):3481. doi: 10.3390/ma12213481.

Authors

Nicole A P van Gestel^{1

2}, Floor Gabriels³, Jan A P Geurts⁴, Dennis J W Hulsen^{5

6

7}, Caroline E Wyers^{8

9}, Joop P van de Bergh^{10

11

12}, Keita Ito^{13

14}, Sandra Hofmann^{15

16}, Jacobus J Arts^{17

18}, Bert van Rietbergen^{19

20}

Affiliations

¹ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. n.a.p.v.gestel@tue.nl.
² Institute for Complex Molecular Systems, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. n.a.p.v.gestel@tue.nl.
³ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. floor.gabriels@log-ten.com.
⁴ Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands. j.geurts@mumc.nl.
⁵ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. d.hulsen@jbz.nl.
⁶ Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands. d.hulsen@jbz.nl.
⁷ MICT Department, Jeroen Bosch Ziekenhuis, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands. d.hulsen@jbz.nl.
⁸ Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands. cwyers@viecuri.nl.
⁹ Department of Internal Medicine, NUTRIM School for Translational Research in Metabolism, Maastricht UMC+, PO Box 5800, 6229 HX Maastricht, The Netherlands. cwyers@viecuri.nl.
¹⁰ Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands. jvdbergh@viecuri.nl.
¹¹ Department of Internal Medicine, NUTRIM School for Translational Research in Metabolism, Maastricht UMC+, PO Box 5800, 6229 HX Maastricht, The Netherlands. jvdbergh@viecuri.nl.
¹² Biomedical Research Institute, Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium. jvdbergh@viecuri.nl.
¹³ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. k.ito@tue.nl.
¹⁴ Institute for Complex Molecular Systems, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. k.ito@tue.nl.
¹⁵ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. s.hofmann@tue.nl.
¹⁶ Institute for Complex Molecular Systems, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. s.hofmann@tue.nl.
¹⁷ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. j.arts@mumc.nl.
¹⁸ Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands. j.arts@mumc.nl.
¹⁹ Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. b.v.rietbergen@tue.nl.
²⁰ Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, PO Box 5800, 6229 HX Maastricht, The Netherlands. b.v.rietbergen@tue.nl.

Abstract

Bioactive glass (BAG) granules (S53P4) have shown good clinical results in one-stage treatment of osteomyelitis. During this treatment, a cortical window is created, and infected bone is debrided, which results in large defects that affect the mechanical properties of the bone. This study aimed to evaluate the role of BAG granules in load-bearing bone defect grafting. First, the influence of the geometry of the cortical window on the bone bending stiffness and estimated failure moments was evaluated using micro finite element analysis (µFE). This resulted in significant differences between the variations in width and length. In addition, µFE analysis showed that BAG granules contribute to bearing loads in simulated compression of a tibia with a defect grafted with BAG and a BAG and bone morsel mixture. These mixtures potentially can unload the cortical bone that is weakened by a large defect directly after the operation by up to approximately 25%, but only in case of optimal load transfer through the mixture.

Keywords: bioactive glass granules; finite element analysis; load sharing; mechanical properties; osteomyelitis; stiffness; treatment.

Grants and funding

WISE-2014-1004081/Women in Science and Engineering, Eindhoven University of Technology