Efficacy and Safety of Beta-Tricalcium Phosphate/Polylactic-Co-Glycolic Acid for Implantation of Bone Defects

Soichiro Tokeshi; Taisuke Fukawa; Eichi Itadera; Tsutomu Akazawa; Takayuki Fujiyoshi; Masashi Takaso; Koichi Nakagawa; Tomonori Yamauchi; Naoki Osada; Seiji Ohtori

doi:10.7759/cureus.43597

Efficacy and Safety of Beta-Tricalcium Phosphate/Polylactic-Co-Glycolic Acid for Implantation of Bone Defects

Cureus. 2023 Aug 16;15(8):e43597. doi: 10.7759/cureus.43597. eCollection 2023 Aug.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN.
² Orthopaedics, Narita Red Cross Hospital, Chiba, JPN.
³ Department of Orthopaedic Surgery, St. Marianna University, Kawasaki-City, JPN.
⁴ Orthopaedics, Kimitsu Chuo Hospital, Kisasrazu, JPN.
⁵ Orthopaedic Surgery, Kitasato University, Sagamihara, JPN.
⁶ Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN.
⁷ Orthodontics, Asahi General Hospital, Asahi, JPN.
⁸ Orthopaedics, ORTHOReBIRTH Co., Yokohama, JPN.
⁹ Orthopaedics, Chiba University Hospital, Chiba, JPN.

Abstract

Introduction: Bone defects are often observed after surgery for fractures and bone tumors. Their treatment is technically difficult and sometimes results in negative clinical and economic outcomes. To repair bone defects, a bone graft is implanted by selecting a transplant material from an autologous or artificial bone. Each method has its advantages and disadvantages. Compared to the gold standard of autologous bone graft, bone graft substitutes are not limited by the amount of harvested graft and avoid complications at the donor site. ORB-03 is a new cotton-like bone graft substitute composed of beta-tricalcium phosphate (β-TCP) and a bioabsorbable polymer, polylactic-co-glycolic acid (PLGA). ORB-03 is easy to mold and can fill various bone defect shapes, and its three-dimensional microfiber scaffold can enhance the differentiation of osteoblasts and promote osteogenesis. We investigated the efficacy, ease of handling, and safety of ORB-03 as a bone graft substitute. A multicenter, open-label, single-group study was conducted at six institutions.

Methods: Between July 2018 and August 2019, 60 patients with bone defects caused by fracture, benign tumors, or an iliac donor site from bone harvesting were enrolled in this study; 54 patients were finally included for the safety analysis and 48 patients for the image analysis. During surgery, ORB-03 was mixed with the patient's blood and molded into a bone defect. To evaluate the efficacy of ORB-03, radiography and computed tomography (CT) were performed at intervals until 24 weeks after surgery.

Results: The effective rate and its accurate bilateral 95% confidence interval (CI) were calculated based on the efficacy criteria at 24 weeks postoperatively. The ease with which ORB-03 could be handled in surgery was evaluated. Adverse events that occurred after surgery were evaluated, and those associated with ORB-03 were examined. Bone fusion was good in all cases, and the radiography and CT effective rates were 100.0% and 91.5%, respectively. Handling was easy in all cases. There were four adverse events, none of which were clinically problematic.

Conclusions: ORB-03 was found to be easy to handle, safe, and effective as a bone graft substitute for bone defects.

Keywords: absorbable implants; beta-tricalcium phosphate; bone graft substitutes; glycolic acid; osteoblasts; osteogenesis.