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. 2006 Jun 8:7:50.
doi: 10.1186/1471-2474-7-50.

First histological observations on the incorporation of a novel nanocrystalline hydroxyapatite paste OSTIM in human cancellous bone

Franz-Xaver Huber  1 , Orlin Belyaev, Joachim Hillmeier, Hans-Juergen Kock, Colette Huber, Peter-Juergen Meeder, Irina Berger
Affiliations

First histological observations on the incorporation of a novel nanocrystalline hydroxyapatite paste OSTIM in human cancellous bone

Franz-Xaver Huber et al. BMC Musculoskelet Disord. .

Abstract

Background: A commercially available nanocrystalline hydroxyapatite paste Ostim has been reported in few recent studies to surpass other synthetic bone substitutes with respect to the observed clinical results. However, the integration of this implantable material has been histologically evaluated only in animal experimental models up to now. This study aimed to evaluate the tissue incorporation of Ostim in human cancellous bone after reconstructive bone surgery for trauma.

Methods: Biopsy specimens from 6 adult patients with a total of 7 tibial, calcaneal or distal radial fractures were obtained at the time of osteosynthesis removal. The median interval from initial operation to tissue sampling was 13 (range 3-15) months. Samples were stained with Masson-Goldner, von Kossa, and toluidine blue. Osteoid volume, trabecular width and bone volume, and cortical porosity were analyzed. Samples were immunolabeled with antibodies against CD68, CD56 and human prolyl 4-hydroxylase to detect macrophages, osteoblasts, and fibroblasts, respectively. TRAP stainings were used to identify osteoclasts.

Results: Histomorphometric data indicated good regeneration with normal bone turnover: mean osteoid volume was 1.93% of the trabecular bone mass, trabecular bone volume--28.4%, trabecular width--225.12 microm, and porosity index--2.6%. Cortical and spongious bone tissue were well structured. Neither inflammatory reaction, nor osteofibrosis or osteonecrosis were observed. The implanted material was widely absorbed.

Conclusion: The studied nanocrystalline hydroxyapatite paste showed good tissue incorporation. It is highly biocompatible and appears to be a suitable bone substitute for juxtaarticular comminuted fractures in combination with a stable screw-plate osteosynthesis.

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Figures

Figure 1
Figure 1
Pure nanocrystalline hydroxyapatite (Ostim®) forms aggregates of needle-shaped crystals in transmission electron microscopy (magnification: left 7500×; right 150 000×)
Figure 2
Figure 2
An angularly stable screw-plate system is used for fixation. The metaphyseal defect of the radius is filled with a nanocrystalline hydroxyapatite paste through a free screw-hole in the metal plate.
Figure 3a
Figure 3a
The DBCS drill (Biomet Merck, Darmstadt, Germany) is used to obtain a cylindrical biopsy. The plate is still in place at that time. B Intraoperative view of the radius after drilling and plate removal. The biopsy hole has the diameter of a screw hole, so stability of the reconstructed bone is threatened in no way.
Figure 4
Figure 4
X-ray images of the hand of patient No. 5 three months after the reconstruction (4a and 4b) and after the plate removal 10 months later (4c and 4d). New bone has refilled the metaphyseal defect.
Figure 5
Figure 5
Remnants of nanocrystalline hydroxyapatite paste in the medullary space (white arrow). The border between nanocrystalline hydroxyapatite paste and newly formed cancellous bone is shown (black arrows). Histological section, Masson-Goldner staining, 40×.
Figure 6
Figure 6
Low number of macrophages (arrows) localized in close vicinity to particles of the hydroxyapatite paste. Histological section, CD68 immunostaining.
Figure 7
Figure 7
Low number of fibroblasts (arrows) distributed diffusely in the medullary space containing nanocrystalline hydroxyapatite paste. Histological section, h4Ph immunostaining, 24×.
Figure 8
Figure 8
Well structured trabecular bone tissue (white arrow) with osteoid on the trabecular surface (black arrows). Histological section, von Kossa staining, 8×.
Figure 9
Figure 9
A layer of red-stained osteoblasts (white arrows) are found on the surface of newly formed trabecular bone. Histological section, CD56 immunostaining, 40×.
Figure 10
Figure 10
A red-stained osteoclast (white arrow) within a bone trabecle. Histological section, TRAP immunohistochemical staining, 64×.
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