Studies of bone morphogenetic protein-based surgical repair

Abstract

Over the past several decades, recombinant human bone morphogenetic proteins (rhBMPs) have been the most extensively studied and widely used osteoinductive agents for clinical bone repair. Since rhBMP-2 and rhBMP-7 were cleared by the U.S. Food and Drug Administration for certain clinical uses, millions of patients worldwide have been treated with rhBMPs for various musculoskeletal disorders. Current clinical applications include treatment of long bone fracture non-unions, spinal surgeries, and oral maxillofacial surgeries. Considering the growing number of recent publications related to clincal research of rhBMPs, there exists enormous promise for these proteins to be used in bone regenerative medicine. The authors take this opportunity to review the rhBMP literature paying specific attention to the current applications of rhBMPs in bone repair and spine surgery. The prospective future of rhBMPs delivered in combination with tissue engineered scaffolds is also reviewed.

Figure 1

A 62-year-old man fell and experienced a subtrochanteric right femur fracture that was unsuccessfully repaired by intramedullary nail fixation alone. Radiographs show revision surgery with nail repositioning and application of Osigraft® immediately after surgery (A) and 6 months later (B). Radiologically and clinically evident healing is present. (Reproduced from [30] with permission granted by Elsevier.)

Figure 2

Radiographs of the fusion mass at 6 weeks (A), 12 months (b), and 24 months after posterolateral arthrodesis spinal surgery using a ceramic-granule bulking agent with rhBMP-2 loaded collagen sponge to mediate joint ossification. Radiographs show the initial presence of ceramic granules (arrows in A) which are later resorbed and replaced with new bone formation (arrows in B & C). (Reproduced from [91] with permission pending from Rockwater Inc.)