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Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model.

ABSTRACT: The Masquelet technique is a surgical procedure to regenerate segmental bone defects. The two-phase treatment relies on the production of a vascularized foreign-body membrane to support bone grafts over three times larger than the traditional maximum. Historically, the procedure has always utilized a bone cement spacer to evoke membrane production. However, membrane formation can easily be effected by implant surface properties such as material and topology. This study sought to determine if the membrane's mechanical or barrier properties are affected by changing the spacer material to titanium or roughening the surface finish. Ten-week-old, male Sprague Dawley rats were given an externally stabilized, 6?mm femur defect which was filled with a pre-made spacer of bone cement (PMMA) or titanium (TI) with a smooth (?1??m) or roughened (?8??m) finish. After 4?weeks of implantation, the membranes were harvested, and the matrix composition, tensile mechanics, shrinkage, and barrier function was assessed. Roughening the spacers resulted in significantly more compliant membranes. TI spacers created membranes that inhibited solute transport more. There were no differences between groups in collagen or elastin distribution. This suggests that different membrane characteristics can be created by altering the spacer surface properties. Surgeons may unknowingly effecting membrane formation via bone cement preparation techniques.

SUBMITTER: Gaio N

PROVIDER: S-EPMC5895482 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model.

Gaio Natalie N Martino Alice A Toth Zacharie Z Watson J Tracy JT Nicolaou Daemeon D McBride-Gagyi Sarah S

Journal of biomechanics 20180227

The Masquelet technique is a surgical procedure to regenerate segmental bone defects. The two-phase treatment relies on the production of a vascularized foreign-body membrane to support bone grafts over three times larger than the traditional maximum. Historically, the procedure has always utilized a bone cement spacer to evoke membrane production. However, membrane formation can easily be effected by implant surface properties such as material and topology. This study sought to determine if the ...[more]

PMID: 29510858

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Project description:BackgroundThe Masquelet-induced-membrane technique is a commonly used method for treating segmental bone defects. However, there are no established clinical standards for management of the induced membrane before grafting.Questions/purposesTwo clinically based theories were tested in a chronic caprine tibial defect model: (1) a textured spacer that increases the induced-membrane surface area will increase bone regeneration; and (2) surgical scraping to remove a thin tissue layer of the inner induced-membrane surface will enhance bone formation.MethodsThirty-two skeletally mature female goats were assigned to four groups: smooth spacer with or without membrane scraping and textured spacer with or without membrane scraping. During an initial surgical procedure (unilateral, left tibia), a defect was created excising bone (5 cm), periosteum (9 cm), and muscle (10 g). Segments initially were stabilized with an intramedullary rod and an antibiotic-impregnated polymethylmethacrylate spacer with a smooth or textured surface. Four weeks later, the spacer was removed and the induced-membrane was either scraped or left intact before bone grafting. Bone formation was assessed using micro-CT (total bone volume in 2.5-cm central defect region) as the primary outcome; radiographs and histologic analysis as secondary outcomes, with the reviewer blinded to the treatment groups of the samples being assessed 12 weeks after grafting. All statistical tests were performed using a linear mixed effects model approach.ResultsMicro-CT analysis showed greater bone formation in defects with scraped induced membrane (mean, 3034.5 mm3; median, 1928.0 mm3; quartile [Q]1-Q3, 273.3-2921.1 mm3) compared with defects with intact induced membrane (mean, 1709.5 mm3; median, 473.8 mm3; Q1-Q3, 132.2-1272.3 mm3; p = 0.034). There was no difference in bone formation between textured spacers (mean, 2405.5 mm3; median, 772.7 mm3; Q1-Q3, 195.9-2743.8 mm3) and smooth spacers (mean, 2473.2 mm3; median, 1143.6 mm3; Q1-Q3, 230.2-451.1 mm3; p = 0.917).ConclusionsScraping the induced-membrane surface to remove the innermost layer of the induced-membrane increased bone regeneration. A textured spacer that increased the induced-membrane surface area had no effect on bone regeneration.Clinical relevanceScraping the induced membrane during the second stage of the Masquelet technique may be a rapid and simple means of improving healing of segmental bone defects, which needs to be confirmed clinically.

Project description:Objectives: Septic non-union in long-bone fractures represents a challenging clinical entity. Management of lower extremity segmental bone defects, aiming to restore functional anatomy, remains extremely difficult and controversial. Masquelet technique is a reconstruction method for large diaphyseal bone defects, based on the notion of the induced membrane. The principle of the induced membrane is to create a foreign body reaction by placing cement spacer in the bone defect. The purpose of this study was to assess the success rate of induced membrane technique (IMT) in treating lower extremity large bone defects due to septic non-union. Methods:This is a retrospective observational study performed in a single referral center in France, Europe, which is specialized in complex bone and joint infections. All patients operated for septic non-union were identified from a prospectively maintained database. Patients treated with the IMT for septic femoral or tibial non-union between 2013 and 2017 were enrolled in this study. Exclusion criteria were infection of a continuous bone, aseptic non-union, or patients with less than one year of follow-up after antibiotic treatment ending. Results:Twenty-three cases (19 patients) with an average age of 41.3 years were included in the present study. There were 19 tibial and four femoral fractures. The mean bone defect was 65.3 mm. The mean time interval from initial trauma to the first surgical phase was 17 months, while that between the two surgical phases was 77.7 days. After the first surgical phase, samples were positive in 13 cases (68.5%), isolating Staphylococcus (26%) and more than one pathogen in 22% of cases. Bone union was successful in 16 of 23 cases (69.6%, 14 patients). There were seven failures: five amputations due to mechanical and/or infection-related failure and two failed unions. Conclusion:This study found that 69% of cases with septic non-union of tibial or femoral fracture treated with the two-step surgical protocol achieved bone union and infection eradication within about 13.2 months after the second stage of the procedure. The study revealed promising results in patients suffering large-size bone defect; hence, the IMT may prove beneficial in the management of such cases.

Dataset Information

Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model.

Publications

Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model.

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