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Updated: Jun 15, 2026
Biological Compatibility Profile on Biomaterials for Bone Regeneration
Published on: November 16, 2018
Exaggerated inflammatory response after use of recombinant bone morphogenetic protein in recurrent unicameral bone
Kevin M MacDonald1, Morgan M Swanstrom, James J McCarthy
1Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53711, USA.
Insights
Recombinant bone morphogenetic protein (BMP) did not effectively treat recurrent unicameral bone cysts (UBCs) in children. The treatment led to cyst recurrence and severe inflammatory responses, indicating it is not recommended.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Regenerative Medicine
Background:
- Recurrent unicameral bone cysts (UBCs) in children cause significant morbidity.
- Optimal treatment for UBCs remains undefined.
- Recombinant bone morphogenetic protein (BMP) shows promise in bone regeneration.
Observation:
- Three pediatric patients with recurrent UBCs received revision surgery using recombinant BMP.
- Radiographic and clinical outcomes were monitored post-treatment.
Findings:
- Recombinant BMP failed to resolve UBCs in all patients; two experienced complete recurrence.
- All patients exhibited exaggerated inflammatory responses, including swelling and pain mimicking infection.
- Radiographic results were poor, with no significant bone healing observed.
Implications:
- The use of recombinant BMP, as reported, is not recommended for treating recurrent UBCs in children.
- Further research is needed to explore alternative or modified applications of BMP in pediatric bone disorders.
- The paradoxical inflammatory response highlights potential risks associated with BMP in this context.
Background:
Recurrent unicameral bone cysts (UBCs) can result in significant morbidity during a child's physical and emotional development. Multiple treatment options are available and a review of the literature fails to clearly define the optimal treatment for UBCs. Recombinant bone morphogenetic protein (BMP) has been used with success in other disorders of poor bone formation. This manuscript is the first to report on the use of recombinant BMP in the treatment of UBCs.
Methods:
Three patients with recurrent UBCs underwent revision surgery with recombinant BMP. Radiographic and medical review was performed and is reported here.
Results:
In these patients, the use of BMP failed to fully resolve their UBC; 2 patients had complete recurrence that required further surgery. In addition to poor radiographic results, all patients developed exaggerated inflammatory responses in the acute postoperative period. Each child developed clinically significant limb swelling and pain that mimicked infection.
Conclusions:
On the basis of our poor radiographic results and a paradoxical clinical result, we no longer recommend the use of recombinant BMP in the manner reported here for the treatment of recurrent UBCs.
Level Of Evidence:
Level IV, case series.
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