The use of coral as a bone graft substitute

Experiments have been performed to investigate the use of coral skeletons as bone graft substitutes. Skeletal fragments of different coral genera were implanted into cortical and spongy bone defects and used to bridge transcortical resections in the femur. The implant site was monitored for up to 18 months. Radiographically, both cortical and spongy bone defects were at least partially filled by new bone after 8 weeks while the implants underwent continuous resorption. Coral resorption and replacement by new tissue was also observed in the transcortical resections. The process of resorption was attributed to the enzymatic attack, especially carboanhydrase. This was confirmed by experiments in which dogs were implanted with coral in transcortical resections and treated daily with acetazolamide, a carboanhydrase inhibitor; the absorption appeared delayed and the resections failed to heal.