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Masquelet technique: Effects of vancomycin concentration on quality of the induced membrane
Jie Xie1, Wu Wang2, Xiaolei Fan1
1Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan 410008, China.
Purpose:
The purpose of this study was to determine the effects of polymethylmetnacrylate (PMMA) spacer loaded with different concentrations of vancomycin on the proliferative, osteogenic, and angiogenic capacity of the induced membrane.
Methods:
Varying concentrations of vancomycin (0, 1, 2, 4, 6, 8, and 10 g) were fully mixed with bone cement powder (40 g), resulting in seven experimental groups. Hollow cylindrical PMMA spacers (10 mm height, 3 mm external diameter, and 0.8 mm internal diameter) were formed by a mold and submerged in phosphate-buffered saline for antibiotic release by spectrophotometry. Eighty-four New Zealand white rabbits were evenly randomized into seven groups, and segmental radius shaft defects (10 mm) were created. Defects were filled with cylindrical PMMA spacers containing different vancomycin concentrations, and subsequently underwent intramedullary fixation with a retrograde Kirschner's wire. Tissue toxicity was assessed and the proliferative, osteogenic, and angiogenic capacity of induced membranes were qualitatively analyzed by immunohistochemistry and real-time PCR.
Results:
No obvious toxicity was observed in the animal model. Alizarin red s staining and qualitative detection of type I collagen, CD31, Ki67, and STRO-1 by immunohistochemistry revealed an obvious decrease in the percentage of positively stained cells and in osteogenic capacity when the concentration of vancomycin was more than 6 g per cement dose. Quantitation of gene expression related to osteogenesis (Col1a, Alp, and Runx2), vascularization (Vegf, Tgfb1, and vWF), and proliferation (Oct4 and Stro-1) by real-time PCR revealed slight increases in the expression of selected genes at low vancomycin concentrations (1-4 g per cement dose), and relatively lower gene expression when the concentration of vancomycin was more than 6 g per cement dose.
Conclusion:
PMMA spacers loaded with relatively low concentrations of vancomycin (1-4 g per cement dose) did not interfere with the proliferative, osteogenic, and angiogenic capacity of induced membranes, and even promoted their capacity. In contrast, spacers loaded with relatively high concentrations of vancomycin (6-10 g per cement dose) had negative effects on osteoblast viability, angiogenesis, and proliferation.
Insights
Polymethylmethacrylate (PMMA) spacers with low vancomycin concentrations (1-4 g) support bone healing capacity. Higher vancomycin concentrations (6-10 g) in PMMA spacers negatively impact bone regeneration, proliferation, and angiogenesis.
Area of Science:
- Biomaterials Science
- Orthopedic Surgery
- Tissue Engineering
Background:
- Polymethylmethacrylate (PMMA) bone cement is widely used in orthopedic surgery.
- Antibiotic-loaded PMMA spacers are crucial for managing bone infections.
- The impact of vancomycin concentration on the biological capacity of induced membranes requires detailed investigation.
Purpose of the Study:
- To evaluate the effects of varying vancomycin concentrations in PMMA spacers on induced membrane properties.
- To assess the impact on proliferative, osteogenic, and angiogenic capacities.
- To determine optimal vancomycin loading for bone regeneration.
Main Methods:
- Seven groups of PMMA spacers with vancomycin concentrations (0-10 g) were prepared.
- New Zealand white rabbits with segmental radius defects received PMMA spacers.
- Immunohistochemistry and real-time PCR analyzed tissue toxicity, proliferation, osteogenesis, and angiogenesis.
Main Results:
- No significant toxicity was observed in the animal model.
- Low vancomycin concentrations (1-4 g) showed no adverse effects and potentially enhanced osteogenesis and angiogenesis.
- High vancomycin concentrations (>6 g) significantly reduced osteogenic capacity, cell proliferation, and angiogenesis.
Conclusions:
- PMMA spacers with 1-4 g vancomycin are safe and can promote induced membrane capacity.
- Higher vancomycin concentrations (6-10 g) negatively affect osteoblast viability, angiogenesis, and proliferation.
- These findings guide the selection of appropriate vancomycin concentrations in PMMA spacers for bone defect treatment.
