Search PubMed⌕ Search

Biomedical subjects

P Buma

Publications and source records attributed to P Buma.

At least 73 records · Page 4Linked to original sources
PubMed1998

Acetabular reconstruction with impacted morselized cancellous allografts in cemented hip arthroplasty: a histological and biomechanical study on the goat.

Bone defects in total hip arthroplasty revision surgery can be restored with different types of bone graft. The use of impacted morselized allograft chips in combination with cement is the treatment of our choice. To establish the incorporation capacity of the grafts and mechanical stability of the implant, an animal model in the goat was developed. An acetabular defect was created and restored with morselized grafts and a cemented cup. Postoperative performance of the reconstruction was followed both histologically and biomechanically. Histology showed that consolidation of the graft with the host bone bed had occurred within 3 weeks. In the following period a front of vascular sprouts infiltrated the graft. Graft resorption, woven bone deposition, and subsequent remodeling resulted in a new trabecular structure. This structure contained only scarce remnants of the original dead graft material. At the graft-cement interface, graft resorption and new bone formation had resulted in areas of direct vital bone-cement contact. Locally, a soft tissue interface was present. After longer follow-up periods, progressive interface formation and loosening of the cups were found in most animals. Mechanical testing showed that the stability of the reconstruction increased during the first 12 postoperative weeks. Thereafter, the stability decreased, probably by soft-tissue interface formation at the graft cement interface. We conclude that cemented morselized allografts have a high capacity to incorporate. Initial cup stability is adequate to provoke graft incorporation with decreasing stability after the incorporation process has been completed.

Acetabulum↗
PubMed1998

Viability of the acetabular bone bed at revision surgery following cemented primary arthroplasty.

Loosening of total hip replacements is often associated with severe loss of periprosthetic bone. The notion exists that the remaining bone is sclerotic, avascular, and displays little osteogenic activity, and that it therefore potentially compromises the revitalization of bone grafts used to restore bony defects. To verify this opinion we studied the bone characteristics in acetabular bone biopsies taken at primary total hip arthroplasty (PTH) and revision total hip arthroplasty (RTH) for a cemented PTH. In 6 PTH patients and in 10 RTH patients, acetabular bone biopsies were taken from the roof, the center, and the lower rim of each acetabulum. Specimens were evaluated by light microscopy and histomorphometrically measured for specimen size, bone area, perimeter, active osteoid perimeter, number of vessels, and osteoclasts. The vascularity and vitality appeared to be comparable in the RTH and PTH bone biopsies. However, the trabecular organization of the RTH bone differed from that of the PTH biopsies. In the PTH biopsies, the trabeculae were running perpendicular to the subchondral bone layer, whereas in the RTH biopsies the layers of bone were oriented parallel to the implant surface. There was abundant remodeling activity in the RTH bone, with large quantities of active osteoid and osteoclasts. These histologic parameters differed, but not statistically significant, from the PTH biopsies. In conclusion, we found that at revision, the acetabular bone was viable with sufficient vascularity and remodeling activity to provide an acceptable recipient host bone bed for revision surgery combined with bone grafting.

Acetabulum↗
PubMed1998

Effect of transforming growth factor-beta on proteoglycan synthesis by chondrocytes in relation to differentiation stage and the presence of pericellular matrix.

The effects of transforming growth factor-beta (TGF-beta) on proteoglycan synthesis of chondrocytes are controversial. The hypothesis that the differential effect of TGF-beta is related to the differentiation stage of the chondrocytes is investigated in this study. Rabbit auricular chondrocytes were cultured in alginate. When seeded in alginate immediately after isolation, cells keep their cartilaginous phenotype. When cells are first cultured in monolayer, they lose their cartilaginous phenotype and become dedifferentiated. We used three different cell populations: (1) Differentiated cells (P0: immediately after isolation); (2) partially (de)differentiated cells (P1: after one passage in monolayer); (3) dedifferentiated cells (P4: after four passages in monolayer). Cells were characterized by morphology using electron microscopy, amount of proteoglycans using the Farndale assay and type of collagen produced using immunohistochemistry. The effects of addition of 10 ng/ml TGF-beta2 for 7 days to P0, P1 and P4 cells were compared. TGF-beta was added either directly from the start of the alginate culture, or after a preculture period of three weeks in alginate. The amount of proteoglycans was increased in all chondrocyte populations when TGF-beta was added immediately after seeding in alginate, indicating that the effect of TGF-beta on proteoglycan synthesis does not depend on the differentiation stage of cells. After preculture in alginate, stimulation of proteoglycan synthesis (as measured by amount of proteoglycans and 35S-sulfate incorporation) had vanished. This effect was independent of differentiation stage . A dose-response experiment with TGF-beta (1, 10, 50 ng/ml) confirmed this differentiation-stage-independent effect of TGF-beta on proteoglycan synthesis. Stimulation by TGF-beta can be retained after enzymatic digestion of the pericellular matrix and reseeding of the cells in alginate, indicating the importance of pericellular matrix for the effect of TGF-beta on matrix synthesis. Alkaline phosphatase (ALP) activity was largely inhibited by TGF-beta in P0 chondrocytes, either with or without preculture in alginate. After culturing in monolayer, ALP activity was not substantially changed by TGF-beta. This indicates that the effect of TGF-beta on ALP activity, in contrast to the effect on proteoglycan synthesis, does depend on the differentiation stage of the cells. Furthermore, the fact that ALP synthesis in P0 cells is still inhibited by TGF-beta after preculture indicates that these cells remain responsive to TGF-beta. This provides additional evidence for the importance of the pericellular matrix for regulation of the effect of TGF-beta on proteoglycan synthesis. The results indicate that, in pathological cartilage, matrix depletion might be the trigger for increased matrix synthesis in reaction to TGF-beta, suggesting an important role for TGF-beta in cartilage repair.

Animals↗
PubMed1998

Acetabular reconstruction with impacted morsellised cancellous bone graft and cement. A 10- to 15-year follow-up of 60 revision arthroplasties.

We report a long-term review of 60 acetabular components revised using impacted, morsellised bone allografts and a cemented polyethylene cup. The acetabular defects were cavitary (37) or combined (23). Follow-up was for a mean 11.8 years (10 to 15). Further revision was needed in five hips, two for septic and three for aseptic loosening. The overall survival rate at 11.8 years was 90%; excluding the septic cases it was 94%. Acetabular reconstruction with impacted morsellised cancellous grafts and cement gives satisfactory long-term results.

Acetabulum↗
PubMed1998

Innervation of the equine mature and immature proximal sesamoid bone by calcitonin gene-related peptide and substance P-containing nerves.

OBJECTIVE: To localize and determine relative frequency of occurrence of calcitonin gene-related peptide (CGRP) and substance P (SP) fibers in the proximal sesamoid bones (PSB) and adjacent structures in sound horses. SAMPLE POPULATION: 4 foals and 3 adult horses. PROCEDURE: Medial PSB and adjacent ligaments of both forelimbs were collected, flushed, and fixed in buffered 4% formalin. The left PSB were cut into 5 longitudinal, sagittally oriented slabs, and the right PSB were cut into 5 transverse slabs. After decalcification in EDTA, slices were transferred to a 30% sucrose solution, deep frozen, sectioned (80 microm), and stored in Tris-buffered saline solution for free-floating immunocytochemical processing, staining of which was performed by use of the peroxidase-antiperoxidase method with polyclonal rabbit antibodies against CGRP and SP. Sections were examined by light microscopy. RESULTS: Calcitonin gene-related peptide and SP fibers were present throughout the PSB; in ligaments, they were concentrated at the attachment sites. Presentation of the fibers, the innervation pattern, and intensity in the bones of horses differed from that in foals, in which the fibers were more delicate and frequency of occurrence was lower. In horses, innervation with CGRP and SP fibers was more dense in the periphery of the bone, whereas in foals, local difference in innervation of the bone was not evident. With the exception of the intersesamoidean ligament, ligaments were more richly innervated than was bone. CONCLUSION: Presence of the nociceptive peptides CGRP and SP indicated that the PSB and, more practically, the adjacent ligaments are sensitive structures.

Aging↗
PubMed1997

Oto- spondylo-megaepiphyseal dysplasia (OSMED): clinical description of three patients homozygous for a missense mutation in the COL11A2 gene.

We describe a syndrome of midface hypoplasia, non-progressive sensorineural deafness and epiphyseal dysplasia in 3 sibs born to consanguineous parents. Clinical and roentgenographic findings are compatible with a diagnosis of oto-spondylo-megaepiphyseal dysplasia (OSMED). Histologic study of cartilage shows severe osteoarthritis, which may necessitate joint replacements in early adulthood. Ultrastructurally, collagen fibrils are increased in diameter and show aggregation. These findings have not been reported previously and may be diagnostic of OSMED. The affected sibs are homozygous for a COL11A2 missense mutation. We compare the clinical findings in our patients with a group of patients who have a dominantly inherited, non-ocular form of Stickler syndrome due to a COL11A2 splice-site mutation. Both syndromes include midface hypoplasia, epiphyseal dysplasia, and deafness, more pronounced in OSMED. Since mutations affecting the collagen XI genes can obviously result in a spectrum of phenotypes, we performed a literature-search using POSSUM, OSSUM, and the LDDB to identify conditions that might also be caused by mutations in one of the collagen XI genes. A number of conditions matched the search terms in all databases. Of these, Marshall syndrome is very similar to OSMED. Considering these phenotypic similarities and the close association between the COL11A1 and COL11A2 gene products, we propose that Marshall syndrome may be caused by a mutation in COL11A1. We also identify a number of other conditions that could be caused by mutations in one of the collagen XI genes.

Abnormalities, Multiple↗
PubMed1997

Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat.

We hypothesized that reduced stem stiffness of orthopaedic implants contributes to a high risk of loosening, since interface stresses and relative motions may exceed a tolerable range. To study this hypothesis, three types of load-bearing implant with different stiffnesses were inserted into the tibia of the goat. Histological analysis was performed of bone repair after insertion of the implant, bone ingrowth, interface disruption and loosening. A finite element model of the configuration provided the quantitative range of interface stresses and relative motions for the present experiment. The implants were made out of stainless steel, hollow titanium and a thin titanium core covered with a polyacetal coating. The stiffness ratios of these implants were approximately 10:4:1, respectively. All implants were coated with a layer of hydroxyapatite (HA) in order to minimize the possible biological effects of the different implant materials. Irrespective of the type of implant, there was a repair phase that lasted 6-12 weeks. The stiff implants functioned well. Large areas of bone bonding to the HA layer were found after the repair phase at 12 weeks postoperatively. After 24 weeks, some signs of loosening were observed. More loosening occurred with the hollow titanium and polyacetal implants, mainly during the repair phase. Three hollow titanium and three polyacetal coated implants survived this period, and were killed after 24 weeks. The integrity of the HA layer at the bone-implant interface of the titanium implants was good. In the polyacetal implants, the repair reaction of the cortical bone was incomplete. Bone ingrowth into HA was largely lacking. In conclusion, we found significant differences in the repair and interface reactions around implants of different stiffness. Stiff implants showed favourable initial interface conditions for bone ingrowth. Intermediate and flexible implants provoked unfavourable interface conditions for initial bone ingrowth. The finite element study showed that the flexible stems produce larger micromotions and higher interface stresses at the bone-prosthesis interface than the stiff stems, indicating an explanation for the histological findings.

Acetals↗
PubMed1997

The repeated sampling bone chamber: a new permanent titanium implant to study bone grafts in the goat.

We developed a repeated sampling bone chamber (RSBC) and tested its suitability for studying various aspects of the bone allograft incorporation process under reproducible nonload-bearing experimental conditions in a large vertebrate. Our chamber is made of commercially pure titanium and is designed to allow bone or tissue ingrowth into a removable hollow inner core. Three chambers per animal were randomly implanted in the tibias of 10 goats and were harvested every 8 weeks. In experiment 1, two chambers were filled with a fresh-frozen structural allograft or a chip allograft, and one was left empty. In experiment 2, all chambers were left empty to measure intra- and interanimal variation. The results were evaluated by histomorphometry. Clinical results of four growth factor experiments also are presented. Using this model, we conducted 60 harvest operations (median, 4/animal; range, 2 to 8). In experiment 1, more soft tissue ingrowth and osteoclasts were measured in the chambers with allograft (P < 0.005 and P < 0.03 respectively). Bone ingrowth was scant, with no significant differences between chip graft, structural graft, and empty control chamber. Thus, the bone graft did not show any osteoinductive or osteoconductive properties. Experiment 2 indicated consistent tissue ingrowth, with greater interanimal variation than variations among the chambers in any goat. Our method forms a means of studying gradual tissue and bone ingrowth into bone grafts. The inherent low amount of bone ingrowth makes this model suitable for studying bone-inductive substances. Repeated sampling in the same animals lowered the intersample variability and reduced the number of animals that were required.

Animals↗
PubMed1996

Osteocyte density and histomorphometric parameters in cancellous bone of the proximal femur in five mammalian species.

The species-specific relationships between trabecular morphology and osteocyte density were investigated in the femoral heads of 30 adult animals of five mammalian species (rat, rabbit, Rhesus monkey, pig, and cow). Our hypothesis is that osteocytes are mechanosensory cells and are involved in the regulation of bone remodeling. According to the predictions from a simulation model, this hypothesis implies that the influencing distance of osteocytes, together with the magnitude of the mechanical loads, determines the thickness of trabeculae and that the number of osteocytes primarily affects the rate of bone remodeling. The number of osteocytes per bone volume ranged from 93,200 mm-3 in rat to 31,900 mm-3 in bovine cancellous bone. Osteocyte density was inversely related to the size of the species. Since basal metabolic output is related to body mass, we speculate that osteocyte density may be related to metabolic rates. Trabecular thickness was larger in the cow than in the other species, but the range of variation between species was relatively small. This agrees with the hypothesis that trabecular thickness is limited by the domain that can be regulated by an osteocyte and that this domain is of similar size regardless of the species. Only in the rat was trabecular thickness considerably smaller than in the other species. This is probably due to the presence of the cartilaginous growth plate in the femoral head of the rat. The relationships with species are different for osteocyte density than for morphometric parameters. Hence, our data support our hypothesis that osteocyte density is not directly associated with the macroscopic trabecular architecture.

Animals↗
PubMed1996

Biomechanical and histological evaluation of a hydroxyapatite-coated titanium femoral stem fixed with an intramedullary morsellized bone grafting technique: an animal experiment on goats.

To reconstruct femoral intramedullary bone-stock loss in revision surgery of failed total hip arthro-plasties, morsellized trabecular bone grafts can be used. In 14 goats a noncemented hydroxyapatite-coated titanium stem was fixed within a circumferential construction of bone allografts. After 6 or 12 wk, four goats were used for mechanical tests and three for histology. The stability of the stems relative to the bone was determined in a loading experiment with Roentgenstereo-Photogrammatic Analysis (RSA). Owing to two loosenings and two fractures, only one 6-wk specimen and three 12-wk specimens were available for mechanical testing. The prostheses were very stable at 12 wk. The most important movements were axial rotation (maximal 0.17 degrees at 800 N) and subsidence (maximal 0.036 mm at 800 N). After unloading, there was 40-60% elastic recovery. Histological examination showed revascularization and remodelling of the graft in all the specimens investigated. At the graft site, bone apposition and bone resorption had resulted in a mixture of graft and new bone. Bone incorporation was mainly seen in the proximal areas. Graft lysis was evident in the midshaft region and at distal levels around the prostheses.

Animals↗
PubMed1996

Reconstruction of the flexor tendon sheath. An experimental study in rabbits.

The role of the tendon sheath in flexor tendon healing was investigated in rabbits. Tendon sheath was reconstructed with syngeneic parietal peritoneum or a non-tanned processed porcine collagen membrane. Resection of the tendon sheath led to adhesions. Reconstruction of the sheath with either graft resulted in a synovial-like lining, resembling a neo-tendon sheath. Even when combined with tendon repair a neo-tendon sheath was seen after reconstruction with both grafts, without adhesions. Subcutaneously implanted processed porcine collagen membrane was completely resorbed in less than 3 months.

Animals↗
PubMed1996

Total replacement of the metatarsophalangeal joint in the horse. A single pilot study.

In this paper the successful replacement of an equine metatarsophalangeal joint by a human total condylar knee prosthesis is reported. In the period of observation following implantation of the endoprosthesis the experimental animal showed almost no lameness when exercised at walk, bearing weight on the operated limb. Flexion and extension of the joint were markedly reduced. The clinical and histological observations clearly support further investigation into the equine metatarsophalangeal joint replacement by an endoprosthesis.

Animals↗
PubMed1996

Acetabular and femoral reconstruction with impacted graft and cement.

Loosening of primary cemented and noncemented components of total hip arthroplasties always is accompanied by a loss of bone stock. There are several options for reconstruction of the acetabular and femoral defects. The authors' treatment of choice is a standardized cemented revision procedure with tight impaction of morsellized cancellous autograft or allograft chips in acetabular and femoral reconstructions. In this study, the clinical and radiographic evaluation of acetabular defects reconstructed with impacted morsellized allograft femoral heads was described. A cemented cup supplemented with morsellized cancellous grafts and wire meshes in cases of segmental defects was sufficiently stable to allow for complete graft consolidation. After a mean followup of 70 months of 88 hips, 4 cases of clinical failures (including 1 infection) and 6 cases of radiologic failure of the reconstructions were observed, resulting in a failure percentage of 11.4% after 5 years. Autografts and allografts were equally effective. Because the clinical success of the technique also was supported by the results of histologic and biomechanic studies in animals, the authors were encouraged to continue this technique, not only in the acetabulum, but also in the femur.

Acetabulum↗
PubMed1996

Traumatic heterotopic bone formation in the quadriceps muscle. No progression by continuous passive motion in rabbits.

One hind limb in each of 20 New Zealand White rabbits was immobilized for 3 weeks together with daily forcible manipulation to induce heterotopic bone formation in the quadriceps muscle. The rabbits were then divided equally into a control group and a group treated with continuous passive motion (CPM). The effect of CPM on the development of heterotopic bone formation was assessed by radiographs of the femur and by histology. Treatment with CPM did not lead to increased heterotopic bone formation, as compared to the control group.

Animals↗
PubMed1996

Impacted graft incorporation after cemented acetabular revision. Histological evaluation in 8 patients.

We took core biopsies from the acetabulum in 8 patients (at reoperation) after a previous revision with impacted cancellous allograft chips in combination with cement. Except for one biopsy specimen, the graft showed different stages of incorporation. In the specimens taken at 4 months, revascularization of the graft was found. Osteoclasts had removed parts of the graft, while woven bone had formed on the remnants of the graft and in the stroma that was invading the graft. Subsequent specimens showed that this mixture of graft and new bone was in due time remodeled into a normal trabecular bony structure with viable bone marrow that contained little or no remnants of the original graft. The graft-cement interface was present in 4 biopsies taken at 1, 22, 28, and 72 months. The specimen obtained 28 months after revision showed vital bone locally in direct contact with the cement layer; however, a soft tissue interface predominated.

Acetabulum↗
PubMed1995

Changes in innervation of long bones after insertion of an implant: immunocytochemical study in goats with antibodies to calcitonin gene-related peptide and B-50/GAP-43.

In this study, we describe the distribution of fibres that contain calcitonin gene-related peptide in normal bones and in bones that are remodeling after insertion of an implant. With routine histology and antibodies to calcitonin gene-related peptide, small neural and free-running fibres staining positively for calcitonin gene-related peptide were found in the periosteum, endosteum, and cortical bone of the tibia in the goat. In many cases, the free-running fibres were associated with blood vessels that entered the bone through Volkmann's canals. The endosteal blood supply was destroyed as a result of insertion of the implant. The necrotic bone was no longer innervated, as shown by the lack of staining for the antibodies. At 6 weeks, a repair phase started with revascularization and remodeling of the necrotic endosteal bone. During this repair phase, there was increased innervation with fibres containing calcitonin gene-related peptide in the remodeling cavities at the interface between living and necrotic bone. These fibres ended blindly, with many large varicosities, and could be demonstrated by immunostaining with monoclonal antibodies to B-50/growth associated protein-43, an antibody to outgrowing neuronal fibres. The correlative occurrence between extensive sprouting of fibres containing calcitonin gene-related peptide and the remodeling of necrotic endosteal bone suggests that sensory fibres with calcitonin gene-related peptide have a regulatory role in the control of angiogenesis or of bone remodeling associated with the insertion of an implant, or with both processes.

Animals↗
PubMed1995

Chondrocyte behaviour within different types of collagen gel in vitro.

In cartilage repair experiments chondrocytes are transplanted into osteochondral defects. Biological substances are used as cell vehicles and are likely to play an important role in the outcome of these studies. Collagen gel is formed by polymerization of type I collagen and is used in plastic surgery and for three-dimensional culture systems. To test collagen gel as a potential vehicle for transplantation, we evaluated chondrocyte behaviour in vitro in different collagen gels. Collagen type I was extracted and purified from rat tail tendon and fetal calf skin and compared with commercially available collagen type I. After suspension of bovine chondrocytes, five different collagen gels were cultured for 14 days and evaluated by light and electron microscopy. Cells proliferated within all gels and synthesized proteoglycans as assessed by 35S incorporation; 40-90% of cells maintained a chondrocyte-like morphology after 1 week in culture depending on the type of collagen gel. Synthetic and secretory activity was confirmed by electron microscopy. Based on these results, calf skin collagen is recommended for culturing chondrocytes for implantation.

Animals↗