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Choosing the Right Bone Substitute

When trauma occurs affecting the bones, fractures and bone loss may be an added complication. Surgery is often needed to stabilize the area. Healing may be delayed. Bone grafts can be used to help fill in gaps and speed up the process.

The subject of this article is the new bone substitute material available. There are several different types of chemical compounds on the market. Studies to compare them are very limited. For now, the surgeon is on his or her own to know about each one and to choose the best product for each patient.

Dr. D. J. Hak from the University of Colorado School of Medicine summarizes information about bone graft substitutes. He specifically offers the pros and cons of using five substitute products. These include coralline hydroxyapatite (Pro Osteon), collagen-based matrices (Collagraft or NeuGraft), calcium phosphate cement (Norian SRS, Callos) calcium sulfate (Osteoset), and tricalcium phosphate (IsteoMax, Cerasorb,and many others).

These products vary in strength, composition, and the rate that the bone grows or is absorbed. They come in various forms such as pellets, paste, blocks, or granules. Bone graft substitutes are not used alone. They must be used along with instrumentation. Instrumentation refers to plates, screws, and wires used to hold bone fragments together.

Sometimes bone graft substitutes are used along with bone harvested from the patient. The combined use may be needed when the bone defect is very large. The surgeon may choose the substitute based on whether it works to fill in a structural defect or extends across an open fracture site.

The surgeon must be aware that new bone formation is different from person to person and from bone to bone. This is one of the reasons why research results are so limited right now.

The surgeon must also keep in mind when bone graft substitutes should not be used at all. Patients who have osteomyelitis are not good candidates. Anyone who is sensitive to collagen products can't receive the collagen-based matrices.

The surgeon has many other factors to consider. For example, problems can occur if the body absorbs the bone substitute too fast or too slow. Infection is always a concern. Sometimes, the tissue just won't accept the new bone material. The cost must also be considered, especially if the results are poor.

The author reviews the outcomes of studies published so far for each material. He stresses the need for each surgeon to know the products well before using them. Choosing the right patients and using the best material for that situation is very important.

References: David J. Hak, MD, MBA. The Use of Osteoconductive Bone Graft Substitutes in Orthopaedic Trauma. In Journal of the American Academy of Orthopaedic Surgeons. September 2007. Vol. 15. No. 9. Pp. 525-536.

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