The scaffolds used in this study were: Orthoss®, Orthoss® Collagen (Geistlich Surgery, Wolhusen, Switzerland) and Vitoss® (Stryker, Malvern, PA). Orthoss® is a bovine bone mineral, i.e., hydroxyapatite with nano pores (10–20 nm) and macro pores (100–300 μm). Orthoss® Collagen is a similar material as Orthoss® but is complemented with 10% porcine collagen. Vitoss® is a synthetic beta‐tricalcium phosphate with pores of variable size (1–1,000 μm) and is supplemented with type I bovine collagen. Orthoss® was provided as 2–4 mm granules of total 7 g and with an average volume of 8 mm3 per granule. The whole Orthoss® Collagen scaffold block (500 mg, 10 × 10 × 8 mm, 0.8 cc), was divided into eight equal pieces each of ∼100 mm3 volume. Vitoss® strip (25 × 100 × 4 mm, 10 cc) was punched using 4 mm sterile disposable biopsy punch with plunger (Miltex, NJ) into 50 mm3 particles. To standardize the volume of all scaffolds (100 mm3); 12 granules of Orthoss, one piece of Orthoss® Collagen and two particles of Vitoss® were used for each experiment.
Vitoss
Manufactured by Stryker
Sourced in Switzerland, United States, United Kingdom
Vitoss is a synthetic bone graft material produced by Stryker. It is designed to provide a scaffold for bone formation.
Automatically generated - may contain errors
5 protocols using vitoss
1
Comparative Evaluation of Bone Scaffolds
2
Lumbar Fusion Graft Comparison
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We included patients who underwent instrumented lumbar posterolateral fusion with the use of either DBM (Grafton; Medtronic) or BTP (Vitoss; Stryker) for a degenerative diagnosis; were between the ages 18 and 80 years at the time of surgery; and had a minimum follow-up of 1 year, follow-up clinical outcome questionnaires (ie, Oswestry Disability Index [ODI] and visual analog scale [VAS]) available, and a lumbar CT scan available at the final follow-up period. All patients had no more than one more level decompressed compared with fused.
Patients were excluded if neither bone graft substitutes was used; if they were undergoing treatment with immunosuppressant drugs; if they did not have sufficient follow-up, if they had two or more levels decompressed compared with fusion levels; or if there was no CT scan performed or available for review. Patients treated for lumbar fracture, tumor, or infection were also excluded.
Patients were excluded if neither bone graft substitutes was used; if they were undergoing treatment with immunosuppressant drugs; if they did not have sufficient follow-up, if they had two or more levels decompressed compared with fusion levels; or if there was no CT scan performed or available for review. Patients treated for lumbar fracture, tumor, or infection were also excluded.
3
Autologous Bone Graft Treatment Protocols
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Autologous bone graft (RIA system on tibia, femur and pelvis or iliac crest chip) was used in the BG group. In the TCP + BG group, beta-tricalcium phosphate (Vitoss® , Stryker, Kalamazoo, Michigan, USA) was mixed with autologous bone graft. The NBG group was treated through local interventions such as debridement, shortening resection and sufficient biomechanical stabilization alone.
4
Two-Stage Atrophic Non-Union Treatment
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From April 2012 onward, all patients with an atrophic non-union of a long-bone of their lower limb were prospectively enrolled into this study. From this pool of patients, 30 were randomly selected for this study. Seven of these did not meet inclusion criteria due to insufficient follow-up or insufficient data collection. All patients had previously consented to partake in this study. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the ethics committee of the University of Heidelberg (S-532/2011).
Step-1 surgery consisted of exchange of metalwork, non-union debridement, gathering of microbiological samples and implantation of a Gentamicin-laced cement spacer. On average 55 days afterward, in the second step procedure the induced membrane was carefully opened, the spacer removed and the void filled with a combination of autologous bone (iliac crest, RIA from the femur or fibular graft), BMP-7 (3.3 mg OsigraftTM, eptotermin alpha, Stryker) and tricalciumphosphate (VITOSS, Stryker).
Step-1 surgery consisted of exchange of metalwork, non-union debridement, gathering of microbiological samples and implantation of a Gentamicin-laced cement spacer. On average 55 days afterward, in the second step procedure the induced membrane was carefully opened, the spacer removed and the void filled with a combination of autologous bone (iliac crest, RIA from the femur or fibular graft), BMP-7 (3.3 mg OsigraftTM, eptotermin alpha, Stryker) and tricalciumphosphate (VITOSS, Stryker).
5
Enrichment of Mesenchymal Stem Cells from Bone Marrow
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Unprocessed samples of IC-BM and VB-BM aspirates were seeded onto Vitoss™ (Stryker® UK Limited, Berkshire, UK) as described before [29 (link)]. Briefly, 400μl of BM sample was added into 100mm3 of Vitoss then incubated at 37°C with gentle rocking for 3 hours to enhance the cell attachment. Each BM sample was used to seed Vitoss in duplicate to examine the MSC attachment and survival using microscopy and flowcytometry respectively. The scaffolds were next rinsed with PBS to remove red blood cells then moved into culture plates in the StemMACS MSC Expansion media and cultured for 2 weeks. After culture, for microscopy, the scaffolds were examined for cell attachment using a SP2 TCS confocal laser scanning microscope (Leica, Buckinghamshire, UK). The DAPI (Thermo Fisher Scientific) and Phalloidin (Sigma-Aldrich) dyes were used to detect cell nuclei and actin, respectively. For flowcytometry-dependent characterisation, the scaffolds were digested using 0.25% collagenase (Stem Cell Technologies). and the released cells were characterised for the surface phenotype of MSCs as previously described [29 (link)]. The released cells were stained using CD45, CD90 and CD73 antibodies (BD Biosciences) as well as live/dead markers, CellTrace calcein violet and Aqua-fluorescence reactive dye (Thermo Fisher Scientific), to identify live MSCs.
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