The Effect of Surgical Technique and Spacer Texture on Bone Regeneration: A Caprine Study Using the Masquelet Technique. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Luangphakdy, Viviane; Pluhar, Elizabeth G.; Piuzzi, Nicolás S.; D'Alleyrand, Jean‐Claude; Carlson, Cathy S.; Bechtold, Joan E.; Forsberg, Jonathan; Muschler, George F.
• Is Part Of: Clinical orthopaedics and related research. Volume 475:Issue 10(2017)
• Publication Date: 2017-10
• Subjects: Orthopedic surgery -- Periodicals; Orthopedics -- Periodicals; Orthopedics -- Research -- Periodicals; Orthopedics -- Periodicals; Research -- Periodicals; Chirurgie orthopédique -- Périodiques; 616.7005
• DOI: 10.1007/s11999-017-5420-8
• Languages: English
• ISSNs: 0009-921X

Abstract

Abstract: Background: The Masquelet‐induced‐membrane technique is a commonly used method for treating segmental bone defects. However, there are no established clinical standards for management of the induced membrane before grafting. Questions/purposes: Two clinically based theories were tested in a chronic caprine tibial defect model: (1) a textured spacer that increases the induced‐membrane surface area will increase bone regeneration; and (2) surgical scraping to remove a thin tissue layer of the inner induced‐membrane surface will enhance bone formation. Methods: Thirty‐two skeletally mature female goats were assigned to four groups: smooth spacer with or without membrane scraping and textured spacer with or without membrane scraping. During an initial surgical procedure (unilateral, left tibia), a defect was created excising bone (5 cm), periosteum (9 cm), and muscle (10 g). Segments initially were stabilized with an intramedullary rod and an antibiotic‐impregnated polymethylmethacrylate spacer with a smooth or textured surface. Four weeks later, the spacer was removed and the induced‐membrane was either scraped or left intact before bone grafting. Bone formation was assessed using micro‐CT (total bone volume in 2.5‐cm central defect region) as the primary outcome; radiographs and histologic analysis as secondary outcomes, with the reviewer blinded to the treatment groups of the samples being assessed 12 weeks after grafting. All statistical tests were performed using a linear mixed effects model approach. Results: Micro‐CT analysis showed greater bone formation in defects with scraped induced membrane (mean, 3034.5 mm 3 ; median, 1928.0 mm 3 ; quartile [Q]1‐Q3, 273.3‐2921.1 mm 3 ) compared with defects with intact induced membrane (mean, 1709.5 mm 3 ; median, 473.8 mm 3 ; Q1‐Q3, 132.2‐1272.3 mm 3 ; p = 0.034). There was no difference in bone formation between textured spacers (mean, 2405.5 mm 3 ; median, 772.7 mm 3 ; Q1‐Q3, 195.9‐2743.8 mm 3 ) and smooth spacers (mean, 2473.2 mm 3 ; median, 1143.6 mm 3 ; Q1‐Q3, 230.2‐451.1 mm 3 ; p = 0.917). Conclusions: Scraping the induced‐membrane surface to remove the innermost layer of the induced‐membrane increased bone regeneration. A textured spacer that increased the induced‐membrane surface area had no effect on bone regeneration. Clinical Relevance: Scraping the induced membrane during the second stage of the Masquelet technique may be a rapid and simple means of improving healing of segmental bone defects, which needs to be confirmed clinically.