Speaker: Orthobiologics hold great promise for the care of hip fractures

WAILEA, Hawaii — Orthobiologics offer a faster track in hip fracture healing and show great promise for the future, according to a presenter, here.

“The most exciting thing is that everything is about to change,” Thomas A. “Toney” Russell, MD, said at Orthopedics Today Hawaii 2014.

Orthopedic surgeons are looking to orthobiologics to increase fracture construct stability and avoid complications such as avascular necrosis, varus collapse, shortening and nonunion in cases of femoral neck fractures and implant cut-out and shortening in pertrochanteric fractures. This is needed because several recent studies show continuing declines in functional status following traditional, non-augmented treatment of hip fractures.

Thomas A. Russell, MD

Thomas A. “Toney” Russell

“We are no better than we were 50 years ago,” Russell, a professor emeritus at the Campbell Clinic and president of Innovision Inc., said. “This is the killer. In the first year, if you survive after hip fracture, you have a 50% deterioration in your function.”

Current uses

Orthobiologics that are currently being evaluated include implant surface enhancements, such as hydroxyapatite coatings, systemic medications applied to the implants, including bisphosphonates and systemic medications such as parathyroid hormone.

Numerous published studies have shown that the usefulness of orthobiologics has been compromised by our inability to deliver biomaterials into the surgical environment with the correct dose and placement. New options permit the use of structural orthobiologic matrices — the new term for current calcium phosphate cements — as delivery vehicles for osteogenic materials applied through special implants which permit controlled insertion around and through the implant; these techniques need clinical study and validation.

“What has evolved in the calcium phosphate technology of the world is that everything has changed as far as the structural matrix properties,” Russell said. “Now we are talking about intrusion modification into bone trabeculae. We can make the cements more cohesive so they do not flow as easily out of the working zone. We can change the porosity and interconnectivity to maximize cellular replacement. We can change the working time vs. the replacement and curing time. It is a new world for this stuff.”

Looking ahead

Future options for orthobiologics may include the use of new calcium phosphate cements with increased porosity for cellular transfer, improved mixing and delivery methods, as well as implant interface augmentation, he said.

“The biggest thing we have to figure out is how much to put in and where so that we do not interfere with fracture healing and how these things bio-integrate over time,” Russell said. – by Kristine Houck, MA, ELS, and Gina Brockenbrough, MA

Reference:
Russell TA. Will orthobiologics help fixation in hip fractures. Presented at: Orthopedics Today Hawaii 2014; Jan. 19-23, 2014; Wailea, Hawaii.
For more information:
Thomas A. “Toney” Russell, MD, can be reached at Innovision Inc., 1975 Nonconnah Blvd, Memphis, TN 38132; email: tarmd@aol.com.
Disclosure: Russell receives a salary from Innovision Inc.; royalties from Smith & Nephew; is a patent holder for Innovision Inc., Smith & Nephew and Zimmer; and has ownership interest in Etex and Innovision Inc.

WAILEA, Hawaii — Orthobiologics offer a faster track in hip fracture healing and show great promise for the future, according to a presenter, here.

“The most exciting thing is that everything is about to change,” Thomas A. “Toney” Russell, MD, said at Orthopedics Today Hawaii 2014.

Orthopedic surgeons are looking to orthobiologics to increase fracture construct stability and avoid complications such as avascular necrosis, varus collapse, shortening and nonunion in cases of femoral neck fractures and implant cut-out and shortening in pertrochanteric fractures. This is needed because several recent studies show continuing declines in functional status following traditional, non-augmented treatment of hip fractures.

Thomas A. Russell, MD

Thomas A. “Toney” Russell

“We are no better than we were 50 years ago,” Russell, a professor emeritus at the Campbell Clinic and president of Innovision Inc., said. “This is the killer. In the first year, if you survive after hip fracture, you have a 50% deterioration in your function.”

Current uses

Orthobiologics that are currently being evaluated include implant surface enhancements, such as hydroxyapatite coatings, systemic medications applied to the implants, including bisphosphonates and systemic medications such as parathyroid hormone.

Numerous published studies have shown that the usefulness of orthobiologics has been compromised by our inability to deliver biomaterials into the surgical environment with the correct dose and placement. New options permit the use of structural orthobiologic matrices — the new term for current calcium phosphate cements — as delivery vehicles for osteogenic materials applied through special implants which permit controlled insertion around and through the implant; these techniques need clinical study and validation.

“What has evolved in the calcium phosphate technology of the world is that everything has changed as far as the structural matrix properties,” Russell said. “Now we are talking about intrusion modification into bone trabeculae. We can make the cements more cohesive so they do not flow as easily out of the working zone. We can change the porosity and interconnectivity to maximize cellular replacement. We can change the working time vs. the replacement and curing time. It is a new world for this stuff.”

Looking ahead

Future options for orthobiologics may include the use of new calcium phosphate cements with increased porosity for cellular transfer, improved mixing and delivery methods, as well as implant interface augmentation, he said.

“The biggest thing we have to figure out is how much to put in and where so that we do not interfere with fracture healing and how these things bio-integrate over time,” Russell said. – by Kristine Houck, MA, ELS, and Gina Brockenbrough, MA

Reference:
Russell TA. Will orthobiologics help fixation in hip fractures. Presented at: Orthopedics Today Hawaii 2014; Jan. 19-23, 2014; Wailea, Hawaii.
For more information:
Thomas A. “Toney” Russell, MD, can be reached at Innovision Inc., 1975 Nonconnah Blvd, Memphis, TN 38132; email: tarmd@aol.com.
Disclosure: Russell receives a salary from Innovision Inc.; royalties from Smith & Nephew; is a patent holder for Innovision Inc., Smith & Nephew and Zimmer; and has ownership interest in Etex and Innovision Inc.