Enhancing the biological integration of massive bone allografts: A porcine preclinical in vivo pilot-study

• Published in: Bone (New York, N.Y.) N.Y.), 2024-10, Vol.187, p.117213, Article 117213
• Main Authors: Evrard, Robin, Manon, Julie, Maistriaux, Louis, Fievé, Lies, Darius, Tom, Cornu, Olivier, Lengelé, Benoit, Schubert, Thomas
• Format: Article
• Language: English
• Subjects: Bone remodeling; Histology & immunohistochemistry; In vivo osseointegration; Massive bone allograft; Perfusion-decellularization
• ISSN: 8756-3282; 1873-2763; 1873-2763
• DOI: 10.1016/j.bone.2024.117213

Critical bone loss can have several origins: infections, tumors or trauma. Therefore, massive bone allograft can be a solution for limb salvage. Such a biological reconstruction should have the ideal biomechanical qualities. However, their complication rate remains too high. Perfusion-decellularization of massive allografts could promote the vitality of these grafts, thereby improving their integration and bone remodeling. Three perfusion-decellularized massive bone allografts were compared to 3 fresh frozen massive bone allografts in a preclinical in vivo porcine study using an orthopedic surgery model. Three pigs each underwent a critical diaphyseal femoral defects followed by an allogeneic intercalary femoral graft on their both femurs (one decellularized and one conventional fresh frozen as “native”) to reconstruct the defect. Clinical imaging was performed over 3 months of follow-up. The grafts were then explanted and examined by non-decalcified histology, fluoroscopic microscopy and immunohistochemistry. Bone consolidation was achieved in both groups at the same time. However, the volume of bone callus appeared to be greater in the decellularized group. Histology demonstrated a superior bone remodeling in the decellularized group, with a higher number of osteoclasts (p