Orthobiologics

• Published in: Evidence‐Based Orthopedics pp. 100 - 116
• Main Authors: Axelrad, T. William, Einhorn, Thomas A
• Format: Book Chapter
• Language: English
• Published: Oxford, UK Wiley‐Blackwell 09.12.2011
• Subjects: anterior lumbar interbody fusion (ALIF); endothelial precursor cells (EPCs); European Medicines Agency (EMA); Orthobiologics; Quality of the evidence
• ISBN: 9781405184762; 1405184760
• DOI: 10.1002/9781444345100.ch13

Bone, in contradistinction to most other tissues, heals with restoration of its original morphology. This occurs through a coordinated sequence of events that involves a local inflammatory response and recruitment of progenitor cells that first create the extracellular matrix upon which calcium hydroxyapatite is later deposited. This process is typically successful, so that bony union and restoration of load‐bearing function is ultimately achieved. However, some patients suffer from an prolonged or aborted process that can result in delayed union or nonunion. Determining which patients are at risk for these complications is the subject of intense research, as costs are significant when bone healing is disturbed. Bone growth factors are now available to the clinician and their potential uses are expanding, although the evidence that supports their use is limited. Here, we review the perceived risks for nonunion and delayed union and the available evidence for the use of orthobiologics in both the acute treatment of fractures and in reconstructive scenarios, as well as the reported complications of the use of these materials.