ALLOGRAFTS IN BONE HEALING: BIOLOGY AND CLINICAL APPLICATIONS – serie

What are bone morphogenetic proteins (BMPs) and how can they be used in orthopaedic practice? Ever since Urist proposed in 1976 that protein factors from cortical bone appeared to modulate bone healing in animals, there has been a search for these mysterious osteoinductive components. Now that their structure has been elucidated, they have been purified and cloned, and are now available for the improvement of bone healing.The best source of BMPs is demineralised bone. This bone allograft is used to achieve greater osteoinductive capacity. But are the actions of procurement, processing, demineralisation and sterilisation harmful to the BMPs? Unless the BMPs can be assayed, neither their clinical nor their scientific effectiveness can be appraised. All these aspects are logically and scientifically described in this volume. In addition, there is a review of the biochemistry of one of the two main components of bone, namely collagen. This subject is itself a confusing but rapidly growing field. This comprehensive review describes the procedures for building up bone in vivo and in vitro.Bone Morphogenetic Protein and Collagen answers most of the questions of orthopaedic surgeons and tissue bankers on how BMPs can be produced and used to their maximum effectiveness.

This book describes succinctly the factors which affect the incorporation of massive and morsellised allografts after transplantation. Unless special precautions are taken, massive allografts when implanted can undergo stress fatigue, due to the limited incorporation at the graft-host interface. Immunological and cell signalling growth factors can be shown to greatly influence the behaviour of the graft. The bone-biological processes are illustrated in terms of demineralised bone, which can initiate bone induction due to the protection and availability of the original bone-morphogenic protein. The main message is that transplantation without consideration of the underlying biological healing processes can reduce the effectiveness of the procedure.