RANKL
From osteoblasts; cause macrophage fusion = osteoclast formation
How does the body deal with most bone graft substitutes
Creeping substitution
Describe creeping substitution
The body gets rid of a little of the bone graft substitute as it replaces that little bit with
something better, something of its own.
In time, all of the bone graft substitute will be gone and will have been replaced with
autologous tissue.
Wolff's law
Bone will respond (model or remodel) to the forces placed on it by either building and
becoming stronger, or breaking down and becoming weaker.
Stress shielding
Bone is shielded, tissue breaks down (weak)
Load Sharing
Load is shared between implant and bone, igniting wolff's law, race between tissue
healing and implant failure.
Name some key benefits to synthetic bone graft substitutes
Terminally sterile (safe), readily available, tend to be less expensive (except infuse)
because they are made of man-made or xenograft derived materials (supply and
demand), 510(k) indication provides a path to on-label use.
CBM's (cellular bone matrix)
Contain live cells (cryopreserved, aseptic), sourced from young healthy donors
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