Strontium incorporated materials in orthopaedics: gentamicin release in bone cement and scaffolds with highmechanical properties for tissue engineering

Abstract

 Strontium (Sr) is not only widely studied for its compound as a drug for treating osteoporosis, but there is also a growing interest of its addition in orthopaedic biomaterials. Over the years, the development of orthopaedic biomaterials has already advanced to a new era in the search of resorbable and/or bioactive materials. Due to its anabolic and anti-resportive properties of Sr on bone regeneration as a drug, strontium has been extensively investigated for its potential in other orthopaedic applications. The purposes of this study were to investigate strontium containing hydroxyapatite (Sr-HA) bone cement for the delivery of gentamicin and the effects of Sr incorporation in coral and borosilicate glass as bone engineering scaffolds.

Three types of Sr incorporated materials are reported here, in which these include an applied study of the drug elution property of previously published bone cement and two initial studies of the biological properties of newly developed coral and borosilicate scaffolds. Firstly, the gentamicin release, bioactivity and mechanical property of bioactive bone cement filler based on Sr-HA were compared to a commercially available gentamicin-loaded poly(methyl methacrylate) (PMMA). Over the study period of 30 days, the cumulative gentamicin release from Sr-HA bone cement was much greater than PMMA bone cement (+ 34%); better bioactivity of Sr-HA was also confirmed with the apatite formation after simulated body fluid immersion. Goniopora, a highly interconnected porous coral, was hydrothermally converted to coralline hydroxyapatite (CHA) or coated with hydroxyapatite and incorporated with Sr. As the first report of incorporating Sr into coral with the structure remained, about 4-16% Sr was detected on CHA. Sr-HA coated coral was studied in vitro and in vivo (ovariectomized rat model) resulting in better cell proliferation and higher scaffold volume retention (+40%). Finally, the development of Sr incorporated borosilicate (SrB) glass scaffold explored a new material for bone tissue engineering, but more importantly, it introduced a phenomenal idea of the stimulatory effect of a local alkaline microenvironment on bone regeneration. Detections of an exceedingly high pH (~ pH 8.6) condition on the material surface and release of Sr, Si and B ions during the degradation of scaffold SrB were confirmed to stimulate osteoblasts and facilitate apatite formation. Although new bone was observed on both scaffolds, higher bone area/tissue area (B.Ar/T.Ar) on scaffold SrB indicated more new bone formation over borosilicate scaffold without Sr addition.

The significance of this study is to explore and develop three orthopaedic biomaterials advancing the stimulatory effects of Sr on bone regeneration. The drug elution properties of Sr-HA bone cement provides a fascinating alternative for treating osteomyelitis. Furthermore, by incorporating Sr into CHA and borosilicate scaffold, it brings out the importance on the readiness of the Sr release of the materials in order to deliver the stimulatory effects. Subsequently, a localized pH micro-environment arisen by material degradation is emphasized as a controlling factor in bone regeneration on biomaterials.