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Comparison of Autograft with Other Materials

Table prepared by David L. Nelson, MD
Last updated: 11/21/99
Terms:
Osteoinduction: induces the formation of new bone by means of cytokines, such as BMP, which are proteins that influence adjacent cells to transform into osteoblasts.
Osteoconduction: provides a scaffold for the cells to move into the area and create new bone.
Osteogenesis: living cells which are or transform into osteoblasts and create new bone.
 

      Material
      Examples
      Advantage
      Disadvantage

    
 autograft bone


    

    
 


    
    
      
  • cortical,
      
  • cancellous
      
  • corticocancellous
    


    

    
    
      
  • no autoimmune incompatibility
      
  • best for osteoinduction,
      osteoconduction and osteogenesis
      
  • possibly decreased cost
    


    
    
      
  • donor site morbidity
      
  • increased operative time
      
  • possibly increased cost
    



     allograft bone
    
    
      
  • frozen
      
  • freeze dried
      
  • demineralized
    


    
    
      
  • no donor site morbidity
      
  • potential for osteoconduction
      and/or osteoinduction, varies with processing techniques used
    


    
    
      
  • immunogenic
      
  • structurally weaker
      
  • poorer inductive, conductive
      properties
      
  • not osteogenic
    



     matrix proteins
    
    
      
  • Grafton
      
  • Dynagraft
    


    
    
      
  •  osteoinductive
    


    
    
      
  • immunogenic
      
  • no structural properties
      
  • most not osteoconductive
      
  • not osteogenic
    



     synthetic substitutes

       
      

        
        
    
          
  •  mineral
        


        
        
 


        
    
          
  • Interpore ProOsteon (from
          coral)
          
  • Wright OsteoSet
        


        
        
    
          
  • osteoconductive
        


        
        
 


        
    
          
  • variable strength
          
  • remodeled poorly
          
  • not osteoinductive
          
  • not osteogenic
        


      

      

        
        
    
          
  •  mineral cements
        


        
        
    
          
  • Norian SRS
          
  • Stryker/Howmedica BoneSource
          
  • Etex a BSM
        


        
        
    
          
  • some structructural strength
          
  • Norian is currently available
          in US but has only a limited release; available in Europe; others
          available in Europe and elsewhere
        


        
        
    
          
  • not PMMA!
          
  • collapses without support
          
  • not all yet available
          in US, but are available in Europe and elsewhere
        


      

      

        
        
    
          
  •  mineral + collagen
        


        
        
    
          
  •  Zimmer
          Collagraft
        


        
        
    
          
  • osteoconductive
        


        
        
    
          
  • no structural stength
        


      

      

        
        
    
          
  •  mineral + collagen
          +cytokine (bone growth factor)
        


        
        
    
          
  •  in development (PMA,
          IDE)
        


        
        
    
          
  • osteoconductive
          
  • osteoinductive
        


        
        
    
          
  • not yet available
        


      

      

        
        
    
          
  •  collagen +cytokine
          (bone growth factor)
        


        
        
    
          
  • in development (PMA, IDE)
          
  • (Novos, with OP-1)
    
              
        


        
        
    
          
  • osteoconductive
          
  • osteoinductive
        


        
        
    
          
  • not yet available


All of the above would be osteogenic when mixed with bone graft, but not all can be
  
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