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Materials 2018, 11(6), 935; https://doi.org/10.3390/ma11060935

Influence of Absorbable Calcium Sulfate-Based Bone Substitute Materials on Human Haemostasis—In Vitro Biological Behavior of Antibiotic Loaded Implants

1
Klinikum rechts der Isar der Technischen Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaninger Str. 22, 81675 München, Germany
2
Klinikum rechts der Isar der Technischen Universität München, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 München, Germany
3
Chirurgisches Klinikum München Süd, Am Isarkanal 30, 81379 München, Germany
These authors contributed equally to this work.
These authors also contributed equally to this work.
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Received: 20 April 2018 / Revised: 16 May 2018 / Accepted: 30 May 2018 / Published: 1 June 2018
(This article belongs to the Special Issue Bone Substitute Materials)
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Abstract

Calcium sulfate (CS) formulations are frequently implanted as antibiotically impregnated bone substitutes in orthopedic and trauma surgery to prevent or treat bone infections. Calcium ions have been discussed as candidates to accelerate blood coagulation. The goal of this study is to evaluate substance-specific influences of CS formulations on blood coagulation. Specific ELISAs were conducted to determine markers of activated blood coagulation after incubation of human blood with CS beads. Additionally, wettability with freshly drawn human blood was measured. Three different types of CS bone substitute beads were compared (CS dihydrate with tripalmitin, containing Gentamicin (Herafill®-G: Group A) or Vancomycin (CaSO4-V: Group B); and a CS hemihydrate with Tobramycin (Osteoset®: Group C)). Examinations were performed by ELISA assays for F1+2, FXIIa and C3a. Our results prove that none of the CS preparations accelerated single specific assays for activated coagulation markers. This allows the conclusion that neither Herafill®-G (CaSO4-G) nor CaSO4-V alter haemostasis negatively. Blood samples incubated with Osteoset® display an elevated F1+2-activity. The addition of tripalmitin in Herafill®-G shifts the original into a significantly hydrophobic formulation. This was additionally proven by contact angle examination of the three substances with freshly drawn human blood, showing that acceleration of plasmatic coagulation is hindered by lipids and induced by surface effects caused by presence of rapidly soluble calcium ions in the Osteoset® preparation. View Full-Text
Keywords: calcium sulfate formulations; calcium carbonate; tripalmitin; coagulation; in vitro; Herafill®-G; Osteoset®, gentamicin; vancomycin; tobramycin; FXIIa; C3a; F1+2 calcium sulfate formulations; calcium carbonate; tripalmitin; coagulation; in vitro; Herafill®-G; Osteoset®, gentamicin; vancomycin; tobramycin; FXIIa; C3a; F1+2
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Pförringer, D.; Harrasser, N.; Beirer, M.; Crönlein, M.; Stemberger, A.; van Griensven, M.; Lucke, M.; Burgkart, R.; Obermeier, A. Influence of Absorbable Calcium Sulfate-Based Bone Substitute Materials on Human Haemostasis—In Vitro Biological Behavior of Antibiotic Loaded Implants. Materials 2018, 11, 935.

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