These studies are indicative of the potential utility of resorbable and nonresorbable inorganic materials as bone graft substitutes. Bone transplants and bone substitute materials are necessary in +/−10% of all skeletal reconstructive operations. The higher osteogenic potential of autografts compared to allogenic transplants is undisputed, but restricted by limited availability and necessity of secondary operations.

Commercial bone graft materials show variety of compositions and properties, many very different from those of autologous bone. Physicochemical properties of these materials were compared using x-ray diffraction, scanning and transmission electron microscopy. Biological reactivity of different materials was also compared in histological evaluations in animal models. Experimental and clinical studies have been encouraging, especially in metaphyseal defects.

Bone substituting the artificial material should be able to bear weight and, if possible, be lamellar bone. Since fundamental examinations of osteoinduction and affiliated isolation of growth factors (Urist 1965), extensive scientific research on growth factors contained in bone matrix has been performed. Proteins of the TGF-β family play a key role in regulation of bone regeneration. In past years, alkaline fibroblast growth factor has raised increased interest among researchers. Its presence implies that it plays an important role in the development of bone substance. One best known effect is significant augmentation of microangiogenesis, which could be demonstrated among others in experimental wound healing investigations. Further experimental examinations showed significant increase of callus formation in rats and miniature pigs, in which FGF had been injected into the fracture site.

Current bone substitute materials are only to be used in clearly defined indications, as they do not currently meet the biological or mechanical properties of autogenous bone. Our knowledge is grounded on various experimental models, which are not always comparable. Therefore many aspects have to be considered as a working understanding.

Infections in total joint arthroplasty, particularly with multiresistant bacteria, are a serious problem. A new nanoparticulate silver cement had previously shown good biocompatibility combined with good in vitro antimicrobial activity against multiresistant bacteria.

The purpose of the current study was to evaluate the antibacterial activity of nanoparticulate silver cement against biofilm-building methicillin-resistant S. aureus (MRSA) in a rabbit model and to compare it to that of gentamicin-loaded cement.

Gentamicin cement or nanoparticulate silver bone cement was injected into the proximal half of one femur in 10 animals, respectively. Before hardening of the cement 10⁷ or 10⁸ colony forming units of MRSA with high gentamicin resistance were inoculated at the cement bone interface in 5 rabbits of each group. The animals were euthanized after 14 days and both the cement adjacent bone and the cement itself were studied using microbiological and histological methods. Infection was defined as positive culture growth from the bone and/or cement samples.

Infections rates were 100% for the gentamicin group (10 of 10 animals had infection) and 30% for the NanoSilver group (3 of 10 animals). Thus, nanoparticulate silver bone cement significantly reduced infection rates by 70%.

Nanoparticulate silver cement exhibited good antimicrobial activity in the prophylaxis of cement-related infections with MRSA and is therefore a promising alternative in total joint arthroplasty.

A randomised, double-blind study was performed in two groups of 15 patients undergoing total hip replacements, using antibiotic-loaded acrylic cement containing 0.5 g and 1.0 g gentamicin base respectively per 40 g pack of powdered polymer. Postoperatively, the gentamicin levels in the blood, in the urine and in the wound drainage fluid were measured. In both groups of patients, the serum gentamicin concentrations were low whereas the wound drainage fluid contained highly effective antibacterial concentrations. Serum, urine and wound secretion levels showed approximately two-fold higher concentrations in the group of patients receiving the higher gentamicin load.

Gentamicin incorporated in beads of polymethylmethacrylate has been shown capable of being released over a period of several months in concentrations sufficiently high to control most pathogens. The therapeutic efficacy of such beads has been demonstrated in a model of osteomyelitis of the femur in the dog. Good tolerance has been shown, both in the animal model and in tissue cultures. In forty-one patients with infection of either bone or soft tissue, mainly of the lower limb, the findings were similar. The concentrations in serum and urine were low, which excludes side-effects. The insertion of gentamicin-PMMA beads may prove to be a valuable new form of local antibiotic therapy.