Biomedical Engineering Reference
In-Depth Information
To conclude this topic, one should stress that the performance
of living tissues is the result of millions years of evolution, while the
performance of acceptable artificial substitutions those humankind
has designed to repair damaged tissues are only a few decades
old. This explains the greatest differences between them. To get
the historical perspective on the development of artificial grafts
prepared from other materials, the interested readers are referred
to the special literature [7, 9-12, 174-177].
8.8 Calcium Orthophosphates as Bone Graft
Substitutes: A Historical Perspective
Historically, plaster of Paris (calcium sulfate) was the first widely
tested artificial bioceramics. For example, according to Wikipedia,
the free encyclopedia, literature dating back to 975 AD notes that
calcium sulfate was useful for setting broken bones. However, those
were
applications. According to the available literature, by
the end of the 19
ex vivo
th
century, surgeons already used plaster of Paris as
a bone-filling substitute [178]. Nevertheless, it was a famous German
surgeon Themistocles Gluck (1853-1942), who, amongst his range of
contributions, on 20 May 1890 performed the first well documented
ivory (virtually, pure biological apatite) knee replacement bedded
in a calcium sulfate based cement, which was followed by a total
wrist replacement in another patient three weeks later [179]. Later
in 1890, Gluck presented a further case of a total knee replacement
to the Berlin Medical Society: at only 35 days after operation, the
patient was pain free with active knee flexion and extension. All
the joint arthroplasties performed by Gluck were remarkably
successful in the short term; however, all ultimately failed because
of chronic infections [180, 181]. After the abovementioned case of
lacto-phosphate of lime (Fig. 8.3), this seems to be the second well-
documented grafting application of calcium orthophosphates.
However, in the aforementioned cases, either the biomedical
applications of biologically produced calcium orthophosphates
(Gluck) or dental applications, not requiring any surgery (Cravens)
have been described. According to both the electronic databases and
previous reviews on the subject [7, 9-12, 174-177], the first attempt
to implant a laboratory produced calcium orthophosphate (it was
TCP) as an artificial material to repair surgically created defects
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