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. 2018 Jun 1;11(6):935.
doi: 10.3390/ma11060935.

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

Dominik Pförringer  1 , Norbert Harrasser  2 , Marc Beirer  3 , Moritz Crönlein  4 , Axel Stemberger  5 , Martijn van Griensven  6 , Martin Lucke  7 , Rainer Burgkart  8 , Andreas Obermeier  9
Affiliations

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

Dominik Pförringer et al. Materials (Basel). .

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.

Keywords: C3a; F1+2; FXIIa; Herafill®-G; Osteoset®, gentamicin; calcium carbonate; calcium sulfate formulations; coagulation; in vitro; tobramycin; tripalmitin; vancomycin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Workflow of preparing blood samples for ELISA assays and testing markers of activated coagulation and complement system.
Figure 2
Figure 2
Coagulation markers following incubation of blood with tested beads (n = 16). Levels of significance used were **: p < 0.01.
Figure 3
Figure 3
Contact angle measurement in graphic comparison. Magnifications showing average contact angles of fresh human blood on test surfaces (n = 8). White scale bar indicating 1 mm.
See this image and copyright information in PMC

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