Masquelet Technique: Effects of Spacer Material and Micro-topography on Factor Expression and Bone Regeneration.

We and others have shown that changing surface characteristics of the spacer implanted during the first Masquelet stage alters some aspects of membrane development. Previously we demonstrated that titanium (TI) spacers create membranes that are better barriers to movement of solutes > 70 kDa in size than polymethyl methacrylate (PMMA) induced-membranes, and roughening creates more mechanically compliant membranes. However, it is unclear if these alterations affect the membrane's biochemical environment or bone regeneration during the second stage. Ten-week-old, male Sprague-Dawley rats underwent an initial surgery to create an externally stabilized 6 mm femoral defect. PMMA or TI spacers with smooth (~ 1 μm) or roughened (~ 8 μm) surfaces were implanted. Four weeks later, rats were either euthanized for membrane harvest or underwent the second Masquelet surgery. TI spacers induced thicker membranes that were similar in structure and biochemical expression. All membranes were bilayered with the inner layer having increased factor expression [bone morphogenetic protein 2 (BMP2), transforming growth factor beta (TGFβ), interleukin 6 (IL6), and vascular endothelial growth factor (VEGF)]. Roughening increased overall IL6 levels. Ten-weeks post-engraftment, PMMA-smooth induced membranes better supported bone regeneration (60% union). The other groups only had 1 or 2 that united (9-22%). There were no significant differences in any micro computed tomography or dynamic histology outcome. In conclusion, this study suggests that the membrane's important function in the Masquelet technique is not simply as a barrier. There is likely a critical biochemical, cellular, or vascular component as well.