Effect of poly DL-lactide--co-glycolide implants and xenogeneic bone matrix-derived growth factors on calvarial bone repair in the rabbit.

Polymer implant discs composed of 50:50 poly DL-lactide-co-glycolide (molecular weight about 9000) were used to repair 5 mm calvarial defects in 2 kg rabbits and osseous repair compared to spontaneous healing (control). After 4 weeks the implants had undergone substantial degradation with little evidence of residual polymer. The extent to which the defects had been replaced by bone showed individual variation. In some animals a layer of bone with normal cancellous architecture had bridged the defect, but at no time was bone observed in intimate contact with the polymer matrix, suggesting that the material had acted as a tissue spacer rather than an osteoconductive substrate. Non-osseous tissue consisted of a highly vascular fibrous connective tissue containing variable numbers of inflammatory cells. In some sites numerous macrophages and multinucleate giant cells were observed, the majority of which were shown by immunocytochemistry to be MHC class II-positive. Histomorphometric analysis demonstrated no statistically significant difference in osseous repair between control and polymer implant groups after 1, 2 or 3 months. Incorporation of bone matrix proteins extracted from bovine cortical bone into the discs, however, provoked a cellular and humoral immune response which had a significant inhibitory effect on osseous repair. These data suggest, first, that while synthetic polymers have potential as bone graft substitutes, improvements in their performance in vivo are needed and, second, it is advisable to use allogeneic proteins in rabbit models of bone regeneration.