1. Bone morphogenetic protein and orthopaedic surgery: Can we legitimate its off-label use?
- Author
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Laurent Obert, Aurélien Courvoisier, Frédéric Sailhan, Olivier Laffenetre, Santé, Plasticité, Motricité (TIMC-IMAG-SPM), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Centre Hospitalier Universitaire [Grenoble] (CHU), Service d'orthopédie [CHU Cochin], Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
- Subjects
medicine.medical_specialty ,animal structures ,MESH: Bone Morphogenetic Proteins ,[SDV]Life Sciences [q-bio] ,Arthrodesis ,Off-label use ,Bioinformatics ,Bone morphogenetic protein ,Transplantation, Autologous ,Non union ,Bone and Bones ,MESH: Orthopedic Procedures ,MESH: Recombinant Proteins ,Fractures, Bone ,Osteogenesis ,medicine ,Humans ,MESH: Off-Label Use ,Orthopedics and Sports Medicine ,Bone formation ,Orthopedic Procedures ,MESH: Osteogenesis ,MESH: Humans ,business.industry ,[SCCO.NEUR]Cognitive science/Neuroscience ,MESH: Fractures, Bone ,Off-Label Use ,MESH: Bone and Bones ,MESH: Spinal Fusion ,Recombinant Proteins ,MESH: Transplantation, Autologous ,3. Good health ,Surgery ,MESH: Fractures, Ununited ,Spinal Fusion ,Fractures, Ununited ,Orthopedic surgery ,Bone Morphogenetic Proteins ,embryonic structures ,Female ,business ,MESH: Arthrodesis ,MESH: Female - Abstract
Bone morphogenetic proteins (BMP) are recombinant osteoinductive proteins with their primary role being to promote bone formation. The off-label use of BMP in orthopaedic surgery has dramatically increased. However, reports of complications with BMP have emerged, and the safety of these proteins in orthopaedics is questioned. The purpose of this review was to evaluate safe situations in which BMP should be used and situations in which their use should be restricted.We recorded all studies from PubMed database from 2002 (date of first authorisation for both BMPs) until January 2014 using "BMP" or "bone morphogenetic protein". Then we screened and extracted all studies dealing with orthopaedic surgery. All situations in which BMP were used, even cases reports, were considered, and complications reported were then listed.Situations in which it seems safe and efficient to use BMP are long-bone nonunions, or arthrodesis as an alternative or combined to autograft in small-bone loss. Surgeons and patients should be aware of transient aseptic wound swelling when BMP is located superficially. The use of BMP in spine surgery for intersomatic fusion is efficient but should be restricted to approaches that respect the vertebral canal to avoid neurological complications.This review is an off-label map of BMP use in orthopaedics during the past 10 years. Our results could provide a useful tool to help decisions around when to use a BMP in a specific complex, and sometimes off-label, situation.
- Published
- 2014
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