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Smart Healing

A unique bone regeneration technology that naturally stimulates bone formation and inhibits bacterial growth

Antimicrobial resistance (AMR) is one of the greatest challenges facing healthcare today. In the face of growing resistance, we need solutions to an increasingly complex global problem. Solutions, that are smarter and more sustainable for patients worldwide.

Bonalive® granules is a CE marked Class III medical device, providing a Smart HealingTM solution for bone infections and bone reconstruction. Bonalive® granules has been proven to naturally inhibit the bacterial growth of up to 50 clinically relevant bacteria strains.*

The clinical efficacy and performance of the granules has been proven over the past 20 years in orthopedic, trauma and mastoid surgery. Bonalive® granules is verified as safe for use in paediatric surgery and consists only of elements that are naturally present in the human body.

The science bit

Increased PH level releasing sodium ions to increase osmotic pressure — Inhibition of bacterial growth

The bacterial growth inhibiting feature of Bonalive® granules is due to two simultaneous chemical and physical processes occurring once the bioactive glass reacts with body fluids.
1. Sodium (Na) is released from the surface of the bioactive glass and induces an **increase in pH** (alkaline environment), which is not favorable for the bacteria, thus inhibiting their growth.
2. The released Na, Ca, Si and P ions give rise to an **increase in osmotic pressure** due to an elevation in the salt concentration, i.e. an environment where bacteria cannot grow.

Bone regeneration and remodelling

Bonalive® S53P4 bioactive glass is osteoconductive and also osteoproductive in the promotion, migration, replication and differentiation of osteogenic cells and their matrix production.*
The release of ions and surface reactions develope a silica gel layer on the bioactive glass that attracts CaP to crystallize into natural hydroxyapatite.
Once the hydroxyapatite layer is formed the bioactive glass interacts with biological entities, i.e. blood proteins and growth factors. Following this interactive, osteoconductive and osteostimulative process, new bone grows onto and between the bioactive glass structures.

Areas of Use

Cavitary osteomyelitis

Bonalive® granules have proven effective for bone cavity filling in bone infection surgery. In cases where the cavitary defect allows the sufficient debridement of the necrotic tissue, the granules can be used in a one-stage procedure without application of local antibiotics. Simultaneously, with the inhibiting of bacterial growth, the granules stimulate new bone formation. This enables cost-effective healing and reduces the length of hospital stays.
Septic non-unions

Bone regeneration may be hampered when bacteria are disturbing the process of consolidation. Bonalive® granules has proven to be a useful tool in protecting the area where bone healing needs to take place. Thorough debridement and bone decortication of the non-union site is required. Due to the inhibition of bacterial growth, the use of local antibiotics is not necessary, making Bonalive® granules a distinctly sustainable solution for septic non-union treatment.
Segmental defect reconstruction

Several strategies are available where Bonalive can be used for the management of segmental defects, including bone transport and the induced membrane (Masquelet) techniques. Bonalive® granules has proven useful in docking site surgery in bone transport and as an expander to autograft or RIA in the induced membrane technique to give addition structure to the graft and provide inhibition of bacterial growth.
Other infection complications

As antimicrobial resistance (AMR) is increasing, infections are becoming more challenging to treat and as the population is aging, the tendency to suffer from iatrogenic infections increases. Open heart surgery can result in complex sternum infections, diabetes may result in chronic soft tissue ulcers and diabetic foot osteomyelitis and spine fusion surgery may cause spine infections. Bonalive® granules has been used in innovative ways as a bacterial growth inhibiting tool in the management of a vast array of bone infections.