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VITOSS is FDA cleared for use in the pelvis,

the extremities, and posterolateral spine.

Evidence Based Medicine


Joint Replacements
Trauma, Extremities, Deformities

200
180
160
140
120
100
80
60
40
20
0

The Gold Standard2

Craniomaxillofacial

What makes Iliac Crest Bone Graft (ICBG) the gold standard?

Spine

Scaffold

Orthobiologics
Surgical Products

20
07

20
06

20
05

20
04

20
03

20
02

20
01

20
00

19
99

19
98

Neuro & ENT


19
97

19
96

Number of Bone Graft Products

The Cumulative Number of Bone Graft Products 510(k) Cleared4

Iliac Crest Bone Graft (ICBG) has a Calcium Phosphate


(CaP) surface with an open, inter-connected structure
that serves as a scaffold.

The #1 Synthetic
Bone Graft1

Interventional Spine

Year

Navigation

Currently, there are over 180 510(k) clearances for orthopaedic bone graft
products. Because of the vast number of products available, it is often
difficult for surgeons to assess the best choices for bone grafting.5
Epstein, N.E., An analysis of Noninstrumented Posterolateral Lunbar Fusions Performed
in Predominantly Geriatric Patients Using Lamina Autograft and Beta-Tricalcium Phosphate. The Spine Journal, February 2008.
Study Design:
Prospective; 60 patients using Noninstrumented PLF; Average age = 70 years
Outcome Measures:
CT scans - Fusion assessment; Dynamic X-rays; Fusion assessed separately by 2 neuroradiologists blinded to the treatment; Post-operative outcomes using SF-36; 3, 6, 12, and
24 months follow up
Results:
Successful fusion in 85% of patients (51/60) when judged by CT and F/E
Epstein, N.E., Beta-Tricalcium Phosphate: Observation of Use in 100 Posterolateral
Lumbar Instrumented Fusions. The Spine Journal, June 2009.
Study Design:
Prospective; 100 patients with lumbar spinal stenosis; Multisegment laminectomies (avg. 3.6
segments) and one segment (78 patients) or two segment (22 patients) instrumented PLF
Outcome Measures:
Dynamic X-rays; 2D-CT Scans; Post-operative outcomes using SF-36; Fusion assessed
separately by 2 neuroradiologists blinded to the treatment; 3, 4.5, 6, and 12 month follow
up with a minimum of 2.5 years and maximum of 5.0 years (avg. 3.1 years)
Results:
Successful fusion in 95% of patients (95/100) when judged by CT and Dynamic X-ray

The vast majority of products have no human clinical data to support their use.
Ultimately, human clinical data should be used to select a bone graft.
5

The #1 Synthetic Bone Graft1


VITOSS continues to be the #1 Synthetic Bone Graft for the simplest of
reasons...IT WORKS and has HUMAN CLINICAL DATA to support its efficacy.
Clinical Experience - Over 375,000 implantations worldwide6
Clinical Proof - Numerous human clinical studies (including prospective and peer reviewed) demonstrating VITOSS with autologous
bone marrow is an effective autograft replacement.7

Cells & Signals

Endoscopy
1 - Millennium Research Group: US Markets for Orthopedic Biomaterials 2010.
2 - Peter Ullrich Jr., Autograft: The Patient's Own Bone. Published in 9/8/99 and updated on 11/25/09 on Spine Universe.
3 - Bellincampi, L., Clineff, T., Erbe, E., Osteoinductivity of Vitoss with Isologous Bone Marrow in Urist Rat Pouch Model.
Society for Biomaterials, Tampa, FL, April 24-27, 2002 (Podium).
4 - www.fda.gov, MQV products, November 2007.
5 - The Evolving Role of Bone Graft Substitutes. American Academy of Orthopaedic Surgeons 77th Annual Meeting,
March 9-13, 2010.
6 - Stryker Orthobiologics Internal Sales Data, July 2011.
7 - Vitoss Bibliography, P/N 5606-0117 Rev. 00, 2010.
8 - Motomiya, M., et al., Effect of Hydroxyapatite Porous Characteristics on Healing Outcomes in Rabbit Posterolateral
Spinal Fusion Model. European Spine Journal, 2007; 16: 2215-2224.
9 - Orthovita Test Report P/N 1070-0008R.
10 - Orthovita Test Report P/N 1050-0003R.
11 - Characteristics of Vitoss BA Product.
12 - Hench, L.L., Splinter, R.J., and Allen, W.C., Bonding Mechanisms at the Interface of Ceramic Prosthetic Materials.
Journal of Biomedical Materials Research, 1971; 2(1): 117-141.
13 - Hench, L.L., Paschall, H.A., Direct Chemical Bond of Bioactive Glass-Ceramic Materials to Bone and Muscle.
Journal of Biomedical Materials Research, 1973; 4: 25-42.
14 - Gross, U., The Interface of Various Glasses and Glass Ceramics with a Bony Implantation Bed. Journal of Biomedical
Materials Research, 1985; 19: 251-271.
15 - Sanders, D.M., Hench, L.L., Mechanisms of Glass Corrosion. Journal of American Ceramic Society. 1973; 56(7): 373-377.
16 - Hench, L.L., Characterization of Glass Corrosion and Durability. Journal of Non-Crystalline Solids, 1975; 19: 27-39.
17 - Ogino, M., Hench, L.L., Formation of Calcium Phosphate Films on Silicate Glasses. Journal of Non-Crystalline Solids,
1980; 38 and 39: 673-678.
18 - Vrouwenvelder, W.C.A., Histological and Biochemical Evaluation of Osteoblasts Cultured on Bioactive Glass,
Hydroxyapatite, Titanium Alloy, and Stainless Steel. Journal of Biomedical Materials Research, 1993 Apr; 27(4): 465-75.
19 - Hench, L.L., The Story of Bioglass. Journal of Materials Science: Materials in Medicine, 2006 Nov; 17(11): 967-78.
20 - Oonishi, H., et al., Particulate Bioglass Compared with Hydroxyapatite as a Bone Graft Substitute. Clinical Orthopaedics
and Related Research, 1997 Jan; 334: 316-25.
21 - Xynos, I.D., Edgar, A.J., Buttery, L.D.K., Hench, L.L., and Polak, J.M., Ionic Products of Bioactive Glass Dissolution Increase
Proliferation of Human Osteoblasts and Induce Insulin-like Growth Factor II mRNA Expression and Protein Synthesis.
Biochemical and Biophysical Research Communications, 2000 September 24; 276(2): 461-5.
22 - Anker et al, Ultraporous Beta-Tricalcium Phosphate is Well Incorporated in Small Cavitary Defects. Clinical
Orthopaedics and Related Research, 2005 May; 434: 251-7.
23 - Brown, LS, Darmoc, MM, Owsiany, RS, Clineff, TD, Improvements in Healing with a Bioactive Bone Graft
Substitute in a Canine Metaphyseal Defect. 55th Annual Meeting of the Orthopaedic Research Society, 2009.
24 - Havener, MB, Clineff, TD, Darmoc, MM, Brown, LS, Owsiany, R, A Comparative Study of Synthetic Bone Graft
Substitutes in a Canine Metaphyseal Defect. 54th Annual Meeting of the Orthopaedic Research Society, 2008.
25 - Marx, J., Bone Marrow: A Validated Biological Driver for Bone Regeneration, White Paper.
26 - Muschler, G.F., Nakamoto, C., Griffith, L.G., Engineering Principles of Clinical Cell-Based Tissue Engineering.
Journal of Bone and Joint Surgery, 2004; 86(7): 1541.
27 - Curylo, L.J., et al., Augmentation of Spinal Arthrodesis With Autologous Bone Marrow in a Rabbit Posterolateral Spine
Fusion Model. Spine, 1999 March 1, 24(5 ): 434-8.
28 - Deakin, D.E., Bannister, G.C., Graft Incorporation After Acetabular and Femoral Impaction Grafting With Washed
Irradiated Allograft and Autologous Marrow. The Journal of Arthroplasty, 2007 January; 22(1): 89-94.
29 - Kim, K.J., et al., Effect of Bone Marrow Grafting on the Titanium Porous-Coated Implant in Bilateral Total Knee
Arthroplasty. Acta Orthopaedica, 2007 February; 78(1): 116-22.

Communications

ICBG contains bone marrow rich with


mesenchymal stem cells and hematopoetic
stem cells that facilitate bone regeneration
and neo-vascularization. In addition, ICBG
provides signals that help drive bone formation.

Imaging

Bone marrow is a biologic driver found in ICBG.


Patient Handling Equipment

VITOSS resembles ICBG, the gold


standard, in that it has the same
three components: SCAFFOLD,
CELLS, and SIGNALS.3

Signal

EMS Equipment

Cells
Scaffold

Autograft (ICBG)

45 Great Valley Parkway


Malvern, PA 19355
1.888.774.8870 (tel)
1.610.640.2603 (fax)
www.stryker.com

VITOSS and BMA

VITOSS + BMA = synthetic autograft

BMA Harvesting Sites


Bone marrow can easily be aspirated from several anatomical locations throughout the
body. VITOSS can be used with or without bone marrow aspirate.

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular
product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be
trained in the use of any particular product before using it in surgery. The information presented in this brochure is
intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions
before using any Stryker product. Products may not be available in all markets. Product availability is subject to the
regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have
questions about the availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks
or service marks: Imbibe, Stryker, Vitoss. All other trademarks are trademarks of their respective owners or holders.
Literature Number: 5701-0000 Rev. 00
AQ/LW 08/11
Copyright 2011 Stryker
Printed in USA

Vertebral Body
(via pedicle)
Iliac Crest (PSIS, ASIS)

Calcaneus

VITOSS is FDA cleared for use in the pelvis,


the extremities, and posterolateral spine.

Evidence Based Medicine


Joint Replacements
Trauma, Extremities, Deformities

200
180
160
140
120
100
80
60
40
20
0

The Gold Standard2

Craniomaxillofacial

What makes Iliac Crest Bone Graft (ICBG) the gold standard?

Spine

Scaffold

Orthobiologics
Surgical Products

20
07

20
06

20
05

20
04

20
03

20
02

20
01

20
00

19
99

19
98

Neuro & ENT


19
97

19
96

Number of Bone Graft Products

The Cumulative Number of Bone Graft Products 510(k) Cleared4

Iliac Crest Bone Graft (ICBG) has a Calcium Phosphate


(CaP) surface with an open, inter-connected structure
that serves as a scaffold.

The #1 Synthetic
Bone Graft1

Interventional Spine

Year

Navigation

Currently, there are over 180 510(k) clearances for orthopaedic bone graft
products. Because of the vast number of products available, it is often
difficult for surgeons to assess the best choices for bone grafting.5
Epstein, N.E., An Analysis of Noninstrumented Posterolateral Lumbar Fusions Performed
in Predominantly Geriatric Patients Using Lamina Autograft and Beta-Tricalcium Phosphate. The Spine Journal, February 2008.
Study Design:
Prospective; 60 patients using Noninstrumented PLF; Average age = 70 years
Outcome Measures:
CT scans - Fusion assessment; Dynamic X-rays; Fusion assessed separately by 2 neuroradiologists blinded to the treatment; Post-operative outcomes using SF-36; 3, 6, 12, and
24 months follow up
Results:
Successful fusion in 85% of patients (51/60) when judged by CT and F/E
Epstein, N.E., Beta-Tricalcium Phosphate: Observation of Use in 100 Posterolateral
Lumbar Instrumented Fusions. The Spine Journal, June 2009.
Study Design:
Prospective; 100 patients with lumbar spinal stenosis; Multisegment laminectomies (avg. 3.6
segments) and one segment (78 patients) or two segment (22 patients) instrumented PLF
Outcome Measures:
Dynamic X-rays; 2D-CT Scans; Post-operative outcomes using SF-36; Fusion assessed
separately by 2 neuroradiologists blinded to the treatment; 3, 4.5, 6, and 12 month follow
up with a minimum of 2.5 years and maximum of 5.0 years (avg. 3.1 years)
Results:
Successful fusion in 95% of patients (95/100) when judged by CT and Dynamic X-ray

The vast majority of products have no human clinical data to support their use.
Ultimately, human clinical data should be used to select a bone graft.
5

The #1 Synthetic Bone Graft1


VITOSS continues to be the #1 Synthetic Bone Graft for the simplest of
reasons...IT WORKS and has HUMAN CLINICAL DATA to support its efficacy.
Clinical Experience - Over 375,000 implantations worldwide6
Clinical Proof - Numerous human clinical studies (including prospective and peer reviewed) demonstrating VITOSS with autologous
bone marrow is an effective autograft replacement.7

Cells & Signals

Endoscopy
1 - Millennium Research Group: US Markets for Orthopedic Biomaterials 2010.
2 - Peter Ullrich Jr., Autograft: The Patient's Own Bone. Published in 9/8/99 and updated on 11/25/09 on Spine Universe.
3 - Bellincampi, L., Clineff, T., Erbe, E., Osteoinductivity of Vitoss with Isologous Bone Marrow in Urist Rat Pouch Model.
Society for Biomaterials, Tampa, FL, April 24-27, 2002 (Podium).
4 - www.fda.gov, MQV products, November 2007.
5 - The Evolving Role of Bone Graft Substitutes. American Academy of Orthopaedic Surgeons 77th Annual Meeting,
March 9-13, 2010.
6 - Stryker Orthobiologics Internal Sales Data, July 2011.
7 - Vitoss Bibliography, P/N 5606-0117 Rev. 00, 2010.
8 - Motomiya, M., et al., Effect of Hydroxyapatite Porous Characteristics on Healing Outcomes in Rabbit Posterolateral
Spinal Fusion Model. European Spine Journal, 2007; 16: 2215-2224.
9 - Orthovita Test Report P/N 1070-0008R.
10 - Orthovita Test Report P/N 1050-0003R.
11 - Characteristics of Vitoss BA Product.
12 - Hench, L.L., Splinter, R.J., and Allen, W.C., Bonding Mechanisms at the Interface of Ceramic Prosthetic Materials.
Journal of Biomedical Materials Research, 1971; 2(1): 117-141.
13 - Hench, L.L., Paschall, H.A., Direct Chemical Bond of Bioactive Glass-Ceramic Materials to Bone and Muscle.
Journal of Biomedical Materials Research, 1973; 4: 25-42.
14 - Gross, U., The Interface of Various Glasses and Glass Ceramics with a Bony Implantation Bed. Journal of Biomedical
Materials Research, 1985; 19: 251-271.
15 - Sanders, D.M., Hench, L.L., Mechanisms of Glass Corrosion. Journal of American Ceramic Society. 1973; 56(7): 373-377.
16 - Hench, L.L., Characterization of Glass Corrosion and Durability. Journal of Non-Crystalline Solids, 1975; 19: 27-39.
17 - Ogino, M., Hench, L.L., Formation of Calcium Phosphate Films on Silicate Glasses. Journal of Non-Crystalline Solids,
1980; 38 and 39: 673-678.
18 - Vrouwenvelder, W.C.A., Histological and Biochemical Evaluation of Osteoblasts Cultured on Bioactive Glass,
Hydroxyapatite, Titanium Alloy, and Stainless Steel. Journal of Biomedical Materials Research, 1993 Apr; 27(4): 465-75.
19 - Hench, L.L., The Story of Bioglass. Journal of Materials Science: Materials in Medicine, 2006 Nov; 17(11): 967-78.
20 - Oonishi, H., et al., Particulate Bioglass Compared with Hydroxyapatite as a Bone Graft Substitute. Clinical Orthopaedics
and Related Research, 1997 Jan; 334: 316-25.
21 - Xynos, I.D., Edgar, A.J., Buttery, L.D.K., Hench, L.L., and Polak, J.M., Ionic Products of Bioactive Glass Dissolution Increase
Proliferation of Human Osteoblasts and Induce Insulin-like Growth Factor II mRNA Expression and Protein Synthesis.
Biochemical and Biophysical Research Communications, 2000 September 24; 276(2): 461-5.
22 - Anker et al, Ultraporous Beta-Tricalcium Phosphate is Well Incorporated in Small Cavitary Defects. Clinical
Orthopaedics and Related Research, 2005 May; 434: 251-7.
23 - Brown, LS, Darmoc, MM, Owsiany, RS, Clineff, TD, Improvements in Healing with a Bioactive Bone Graft
Substitute in a Canine Metaphyseal Defect. 55th Annual Meeting of the Orthopaedic Research Society, 2009.
24 - Havener, MB, Clineff, TD, Darmoc, MM, Brown, LS, Owsiany, R, A Comparative Study of Synthetic Bone Graft
Substitutes in a Canine Metaphyseal Defect. 54th Annual Meeting of the Orthopaedic Research Society, 2008.
25 - Marx, J., Bone Marrow: A Validated Biological Driver for Bone Regeneration, White Paper.
26 - Muschler, G.F., Nakamoto, C., Griffith, L.G., Engineering Principles of Clinical Cell-Based Tissue Engineering.
Journal of Bone and Joint Surgery, 2004; 86(7): 1541.
27 - Curylo, L.J., et al., Augmentation of Spinal Arthrodesis With Autologous Bone Marrow in a Rabbit Posterolateral Spine
Fusion Model. Spine, 1999 March 1, 24(5 ): 434-8.
28 - Deakin, D.E., Bannister, G.C., Graft Incorporation After Acetabular and Femoral Impaction Grafting With Washed
Irradiated Allograft and Autologous Marrow. The Journal of Arthroplasty, 2007 January; 22(1): 89-94.
29 - Kim, K.J., et al., Effect of Bone Marrow Grafting on the Titanium Porous-Coated Implant in Bilateral Total Knee
Arthroplasty. Acta Orthopaedica, 2007 February; 78(1): 116-22.

Communications

ICBG contains bone marrow rich with


mesenchymal stem cells and hematopoetic
stem cells that facilitate bone regeneration
and neo-vascularization. In addition, ICBG
provides signals that help drive bone formation.

Imaging

Bone marrow is a biologic driver found in ICBG.


Patient Handling Equipment

VITOSS + BMA resembles ICBG, the


gold standard, in that it has the same
three components: SCAFFOLD,
CELLS, and SIGNALS.3

Signal

EMS Equipment

Cells
Scaffold

Autograft (ICBG)

45 Great Valley Parkway


Malvern, PA 19355
1.888.774.8870 (tel)
1.610.640.2603 (fax)
www.stryker.com

VITOSS and BMA

VITOSS + BMA = synthetic autograft

BMA Harvesting Sites


Bone marrow can easily be aspirated from several anatomical locations throughout the
body. VITOSS can be used with or without bone marrow aspirate.

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular
product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be
trained in the use of any particular product before using it in surgery. The information presented in this brochure is
intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions
before using any Stryker product. Products may not be available in all markets. Product availability is subject to the
regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have
questions about the availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks
or service marks: Imbibe, Stryker, Vitoss. All other trademarks are trademarks of their respective owners or holders.
Literature Number: 5701-0000 Rev. 00
AQ/LW 08/11
Copyright 2011 Stryker
Printed in USA

Vertebral Body
(via pedicle)
Iliac Crest (PSIS, ASIS)

Calcaneus

VITOSS is FDA cleared for use in the pelvis,


the extremities, and posterolateral spine.

Evidence Based Medicine


Joint Replacements
Trauma, Extremities, Deformities

200
180
160
140
120
100
80
60
40
20
0

The Gold Standard2

Craniomaxillofacial

What makes Iliac Crest Bone Graft (ICBG) the gold standard?

Spine

Scaffold

Orthobiologics
Surgical Products

20
07

20
06

20
05

20
04

20
03

20
02

20
01

20
00

19
99

19
98

Neuro & ENT


19
97

19
96

Number of Bone Graft Products

The Cumulative Number of Bone Graft Products 510(k) Cleared4

Iliac Crest Bone Graft (ICBG) has a Calcium Phosphate


(CaP) surface with an open, inter-connected structure
that serves as a scaffold.

The #1 Synthetic
Bone Graft1

Interventional Spine

Year

Navigation

Currently, there are over 180 510(k) clearances for orthopaedic bone graft
products. Because of the vast number of products available, it is often
difficult for surgeons to assess the best choices for bone grafting.5
Epstein, N.E., An Analysis of Noninstrumented Posterolateral Lumbar Fusions Performed
in Predominantly Geriatric Patients Using Lamina Autograft and Beta-Tricalcium Phosphate. The Spine Journal, February 2008.
Study Design:
Prospective; 60 patients using Noninstrumented PLF; Average age = 70 years
Outcome Measures:
CT scans - Fusion assessment; Dynamic X-rays; Fusion assessed separately by 2 neuroradiologists blinded to the treatment; Post-operative outcomes using SF-36; 3, 6, 12, and
24 months follow up
Results:
Successful fusion in 85% of patients (51/60) when judged by CT and F/E
Epstein, N.E., Beta-Tricalcium Phosphate: Observation of Use in 100 Posterolateral
Lumbar Instrumented Fusions. The Spine Journal, June 2009.
Study Design:
Prospective; 100 patients with lumbar spinal stenosis; Multisegment laminectomies (avg. 3.6
segments) and one segment (78 patients) or two segment (22 patients) instrumented PLF
Outcome Measures:
Dynamic X-rays; 2D-CT Scans; Post-operative outcomes using SF-36; Fusion assessed
separately by 2 neuroradiologists blinded to the treatment; 3, 4.5, 6, and 12 month follow
up with a minimum of 2.5 years and maximum of 5.0 years (avg. 3.1 years)
Results:
Successful fusion in 95% of patients (95/100) when judged by CT and Dynamic X-ray

The vast majority of products have no human clinical data to support their use.
Ultimately, human clinical data should be used to select a bone graft.
5

The #1 Synthetic Bone Graft1


VITOSS continues to be the #1 Synthetic Bone Graft for the simplest of
reasons...IT WORKS and has HUMAN CLINICAL DATA to support its efficacy.
Clinical Experience - Over 375,000 implantations worldwide6
Clinical Proof - Numerous human clinical studies (including prospective and peer reviewed) demonstrating VITOSS with autologous
bone marrow is an effective autograft replacement.7

Cells & Signals

Endoscopy
1 - Millennium Research Group: US Markets for Orthopedic Biomaterials 2010.
2 - Peter Ullrich Jr., Autograft: The Patient's Own Bone. Published in 9/8/99 and updated on 11/25/09 on Spine Universe.
3 - Bellincampi, L., Clineff, T., Erbe, E., Osteoinductivity of Vitoss with Isologous Bone Marrow in Urist Rat Pouch Model.
Society for Biomaterials, Tampa, FL, April 24-27, 2002 (Podium).
4 - www.fda.gov, MQV products, November 2007.
5 - The Evolving Role of Bone Graft Substitutes. American Academy of Orthopaedic Surgeons 77th Annual Meeting,
March 9-13, 2010.
6 - Stryker Orthobiologics Internal Sales Data, July 2011.
7 - Vitoss Bibliography, P/N 5606-0117 Rev. 00, 2010.
8 - Motomiya, M., et al., Effect of Hydroxyapatite Porous Characteristics on Healing Outcomes in Rabbit Posterolateral
Spinal Fusion Model. European Spine Journal, 2007; 16: 2215-2224.
9 - Orthovita Test Report P/N 1070-0008R.
10 - Orthovita Test Report P/N 1050-0003R.
11 - Characteristics of Vitoss BA Product.
12 - Hench, L.L., Splinter, R.J., and Allen, W.C., Bonding Mechanisms at the Interface of Ceramic Prosthetic Materials.
Journal of Biomedical Materials Research, 1971; 2(1): 117-141.
13 - Hench, L.L., Paschall, H.A., Direct Chemical Bond of Bioactive Glass-Ceramic Materials to Bone and Muscle.
Journal of Biomedical Materials Research, 1973; 4: 25-42.
14 - Gross, U., The Interface of Various Glasses and Glass Ceramics with a Bony Implantation Bed. Journal of Biomedical
Materials Research, 1985; 19: 251-271.
15 - Sanders, D.M., Hench, L.L., Mechanisms of Glass Corrosion. Journal of American Ceramic Society. 1973; 56(7): 373-377.
16 - Hench, L.L., Characterization of Glass Corrosion and Durability. Journal of Non-Crystalline Solids, 1975; 19: 27-39.
17 - Ogino, M., Hench, L.L., Formation of Calcium Phosphate Films on Silicate Glasses. Journal of Non-Crystalline Solids,
1980; 38 and 39: 673-678.
18 - Vrouwenvelder, W.C.A., Histological and Biochemical Evaluation of Osteoblasts Cultured on Bioactive Glass,
Hydroxyapatite, Titanium Alloy, and Stainless Steel. Journal of Biomedical Materials Research, 1993 Apr; 27(4): 465-75.
19 - Hench, L.L., The Story of Bioglass. Journal of Materials Science: Materials in Medicine, 2006 Nov; 17(11): 967-78.
20 - Oonishi, H., et al., Particulate Bioglass Compared with Hydroxyapatite as a Bone Graft Substitute. Clinical Orthopaedics
and Related Research, 1997 Jan; 334: 316-25.
21 - Xynos, I.D., Edgar, A.J., Buttery, L.D.K., Hench, L.L., and Polak, J.M., Ionic Products of Bioactive Glass Dissolution Increase
Proliferation of Human Osteoblasts and Induce Insulin-like Growth Factor II mRNA Expression and Protein Synthesis.
Biochemical and Biophysical Research Communications, 2000 September 24; 276(2): 461-5.
22 - Anker et al, Ultraporous Beta-Tricalcium Phosphate is Well Incorporated in Small Cavitary Defects. Clinical
Orthopaedics and Related Research, 2005 May; 434: 251-7.
23 - Brown, LS, Darmoc, MM, Owsiany, RS, Clineff, TD, Improvements in Healing with a Bioactive Bone Graft
Substitute in a Canine Metaphyseal Defect. 55th Annual Meeting of the Orthopaedic Research Society, 2009.
24 - Havener, MB, Clineff, TD, Darmoc, MM, Brown, LS, Owsiany, R, A Comparative Study of Synthetic Bone Graft
Substitutes in a Canine Metaphyseal Defect. 54th Annual Meeting of the Orthopaedic Research Society, 2008.
25 - Marx, J., Bone Marrow: A Validated Biological Driver for Bone Regeneration, White Paper.
26 - Muschler, G.F., Nakamoto, C., Griffith, L.G., Engineering Principles of Clinical Cell-Based Tissue Engineering.
Journal of Bone and Joint Surgery, 2004; 86(7): 1541.
27 - Curylo, L.J., et al., Augmentation of Spinal Arthrodesis With Autologous Bone Marrow in a Rabbit Posterolateral Spine
Fusion Model. Spine, 1999 March 1, 24(5 ): 434-8.
28 - Deakin, D.E., Bannister, G.C., Graft Incorporation After Acetabular and Femoral Impaction Grafting With Washed
Irradiated Allograft and Autologous Marrow. The Journal of Arthroplasty, 2007 January; 22(1): 89-94.
29 - Kim, K.J., et al., Effect of Bone Marrow Grafting on the Titanium Porous-Coated Implant in Bilateral Total Knee
Arthroplasty. Acta Orthopaedica, 2007 February; 78(1): 116-22.

Communications

ICBG contains bone marrow rich with


mesenchymal stem cells and hematopoetic
stem cells that facilitate bone regeneration
and neo-vascularization. In addition, ICBG
provides signals that help drive bone formation.

Imaging

Bone marrow is a biologic driver found in ICBG.


Patient Handling Equipment

VITOSS + BMA resembles ICBG, the


gold standard, in that it has the same
three components: SCAFFOLD,
CELLS, and SIGNALS.3

Signal

EMS Equipment

Cells
Scaffold

Autograft (ICBG)

45 Great Valley Parkway


Malvern, PA 19355
1.888.774.8870 (tel)
1.610.640.2603 (fax)
www.stryker.com

VITOSS and BMA

VITOSS + BMA = synthetic autograft

BMA Harvesting Sites


Bone marrow can easily be aspirated from several anatomical locations throughout the
body. VITOSS can be used with or without bone marrow aspirate.

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular
product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be
trained in the use of any particular product before using it in surgery. The information presented in this brochure is
intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions
before using any Stryker product. Products may not be available in all markets. Product availability is subject to the
regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have
questions about the availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks
or service marks: Imbibe, Stryker, Vitoss. All other trademarks are trademarks of their respective owners or holders.
Literature Number: 5701-0000 Rev. 00
AQ/LW 08/11
Copyright 2011 Stryker
Printed in USA

Vertebral Body
(via pedicle)
Iliac Crest (PSIS, ASIS)

Calcaneus

Not All Scaffolds are Created Equal

The VITOSS Advantage


Why are porosity, structure, bioactivity, and chemistry important?

3 Weeks

6 Weeks

12 Weeks

VITOSS Product Portfolio


24 Weeks

52 Weeks

VITOSS

Morsels

Foam Pack*

Imbibe

Vitoss Morsels and Blocks are an


economical way to provide a quality
synthetic product to your patients for
large volume grafting applications.
Vitoss Morsels offer a cost comparative option to allograft chips.

Vitoss Foam Pack is a versatile material


that is stable in a uid environment, can
soak and hold bone marrow, is compression-resistant, and can be mixed
with local bone to form a composite.

Imbibe is a system of disposable


products from syringes to needles to graft delivery devices.
The syringes have a unique
screw off cap to allow for a larger
ow. The Imbibe bone marrow
aspiration needles provide a minimally invasive way to
harvest stem cells contained in bone marrow. These
needles come with both bullet-tip and sharp-trocar
stylets, which are color coded to distinguish each
needle. The graft delivery tools can be used to
deliver Vitoss in a minimally invasive application.

1.2cc

sponge
15cc Macro
(2102-0020)

golf ball
other
scaffolds

porosity

ActiFuse

2.5cc

5cc
30cc Macro
(2102-0021)

(2102-1405)
(2102-1605) BA
(2102-2105) BA

10cc

(2102-1410)
(2102-1610) BA
(2102-2110) BA

ProOsteon

structure

(2102-1401)
(2102-1601) BA
(2102-2101) BA2X
(2102-1402)
(2102-1602) BA
(2102-2102) BA

Only materials with interconnected porosity will allow


for 3-D regeneration of bone as opposed to creeping
substitution. Additionally, increased porosity has been
shown to lead to higher fusion rates.8 VITOSS is a highly
porous calcium-phosphate (up to 90% porous).9

VITOSS

* Also available in Vitoss BA and BA2X

1.2cc Blocks
(2102-0013)

10cc Blocks
(2102-0006)

Despite having similar chemistries, many


products perform differently due to different
structure. VITOSS has an open-interconnected
structure that facilitates 3-D bone regeneration.10

30cc Macro (x10)


(2102-0131)

MasterGraft

Comparison of VITOSS to ActiFuse, ProOsteon, and MasterGraft in a canine metaphyseal study in order to radiologically compare
healing at 3, 6, 12, 24, and 52 weeks. A 10mm x 22mm drill defect was created in the proximal humerus and lled with 2cc of bone graft.24

bioactivity11
Bioactive glass has shown positive bondingto-bone properties.12-14 Upon implantation, the
ionic constituents (Si+, Na+, Ca2+) of bioactive
glass are released into the surrounding environment and react with the bodily fluids.18-21 This
reaction produces the deposition of a thin layer
of physiologic CaP at its surface, thus attracting
osteoblasts to the layer to create a matrix that
promotes an osteostimulatory effect.12-18 This may
lead to the bonding of new bone to the scaffold.

* Also available in Vitoss BA

Bone Marrow - A Validated Biologic Driver

25

chemistry

VITOSS BA has a unique porosity, structure, bioactivity, and chemistry to drive the 3-D
regeneration of bone and potentially increase the rate of healing as shown in an animal study.23

There are over 150 references supporting the use of bone marrow for grafting.25
Less morbidity

Chemistry affects the rate of resorption. Bone grafts should resorb as


new bone forms in a physiologic time frame. VITOSS is composed of
-TCP and is stable at physiologic pH. It resorbs during the natural
remodeling process of bone. Evidence suggests that -TCP resorbs
in the most relevant time frame.22

Vitoss Foam Strip is a compression resistant pre-formed strip that is exible


when wet, can soak and hold bone
marrow, and is easily customized for
various grafting applications.

BMA enhances fusion over ICBG alone

BMA enhances graft incorporation

BMA is a safe alternative to iliac crest harvest without associated complications


or morbidity. 900(+) patients with bone marrow aspiration (16-200mL) showed
no infection, no hematoma, no chronic pain, and only 2 bruises.26

A pre-clinical evaluation (posterolateral fusion) showed 61% fusion in


ICBG + BMA versus 25% fusion in ICBG + blood at 12 weeks.27

25 x 100 x 4mm
10cc (2102-1100)
25 x 100 x 4mm (BA)
10cc (2102-1500)
25 x 100 x 8mm
20cc (2102-1120)
25 x 100 x 8mm (BA)
20cc (2102-1520)
25 x 240 x 4mm
24cc (2102-1101)
25 x 50 x 4mm
5cc (2102-1105)
25 x 50 x 4mm (BA)
5cc (2102-1505)

90% incorporation of graft with BMA was achieved during impaction grafting
versus 40% for controls (historical).
The addition of autologous marrow is a cheap and highly effective way of
achieving graft incorporation.28

25 x 50 x 8mm
10cc (2102-1110)
25 x 50 x 8mm (BA)
10cc (2102-1510)

There was a statistically significant decrease in radioluscent lines on x-rays of


knees grafted with marrow versus those without.
Iliac marrow is useful as a bone grafting material to enhance the biological
formation in porous coated implants.29

75 x 100 x 4mm
30cc (2102-1130)

10cc
(2105-0010)
20cc
(2105-0020)
30cc
(2105-0030)

Canisters
Vitoss Canisters offer the handling and delivery
of Vitoss Morsels with the use of bone marrow
aspirate or blood. It is a closed system designed to minimize handling and exposure to potential contaminants.
5cc Micro
(2102-0026)
5cc Standard
(2102-0030)

Foam Strip*

Syringes

10cc Micro
(2102-0027)
10cc Standard
(2102-0031)
15cc Micro
(2102-0028)

Needles
11 gauge x 4 inch
(2090-0027)
11 gauge x 6 inch
(2090-0028)
8 gauge x 6 inch
(2090-0029)
8 gauge x 8 inch
(2090-0047)
Fenestrated
8 gauge x 6 inch
(2090-0030)

15cc Standard
(2102-0032)
30cc Micro
(2102-0029)
30cc Standard
(2102-0033)

Bullet-tip

Sharp-tip

Cups

Foam Flow

Vitoss Cups are synthetic bone graft implants


that are designed to simplify the grafting process
in reconstruction procedures. The shapes are
pre-contoured to facilitate placement into the
bony area and provide graft containment.

Vitoss Foam Flow can be percutaneously injected into contained


bone defects, providing an even
ll of graft material. Foam Flow is
excellent for lling bone cysts.

56mm (Int. Dia.) Cup


23cc (2102-1056)

5cc
(2102-1305)
10cc
(2102-1310)

Not All Scaffolds are Created Equal

The VITOSS Advantage


Why are porosity, structure, bioactivity, and chemistry important?

3 Weeks

6 Weeks

12 Weeks

VITOSS Product Portfolio


24 Weeks

52 Weeks

VITOSS

Morsels

Foam Pack*

Imbibe

Vitoss Morsels and Blocks are an


economical way to provide a quality
synthetic product to your patients for
large volume grafting applications.
Vitoss Morsels offer a cost comparative option to allograft chips.

Vitoss Foam Pack is a versatile material


that is stable in a uid environment, can
soak and hold bone marrow, is compression-resistant, and can be mixed
with local bone to form a composite.

Imbibe is a system of disposable


products from syringes to needles to graft delivery devices.
The syringes have a unique
screw off cap to allow for a larger
ow. The Imbibe bone marrow
aspiration needles provide a minimally invasive way to
harvest stem cells contained in bone marrow. These
needles come with both bullet-tip and sharp-trocar
stylets, which are color coded to distinguish each
needle. The graft delivery tools can be used to
deliver Vitoss in a minimally invasive application.

1.2cc

sponge
15cc Macro
(2102-0020)

golf ball
other
scaffolds

porosity

ActiFuse

2.5cc

5cc
30cc Macro
(2102-0021)

(2102-1405)
(2102-1605) BA
(2102-2105) BA

10cc

(2102-1410)
(2102-1610) BA
(2102-2110) BA

ProOsteon

structure

(2102-1401)
(2102-1601) BA
(2102-2101) BA2X
(2102-1402)
(2102-1602) BA
(2102-2102) BA

Only materials with interconnected porosity will allow


for 3-D regeneration of bone as opposed to creeping
substitution. Additionally, increased porosity has been
shown to lead to higher fusion rates.8 VITOSS is a highly
porous calcium-phosphate (up to 90% porous).9

VITOSS

* Also available in Vitoss BA and BA2X

1.2cc Blocks
(2102-0013)

10cc Blocks
(2102-0006)

Despite having similar chemistries, many


products perform differently due to different
structure. VITOSS has an open-interconnected
structure that facilitates 3-D bone regeneration.10

30cc Macro (x10)


(2102-0131)

MasterGraft

Comparison of VITOSS to ActiFuse, ProOsteon, and MasterGraft in a canine metaphyseal study in order to radiologically compare
healing at 3, 6, 12, 24, and 52 weeks. A 10mm x 22mm drill defect was created in the proximal humerus and lled with 2cc of bone graft.24

bioactivity11
Bioactive glass has shown positive bondingto-bone properties.12-14 Upon implantation, the
ionic constituents (Si+, Na+, Ca2+) of bioactive
glass are released into the surrounding environment and react with the bodily fluids.18-21 This
reaction produces the deposition of a thin layer
of physiologic CaP at its surface, thus attracting
osteoblasts to the layer to create a matrix that
promotes an osteostimulatory effect.12-18 This may
lead to the bonding of new bone to the scaffold.

* Also available in Vitoss BA

Bone Marrow - A Validated Biologic Driver

25

chemistry

VITOSS BA has a unique porosity, structure, bioactivity, and chemistry to drive the 3-D
regeneration of bone and potentially increase the rate of healing as shown in an animal study.23

There are over 150 references supporting the use of bone marrow for grafting.25
Less morbidity

Chemistry affects the rate of resorption. Bone grafts should resorb as


new bone forms in a physiologic time frame. VITOSS is composed of
-TCP and is stable at physiologic pH. It resorbs during the natural
remodeling process of bone. Evidence suggests that -TCP resorbs
in the most relevant time frame.22

Vitoss Foam Strip is a compression resistant pre-formed strip that is exible


when wet, can soak and hold bone
marrow, and is easily customized for
various grafting applications.

BMA enhances fusion over ICBG alone

BMA enhances graft incorporation

BMA is a safe alternative to iliac crest harvest without associated complications


or morbidity. 900(+) patients with bone marrow aspiration (16-200mL) showed
no infection, no hematoma, no chronic pain, and only 2 bruises.26

A pre-clinical evaluation (posterolateral fusion) showed 61% fusion in


ICBG + BMA versus 25% fusion in ICBG + blood at 12 weeks.27

25 x 100 x 4mm
10cc (2102-1100)
25 x 100 x 4mm (BA)
10cc (2102-1500)
25 x 100 x 8mm
20cc (2102-1120)
25 x 100 x 8mm (BA)
20cc (2102-1520)
25 x 240 x 4mm
24cc (2102-1101)
25 x 50 x 4mm
5cc (2102-1105)
25 x 50 x 4mm (BA)
5cc (2102-1505)

90% incorporation of graft with BMA was achieved during impaction grafting
versus 40% for controls (historical).
The addition of autologous marrow is a cheap and highly effective way of
achieving graft incorporation.28

25 x 50 x 8mm
10cc (2102-1110)
25 x 50 x 8mm (BA)
10cc (2102-1510)

There was a statistically significant decrease in radioluscent lines on x-rays of


knees grafted with marrow versus those without.
Iliac marrow is useful as a bone grafting material to enhance the biological
formation in porous coated implants.29

75 x 100 x 4mm
30cc (2102-1130)

10cc
(2105-0010)
20cc
(2105-0020)
30cc
(2105-0030)

Canisters
Vitoss Canisters offer the handling and delivery
of Vitoss Morsels with the use of bone marrow
aspirate or blood. It is a closed system designed to minimize handling and exposure to potential contaminants.
5cc Micro
(2102-0026)
5cc Standard
(2102-0030)

Foam Strip*

Syringes

10cc Micro
(2102-0027)
10cc Standard
(2102-0031)
15cc Micro
(2102-0028)

Needles
11 gauge x 4 inch
(2090-0027)
11 gauge x 6 inch
(2090-0028)
8 gauge x 6 inch
(2090-0029)
8 gauge x 8 inch
(2090-0047)
Fenestrated
8 gauge x 6 inch
(2090-0030)

15cc Standard
(2102-0032)
30cc Micro
(2102-0029)
30cc Standard
(2102-0033)

Bullet-tip

Sharp-tip

Cups

Foam Flow

Vitoss Cups are synthetic bone graft implants


that are designed to simplify the grafting process
in reconstruction procedures. The shapes are
pre-contoured to facilitate placement into the
bony area and provide graft containment.

Vitoss Foam Flow can be percutaneously injected into contained


bone defects, providing an even
ll of graft material. Foam Flow is
excellent for lling bone cysts.

56mm (Int. Dia.) Cup


23cc (2102-1056)

5cc
(2102-1305)
10cc
(2102-1310)

Not All Scaffolds are Created Equal

The VITOSS Advantage


Why are porosity, structure, bioactivity, and chemistry important?

3 Weeks

6 Weeks

12 Weeks

VITOSS Product Portfolio


24 Weeks

52 Weeks

VITOSSTM

Morsels

Foam Pack*

Imbibe

Vitoss Morsels and Blocks are an


economical way to provide a quality
synthetic product to your patients for
large volume grafting applications.
Vitoss Morsels offer a cost comparative option to allograft chips.

Vitoss Foam Pack is a versatile material


that is stable in a uid environment, can
soak and hold bone marrow, is compression-resistant, and can be mixed
with local bone to form a composite.

Imbibe is a system of disposable


products from syringes to needles to graft delivery devices.
The syringes have a unique
screw off cap to allow for a larger
ow. The Imbibe bone marrow
aspiration needles provide a minimally invasive way to
harvest stem cells contained in bone marrow. These
needles come with both bullet-tip and sharp-trocar
stylets, which are color coded to distinguish each
needle. The graft delivery tools can be used to
deliver Vitoss in a minimally invasive application.

1.2cc

sponge
15cc Macro
(2102-0020)

golf ball
other
scaffolds

porosity

ActiFuse

2.5cc

5cc
30cc Macro
(2102-0021)

(2102-1405)
(2102-1605) BA
(2102-2105) BA

10cc

(2102-1410)
(2102-1610) BA
(2102-2110) BA

ProOsteon

structure

(2102-1401)
(2102-1601) BA
(2102-2101) BA2X
(2102-1402)
(2102-1602) BA
(2102-2102) BA

Only materials with interconnected porosity will allow


for 3-D regeneration of bone as opposed to creeping
substitution. Additionally, increased porosity has been
shown to lead to higher fusion rates.8 VITOSS is a highly
porous calcium-phosphate (up to 90% porous).9

VITOSS

* Also available in Vitoss BA and BA2X

1.2cc Blocks
(2102-0013)

10cc Blocks
(2102-0006)

Despite having similar chemistries, many


products perform differently due to different
structure. VITOSS has an open-interconnected
structure that facilitates 3-D bone regeneration.10

30cc Macro (x10)


(2102-0131)

MasterGraft

bioactivity11
Bioactive glass has shown positive bondingto-bone properties.12-14 Upon implantation, the
ionic constituents (Si+, Na+, Ca2+) of bioactive
glass are released into the surrounding environment and react with the bodily fluids.18-21 This
reaction produces the deposition of a thin layer
of physiologic CaP at its surface, thus attracting
osteoblasts to the layer to create a matrix that
promotes an osteostimulatory effect.12-18 This may
lead to the bonding of new bone to the scaffold.

Comparison of VITOSS to ActiFuse, ProOsteon, and MasterGraft in a canine metaphyseal study in order to radiologically compare
healing at 3, 6, 12, 24, and 52 weeks. A 10mm x 22mm drill defect was created in the proximal humerus and lled with 2cc of bone graft.24

* Also available in Vitoss BA

Bone Marrow - A Validated Biologic Driver

25

chemistry

VITOSS has a unique porosity, structure, bioactivity, and chemistry to drive


the 3-D regeneration of bone and potentially increase the rate of healing.23

There are over 175 references supporting the use of bone marrow for grafting.25
Less/no morbidity

Chemistry affects the rate of resorption. Bone grafts should resorb as


new bone forms in a physiologic time frame. VITOSS is composed of
-TCP and is stable at physiologic pH. It resorbs during the natural
remodeling process of bone. Evidence suggests that -TCP resorbs
in the most relevant time frame.22

Vitoss Foam Strip is a compression resistant pre-formed strip that is exible


when wet, can soak and hold bone
marrow, and is easily customized for
various grafting applications.

BMA enhances fusion over ICBG alone

BMA enhances graft incorporation

BMA is a safe alternative to iliac crest harvest without associated complications


or morbidity. 900(+) patients with bone marrow aspiration (16-200mL) showed
no infection, no hematoma, no chronic pain, and only 2 bruises.26

A pre-clinical evaluation (posterolateral fusion) showed 61% fusion in


ICBG + BMA versus 25% fusion in ICBG + blood at 12 weeks.27

25 x 100 x 4mm
10cc (2102-1100)
25 x 100 x 4mm (BA)
10cc (2102-1500)
25 x 100 x 8mm
20cc (2102-1120)
25 x 100 x 8mm (BA)
20cc (2102-1520)
25 x 240 x 4mm
24cc (2102-1101)
25 x 50 x 4mm
5cc (2102-1105)
25 x 50 x 4mm (BA)
5cc (2102-1505)

90% incorporation of graft with BMA was achieved during impaction grafting
versus 40% for controls (historical).
The addition of autologous marrow is a cheap and highly effective way of
achieving graft incorporation.28

25 x 50 x 8mm
10cc (2102-1110)
25 x 50 x 8mm (BA)
10cc (2102-1510)

There was a statistically significant decrease in radioluscent lines on x-rays of


knees grafted with marrow versus those without.
Iliac marrow is useful as a bone grafting material to enhance the biological
formation in porous coated implants.29

75 x 100 x 4mm
30cc (2102-1130)

10cc
(2105-0010)
20cc
(2105-0020)
30cc
(2105-0030)

Canisters
Vitoss Canisters offer the handling and delivery
of Vitoss Morsels with the use of bone marrow
aspirate or blood. It is a closed system designed to minimize handling and exposure to potential contaminants.
5cc Micro
(2102-0026)
5cc Standard
(2102-0030)

Foam Strip*

Syringes

10cc Micro
(2102-0027)
10cc Standard
(2102-0031)
15cc Micro
(2102-0028)

Needles
11 gauge x 4 inch
(2090-0027)
11 gauge x 6 inch
(2090-0028)
8 gauge x 6 inch
(2090-0029)
8 gauge x 8 inch
(2090-0047)
Fenestrated
8 gauge x 6 inch
(2090-0030)

15cc Standard
(2102-0032)
30cc Micro
(2102-0029)
30cc Standard
(2102-0033)

Bullet-tip

Sharp-tip

Cups

Foam Flow

Vitoss Cups are synthetic bone graft implants


that are designed to simplify the grafting process
in reconstruction procedures. The shapes are
pre-contoured to facilitate placement into the
bony area and provide graft containment.

Vitoss Foam Flow can be percutaneously injected into contained


bone defects, providing an even
ll of graft material. Foam Flow is
excellent for lling bone cysts.

56mm (Int. Dia.) Cup


23cc (2102-1056)

5cc
(2102-1305)
10cc
(2102-1310)

Not All Scaffolds are Created Equal

The VITOSS Advantage


Why are porosity, structure, bioactivity, and chemistry important?

3 Weeks

6 Weeks

12 Weeks

VITOSS Product Portfolio


24 Weeks

52 Weeks

VITOSSTM

Morsels

Foam Pack*

Imbibe

Vitoss Morsels and Blocks are an


economical way to provide a quality
synthetic product to your patients for
large volume grafting applications.
Vitoss Morsels offer a cost comparative option to allograft chips.

Vitoss Foam Pack is a versatile material


that is stable in a uid environment, can
soak and hold bone marrow, is compression-resistant, and can be mixed
with local bone to form a composite.

Imbibe is a system of disposable


products from syringes to needles to graft delivery devices.
The syringes have a unique
screw off cap to allow for a larger
ow. The Imbibe bone marrow
aspiration needles provide a minimally invasive way to
harvest stem cells contained in bone marrow. These
needles come with both bullet-tip and sharp-trocar
stylets, which are color coded to distinguish each
needle. The graft delivery tools can be used to
deliver Vitoss in a minimally invasive application.

1.2cc

sponge
15cc Macro
(2102-0020)

golf ball
other
scaffolds

porosity

ActiFuse

2.5cc

5cc
30cc Macro
(2102-0021)

(2102-1405)
(2102-1605) BA
(2102-2105) BA

10cc

(2102-1410)
(2102-1610) BA
(2102-2110) BA

ProOsteon

structure

(2102-1401)
(2102-1601) BA
(2102-2101) BA2X
(2102-1402)
(2102-1602) BA
(2102-2102) BA

Only materials with interconnected porosity will allow


for 3-D regeneration of bone as opposed to creeping
substitution. Additionally, increased porosity has been
shown to lead to higher fusion rates.8 VITOSS is a highly
porous calcium-phosphate (up to 90% porous).9

VITOSS

* Also available in Vitoss BA and BA2X

1.2cc Blocks
(2102-0013)

10cc Blocks
(2102-0006)

Despite having similar chemistries, many


products perform differently due to different
structure. VITOSS has an open-interconnected
structure that facilitates 3-D bone regeneration.10

30cc Macro (x10)


(2102-0131)

MasterGraft

bioactivity11
Bioactive glass has shown positive bondingto-bone properties.12-14 Upon implantation, the
ionic constituents (Si+, Na+, Ca2+) of bioactive
glass are released into the surrounding environment and react with the bodily fluids.18-21 This
reaction produces the deposition of a thin layer
of physiologic CaP at its surface, thus attracting
osteoblasts to the layer to create a matrix that
promotes an osteostimulatory effect.12-18 This may
lead to the bonding of new bone to the scaffold.

Comparison of VITOSS to ActiFuse, ProOsteon, and MasterGraft in a canine metaphyseal study in order to radiologically compare
healing at 3, 6, 12, 24, and 52 weeks. A 10mm x 22mm drill defect was created in the proximal humerus and lled with 2cc of bone graft.24

* Also available in Vitoss BA

Bone Marrow - A Validated Biologic Driver

25

chemistry

VITOSS has a unique porosity, structure, bioactivity, and chemistry to drive


the 3-D regeneration of bone and potentially increase the rate of healing.23

There are over 175 references supporting the use of bone marrow for grafting.25
Less/no morbidity

Chemistry affects the rate of resorption. Bone grafts should resorb as


new bone forms in a physiologic time frame. VITOSS is composed of
-TCP and is stable at physiologic pH. It resorbs during the natural
remodeling process of bone. Evidence suggests that -TCP resorbs
in the most relevant time frame.22

Vitoss Foam Strip is a compression resistant pre-formed strip that is exible


when wet, can soak and hold bone
marrow, and is easily customized for
various grafting applications.

BMA enhances fusion over ICBG alone

BMA enhances graft incorporation

BMA is a safe alternative to iliac crest harvest without associated complications


or morbidity. 900(+) patients with bone marrow aspiration (16-200mL) showed
no infection, no hematoma, no chronic pain, and only 2 bruises.26

A pre-clinical evaluation (posterolateral fusion) showed 61% fusion in


ICBG + BMA versus 25% fusion in ICBG + blood at 12 weeks.27

25 x 100 x 4mm
10cc (2102-1100)
25 x 100 x 4mm (BA)
10cc (2102-1500)
25 x 100 x 8mm
20cc (2102-1120)
25 x 100 x 8mm (BA)
20cc (2102-1520)
25 x 240 x 4mm
24cc (2102-1101)
25 x 50 x 4mm
5cc (2102-1105)
25 x 50 x 4mm (BA)
5cc (2102-1505)

90% incorporation of graft with BMA was achieved during impaction grafting
versus 40% for controls (historical).
The addition of autologous marrow is a cheap and highly effective way of
achieving graft incorporation.28

25 x 50 x 8mm
10cc (2102-1110)
25 x 50 x 8mm (BA)
10cc (2102-1510)

There was a statistically significant decrease in radioluscent lines on x-rays of


knees grafted with marrow versus those without.
Iliac marrow is useful as a bone grafting material to enhance the biological
formation in porous coated implants.29

75 x 100 x 4mm
30cc (2102-1130)

10cc
(2105-0010)
20cc
(2105-0020)
30cc
(2105-0030)

Canisters
Vitoss Canisters offer the handling and delivery
of Vitoss Morsels with the use of bone marrow
aspirate or blood. It is a closed system designed to minimize handling and exposure to potential contaminants.
5cc Micro
(2102-0026)
5cc Standard
(2102-0030)

Foam Strip*

Syringes

10cc Micro
(2102-0027)
10cc Standard
(2102-0031)
15cc Micro
(2102-0028)

Needles
11 gauge x 4 inch
(2090-0027)
11 gauge x 6 inch
(2090-0028)
8 gauge x 6 inch
(2090-0029)
8 gauge x 8 inch
(2090-0047)
Fenestrated
8 gauge x 6 inch
(2090-0030)

15cc Standard
(2102-0032)
30cc Micro
(2102-0029)
30cc Standard
(2102-0033)

Bullet-tip

Sharp-tip

Cups

Foam Flow

Vitoss Cups are synthetic bone graft implants


that are designed to simplify the grafting process
in reconstruction procedures. The shapes are
pre-contoured to facilitate placement into the
bony area and provide graft containment.

Vitoss Foam Flow can be percutaneously injected into contained


bone defects, providing an even
ll of graft material. Foam Flow is
excellent for lling bone cysts.

56mm (Int. Dia.) Cup


23cc (2102-1056)

5cc
(2102-1305)
10cc
(2102-1310)

VITOSS is FDA cleared for use in the pelvis,


the extremities, and posterolateral spine.

Evidence Based Medicine


Joint Replacements
Trauma, Extremities, Deformities

200
180
160
140
120
100
80
60
40
20
0

The Gold Standard2

Craniomaxillofacial

What makes Iliac Crest Bone Graft (ICBG) the gold standard?

Spine

Scaffold

Orthobiologics
Surgical Products

20
07

20
06

20
05

20
04

20
03

20
02

20
01

20
00

19
99

19
98

Neuro & ENT


19
97

19
96

Number of Bone Graft Products

The Cumulative Number of Bone Graft Products 510(k) Cleared4

Iliac Crest Bone Graft (ICBG) has a Calcium Phosphate


(CaP) surface with an open, inter-connected structure
that serves as a scaffold.

The #1 Synthetic
Bone Graft1

Interventional Spine

Year

Navigation

Currently, there are over 180 510(k) clearances for orthopaedic bone graft
products. Because of the vast number of products available, it is often
difficult for surgeons to assess the best choices for bone grafting.5
Epstein, N.E., An analysis of Noninstrumented Posterolateral Lunbar Fusions Performed
in Predominantly Geriatric Patients Using Lamina Autograft and Beta-Tricalcium Phosphate. The Spine Journal, February 2008.
Study Design:
Prospective; 60 patients using Noninstrumented PLF; Average age = 70 years
Outcome Measures:
CT scans - Fusion assessment; Dynamic X-rays; Fusion assessed separately by 2 neuroradiologists blinded to the treatment; Post-operative outcomes using SF-36; 3, 6, 12, and
24 months follow up
Results:
Successful fusion in 85% of patients (51/60) when judged by CT and F/E
Epstein, N.E., Beta-Tricalcium Phosphate: Observation of Use in 100 Posterolateral
Lumbar Instrumented Fusions. The Spine Journal, June 2009.
Study Design:
Prospective; 100 patients with lumbar spinal stenosis; Multisegment laminectomies (avg. 3.6
segments) and one segment (78 patients) or two segment (22 patients) instrumented PLF
Outcome Measures:
Dynamic X-rays; 2D-CT Scans; Post-operative outcomes using SF-36; Fusion assessed
separately by 2 neuroradiologists blinded to the treatment; 3, 4.5, 6, and 12 month follow
up with a minimum of 2.5 years and maximum of 5.0 years (avg. 3.1 years)
Results:
Successful fusion in 95% of patients (95/100) when judged by CT and Dynamic X-ray

The vast majority of products have no human clinical data to support their use.
Ultimately, human clinical data should be used to select a bone graft.
5

The #1 Synthetic Bone Graft1


VITOSS continues to be the #1 Synthetic Bone Graft for the simplest of
reasons...IT WORKS and has HUMAN CLINICAL DATA to support its efficacy.
Clinical Experience - Over 375,000 implantations worldwide6
Clinical Proof - Numerous human clinical studies (including prospective and peer reviewed) demonstrating VITOSS with autologous
bone marrow is an effective autograft replacement.7

Cells & Signals

Endoscopy
1 - Millennium Research Group: US Markets for Orthopedic Biomaterials 2010.
2 - Peter Ullrich Jr., Autograft: The Patient's Own Bone. Published in 9/8/99 and updated on 11/25/09 on Spine Universe.
3 - Bellincampi, L., Clineff, T., Erbe, E., Osteoinductivity of Vitoss with Isologous Bone Marrow in Urist Rat Pouch Model.
Society for Biomaterials, Tampa, FL, April 24-27, 2002 (Podium).
4 - www.fda.gov, MQV products, November 2007.
5 - The Evolving Role of Bone Graft Substitutes. American Academy of Orthopaedic Surgeons 77th Annual Meeting,
March 9-13, 2010.
6 - Stryker Orthobiologics Internal Sales Data, July 2011.
7 - Vitoss Bibliography, P/N 5606-0117 Rev. 00, 2010.
8 - Motomiya, M., et al., Effect of Hydroxyapatite Porous Characteristics on Healing Outcomes in Rabbit Posterolateral
Spinal Fusion Model. European Spine Journal, 2007; 16: 2215-2224.
9 - Orthovita Test Report P/N 1070-0008R.
10 - Orthovita Test Report P/N 1050-0003R.
11 - Characteristics of Vitoss BA Product.
12 - Hench, L.L., Splinter, R.J., and Allen, W.C., Bonding Mechanisms at the Interface of Ceramic Prosthetic Materials.
Journal of Biomedical Materials Research, 1971; 2(1): 117-141.
13 - Hench, L.L., Paschall, H.A., Direct Chemical Bond of Bioactive Glass-Ceramic Materials to Bone and Muscle.
Journal of Biomedical Materials Research, 1973; 4: 25-42.
14 - Gross, U., The Interface of Various Glasses and Glass Ceramics with a Bony Implantation Bed. Journal of Biomedical
Materials Research, 1985; 19: 251-271.
15 - Sanders, D.M., Hench, L.L., Mechanisms of Glass Corrosion. Journal of American Ceramic Society. 1973; 56(7): 373-377.
16 - Hench, L.L., Characterization of Glass Corrosion and Durability. Journal of Non-Crystalline Solids, 1975; 19: 27-39.
17 - Ogino, M., Hench, L.L., Formation of Calcium Phosphate Films on Silicate Glasses. Journal of Non-Crystalline Solids,
1980; 38 and 39: 673-678.
18 - Vrouwenvelder, W.C.A., Histological and Biochemical Evaluation of Osteoblasts Cultured on Bioactive Glass,
Hydroxyapatite, Titanium Alloy, and Stainless Steel. Journal of Biomedical Materials Research, 1993 Apr; 27(4): 465-75.
19 - Hench, L.L., The Story of Bioglass. Journal of Materials Science: Materials in Medicine, 2006 Nov; 17(11): 967-78.
20 - Oonishi, H., et al., Particulate Bioglass Compared with Hydroxyapatite as a Bone Graft Substitute. Clinical Orthopaedics
and Related Research, 1997 Jan; 334: 316-25.
21 - Xynos, I.D., Edgar, A.J., Buttery, L.D.K., Hench, L.L., and Polak, J.M., Ionic Products of Bioactive Glass Dissolution Increase
Proliferation of Human Osteoblasts and Induce Insulin-like Growth Factor II mRNA Expression and Protein Synthesis.
Biochemical and Biophysical Research Communications, 2000 September 24; 276(2): 461-5.
22 - Anker et al, Ultraporous Beta-Tricalcium Phosphate is Well Incorporated in Small Cavitary Defects. Clinical
Orthopaedics and Related Research, 2005 May; 434: 251-7.
23 - Brown, LS, Darmoc, MM, Owsiany, RS, Clineff, TD, Improvements in Healing with a Bioactive Bone Graft
Substitute in a Canine Metaphyseal Defect. 55th Annual Meeting of the Orthopaedic Research Society, 2009.
24 - Havener, MB, Clineff, TD, Darmoc, MM, Brown, LS, Owsiany, R, A Comparative Study of Synthetic Bone Graft
Substitutes in a Canine Metaphyseal Defect. 54th Annual Meeting of the Orthopaedic Research Society, 2008.
25 - Marx, J., Bone Marrow: A Validated Biological Driver for Bone Regeneration, White Paper.
26 - Muschler, G.F., Nakamoto, C., Griffith, L.G., Engineering Principles of Clinical Cell-Based Tissue Engineering.
Journal of Bone and Joint Surgery, 2004; 86(7): 1541.
27 - Curylo, L.J., et al., Augmentation of Spinal Arthrodesis With Autologous Bone Marrow in a Rabbit Posterolateral Spine
Fusion Model. Spine, 1999 March 1, 24(5 ): 434-8.
28 - Deakin, D.E., Bannister, G.C., Graft Incorporation After Acetabular and Femoral Impaction Grafting With Washed
Irradiated Allograft and Autologous Marrow. The Journal of Arthroplasty, 2007 January; 22(1): 89-94.
29 - Kim, K.J., et al., Effect of Bone Marrow Grafting on the Titanium Porous-Coated Implant in Bilateral Total Knee
Arthroplasty. Acta Orthopaedica, 2007 February; 78(1): 116-22.

Communications

ICBG contains bone marrow rich with


mesenchymal stem cells and hematopoetic
stem cells that facilitate bone regeneration
and neo-vascularization. In addition, ICBG
provides signals that help drive bone formation.

Imaging

Bone marrow is a biologic driver found in ICBG.


Patient Handling Equipment

VITOSS resembles ICBG, the gold


standard, in that it has the same
three components: SCAFFOLD,
CELLS, and SIGNALS.3

Signal

EMS Equipment

Cells
Scaffold

Autograft (ICBG)

45 Great Valley Parkway


Malvern, PA 19355
1.888.774.8870 (tel)
1.610.640.2603 (fax)
www.stryker.com

VITOSS and BMA

VITOSS + BMA = synthetic autograft

BMA Harvesting Sites


Bone marrow can easily be aspirated from several anatomical locations throughout the
body. VITOSS can be used with or without bone marrow aspirate.

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular
product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be
trained in the use of any particular product before using it in surgery. The information presented in this brochure is
intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions
before using any Stryker product. Products may not be available in all markets. Product availability is subject to the
regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have
questions about the availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks
or service marks: Imbibe, Stryker, Vitoss. All other trademarks are trademarks of their respective owners or holders.
Literature Number: 5701-0000 Rev. 00
AQ/LW 08/11
Copyright 2011 Stryker
Printed in USA

Vertebral Body
(via pedicle)
Iliac Crest (PSIS, ASIS)

Calcaneus

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