Biological effects of rinsing morsellised bone grafts before and after impaction

Platelet concentrate as an additive to bone allografts: a laboratory study using an uniaxial compression test

Chemical cleaning procedures of allografts are destroying viable bone cells and denaturing osteoconductive and osteoinductive proteins present in the graft. The aim of the study was to investigate the mechanical differences of chemical cleaned allografts by adding blood, clotted blood; platelet concentrate and platelet gel using a uniaxial compression test. The allografts were chemically cleaned, dried and standardized according to their grain size distribution. Uniaxial compression test was carried out for the four groups before and after compacting the allografts. No statistically significant difference was found between native allografts, allografts mixed with blood, clotted blood, platelet concentrate and platelet concentrate gel regarding their yield limit after compaction. The authors recommend to chemical clean allografts for large defects, optimize their grain size distribution and add platelet concentrate or platelet rich plasma for enhancing as well primary stability as well bone ingrowth.

The biological approach in acetabular revision surgery: impaction bone grafting and a cemented cup

Acetabular impaction bone grafting (IBG) in combination with a cemented cup in revision total hip arthroplasty (THA) is a proven and well-recognised technique which has been used in clinical practice for more than 35 years. Nowadays, with cemented prostheses tending to lose a larger part of the THA market every year in primary and revision cases, and many young surgeons being only trained in implanting uncemented prostheses, this technique is considered by many as technically demanding and time consuming, making its use less appealing. Despite this image and many new innovative techniques using uncemented implants in acetabular revisions over the last 25 years, IBG with a cemented cup is still one of the few techniques that really can reconstitute bone and respects human biology. In this era of many biologically-based breakthroughs in medicine, it is hard to explain that the solution of most orthopaedic surgeons for the extensive bone defects as frequently seen during acetabular revision surgery, consists of implanting bigger and larger metal implants. This review aims to put the IBG method into a historical perspective, to describe the surgical technique and present the clinical results.