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D’Apolito R, Zagra L. Uncemented Cups and Impaction Bone Grafting for Acetabular Bone Loss in Revision Hip Arthroplasty: A Review of Rationale, Indications, and Outcomes. MATERIALS 2022; 15:ma15103728. [PMID: 35629756 PMCID: PMC9145197 DOI: 10.3390/ma15103728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022]
Abstract
Total hip arthroplasty (THA) is increasingly performed in young patients and the number of revisions is estimated to rise over time. Acetabular osteolysis and bone loss are frequently encountered during revision and may be classified and treated in different ways. Impaction bone grafting (IBG) with morselized allograft offers a viable option. IBG was introduced over 40 years ago in combination with cemented cups, and is also used with uncemented cups. The impacted bone chips act as a void filler to restore bone stock; once incorporated they are substituted by host bone. Surgery entails assessment of the defect, acetabular preparation, preparation of the morselized graft, impaction of the graft, and cup implantation. Satisfactory medium- and long-term results have now been reported in most studies. With the advent of high-porosity cups, indications have been extended, enhancing the potential of IBG, in which primary stability of the cup to the host bone is essential for a successful procedure. Synthetic bone substitutes have also been used in combination with allogenic grafts and may extend the original technique for which long-term studies are warranted.
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Marshall T, Chow J, Sivakumar B, Ahmed N, Smith P. Efficient use of a limited resource femoral head allograft: A comparison of allograft preparation methods. J Orthop Surg (Hong Kong) 2018; 25:2309499017727952. [PMID: 28862101 DOI: 10.1177/2309499017727952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of the study was to compare the yield and compressed volume of femoral head allograft prepared by either hand morselization or a bone mill. METHODS Twenty human femoral head allografts were donated from a bone bank and morselized by two different methods. The heads were divided in half and split into two sample groups. One group underwent hand morselization with large bone nibblers, while the other was prepared using a bone mill. The volume of graft produced was measured. Ten-gram aliquots of each sample then underwent 30 impactions in a contained cavity, with the volume of graft compression measured. RESULTS Bone milling yielded approximately 31% more usable graft than hand morselization (81% to 50%; p = 0.0001). There was no difference between the compressed volume of graft prepared by either method ( p = 0.14). CONCLUSION This study demonstrates the efficacy of preparation of allograft with a bone mill and assists the clinician in determining the yield of graft by the weight of femoral head, thereby potentially minimizing excessive ordering and wastage.
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Affiliation(s)
- Timothy Marshall
- 1 Trauma and Orthopaedic Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jason Chow
- 1 Trauma and Orthopaedic Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Brahman Sivakumar
- 2 JMSU Department, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Nushin Ahmed
- 1 Trauma and Orthopaedic Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- 1 Trauma and Orthopaedic Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Kumar V, Ricks M, Abouel-Enin S, Dunlop D. Long term results of impaction Bone grafting using a synthetic graft (Apapore) in revision hip surgery. J Orthop 2017; 14:290-293. [DOI: 10.1016/j.jor.2017.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022] Open
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Modeling Innovative Power Take-Off Based on Double-Acting Hydraulic Cylinders Array for Wave Energy Conversion. ENERGIES 2015. [DOI: 10.3390/en8032230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McNamara I, Howard J, Rayment A, Schalk R, Brooks R, Best S, Rushton N. Mechanical properties of morcellised bone graft with the addition of hydroxyapatite. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:321-327. [PMID: 24390340 DOI: 10.1007/s10856-013-5085-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/25/2013] [Indexed: 06/03/2023]
Abstract
Mixtures of morcellised bone graft (MBG) and hydroxyapatite (HA) are frequently used in revision arthroplasty surgery. However, the changes in the mechanical properties from adding HA to MBG are unknown. This study used a uniaxial compression test to replicate impaction bone grafting and subsequent early postoperative weightbearing to investigate the effect of adding different proportion of HA to MBG. To achieve this aim, human MBG was subjected to increasing impaction forces and the apparent stiffness and creep for each stress level determined. Subsequently, increasing proportions porous and non porous HA were added to the MBG. The major findings were that the apparent stiffness for MBG increased and the associated creep decreased both with the application of increasing stress and with the addition of increasing proportions of HA. In conclusion, greater proportions of HA in the graft mixture improved the mechanical response compared with MBG impacted under the same force. This improvement replicated the properties of pure MBG under high axial stress. This study indicates that graft mixtures of MBG and HA can be tailormade for patients. The need for less impaction force in MBG:HA mixtures to obtain the same properties as pure MBG may decrease the risk of intraoperative fracture.
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Affiliation(s)
- I McNamara
- Norfolk and Norwich University Hospital NHS foundation trust, Norwich, NR4 7UY, UK,
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Holton C, Bobak P, Wilcox R, Jin Z. Impaction grafted bone chip size effect on initial stability in an acetabular model: Mechanical evaluation. J Orthop 2014; 10:177-81. [PMID: 24396238 DOI: 10.1016/j.jor.2013.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 09/01/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Acetabular bone defect reconstruction is an increasing problem for surgeons with patients undergoing complex primary or revision total hip replacement surgery. Impaction bone grafting is one technique that has favourable long-term clinical outcome results for patients who undergo this reconstruction method for acetabular bone defects. Creating initial mechanical stability of the impaction bone graft in this technique is known to be the key factor in achieving a favourable implant survival rate. Different sizes of bone chips were used in this technique to investigate if the size of bone chips used affected initial mechanical stability of a reconstructed acetabulum. METHODOLOGY Twenty acetabular models were created in total. Five control models were created with a cemented cup in a normal acetabulum. Then five models in three different groups of bone chip size were constructed. The three groups had an acetabular protrusion defect reconstructed using either; 2-4 mm(3), 10 mm(3) or 20 mm(3) bone chip size for impaction grafting reconstruction. The models underwent compression loading up to 9500 N and displacement within the acetabular model was measured indicating the initial mechanical stability. RESULTS This study reveals that, although not statistically significant, the largest (20 mm(3)) bone chip size grafted models have an inferior maximum stiffness compared to the medium (10 mm(3)) bone chip size. INTERPRETATIONS Our study suggests that 10 mm(3) size of bone chips provide better initial mechanical stability compared to smaller or larger bone chips. We dismissed the previously held opinion that the biggest practically possible graft is best for acetabular bone graft impaction.
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Affiliation(s)
- Colin Holton
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Peter Bobak
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Ruth Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK ; School of Mechanical Engineering, Xian Jiaotong University, Shanghai 200240, China
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Morsellised sawbones is an acceptable experimental substitute for the in vitro elastic and viscoelastic mechanical characterisation of morsellised cancellous bone undergoing impaction grafting. Med Eng Phys 2013; 36:26-31. [PMID: 24075067 DOI: 10.1016/j.medengphy.2013.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/29/2013] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Impaction grafting using morsellised bone chips is widely used during surgery to mitigate the effects of bone loss. The technique typically involves the packing of morsellised allograft cancellous bone into bone defects, and has found extensive application in revision hip and knee surgery. In the ideal situation, the presence of the bone graft prevents subsidence of the revised prosthesis in the short term, and integrates with the host bone in the longer term. However, the configuration of particles within the graft remains to be optimised, and is highly likely to vary across potential sites and loading conditions. Human bone, for use in experimental investigation, is often difficult to obtain with properties that are relevant from a clinical point of view. This study, therefore, has explored the mechanical response of a Sawbones based experimental substitute. An established confined compression technique was used to characterise the morsellised Sawbones material. Comparison of the results with published values for bovine and human bone indicate that the mechanical response of the morsellised Sawbones material map well onto the elastic and viscoelastic response of bone of a biological origin.
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So K, Kuroda Y, Matsuda S, Akiyama H. Revision total hip replacement with a cemented long femoral component: minimum 9-year follow-up results. Arch Orthop Trauma Surg 2013; 133:869-74. [PMID: 23584837 DOI: 10.1007/s00402-013-1733-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND Surgical revision after failed total hip replacement is a technically challenging procedure. The aim of this study was to analyze the long-term results of revision total hip replacement using a cemented long femoral component and identify factors that influence the results. METHODS We retrospectively reviewed 34 hips in 33 patients who had undergone revision total hip replacement using a cemented long femoral component between 1994 and 2001. Hip function was evaluated according to the scoring system of the Japanese Orthopaedic Association. Radiographic examination was performed for evaluation of stem loosening, and its possible risk factors were investigated. RESULTS The mean follow-up duration was 11.3 years (9-15). Perioperative complications included intraoperative femoral cortex perforation (six hips, 18 %), dislocation (five hips, 15 %), deep venous thrombosis (one hip, 3 %) and postoperative periprosthetic fracture (one hip, 3 %). The mean preoperative Japanese Orthopaedic Association hip score was 50.3 ± 14.9 vs 78.2 ± 11.5 at the latest follow-up. The Kaplan-Meier survival rate at 15 years, calculated using radiological failure or re-revision of the femoral component for any reason as the end point, was 87 or 100 %, respectively. The failure-free survival rate for the subgroup with a good-quality cement mantle was significantly higher than that for the subgroup with poor quality (p = 0.033). CONCLUSIONS The quality of cementation was identified as a significant risk factor for further loosening. Revision total hip replacement using a cemented long femoral component yielded satisfactory long-term results in this series.
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Affiliation(s)
- Kazutaka So
- Department of Orthopaedics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
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Abstract
BACKGROUND AND PURPOSE Acetabular impaction grafting has been shown to be very effective, but concerns regarding its suitability for larger defects have been highlighted. We report the use of this technique in a large cohort of patients, and address possible limitations of the technique. METHODS We investigated a consecutive group of 339 cases of impaction grafting of the cup with morcellised impacted allograft bone for survivorship and mechanisms for early failure. RESULTS Kaplan Meier survival was 89.1% (95% CI 83.2 to 95.0%) at 5.8 years for revision for any reason, and 91.6% (95% CI 85.9 to 97.3%) for revision for aseptic loosening of the cup. Of the 15 cases revised for aseptic cup loosening, nine were large rim mesh reconstructions, two were fractured Kerboull-Postel plates, two were migrating cages, one was a medial wall mesh failure and one had been treated by impaction alone. INTERPRETATION In our series, results were disappointing where a large rim mesh or significant reconstruction was required. In light of these results, our technique has changed in that we now use predominantly larger chips of purely cancellous bone, 8-10 mm3 in size, to fill the cavity and larger diameter cups to better fill the aperture of the reconstructed acetabulum. In addition we now make greater use of i) implants made of a highly porous in-growth surface to constrain allograft chips and ii) bulk allografts combined with cages and morcellised chips in cases with very large segmental and cavitary defects.
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Xu ZJ, Chen LY, Zhong C, Tan YB, He RX. Mechanical properties of 7-10mm bone grafts and small slurry grafts in impaction bone grafting. J Orthop Res 2011; 29:1491-5. [PMID: 21469177 DOI: 10.1002/jor.21357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 12/13/2010] [Indexed: 02/04/2023]
Abstract
We compared the mechanical properties of morselized cancellous bone grafts of two sizes: 7-10 mm bone and small slurry bone (about 2 mm). The in vitro test was designed to simulate the hammer and impactor system for impaction bone grafting used in hip arthroplasty clinical practice. The 7-10 mm bone grafts showed higher height, elastic modulus, and massive extrusion strength than those of the small slurry bone grafts. No difference was found in yield strength. The bone mineral density of the 7-10 mm grafts continued to increase during impaction and became higher than that of the small slurry bone grafts after 10 impactions. Our results demonstrated that the small slurry bone grafts exhibit worse mechanical properties as compared with the 7-10 mm bone grafts, which implies that the use of this material in reconstruction of a bone defect in the acetabulum should be limited.
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Affiliation(s)
- Zheng-Jian Xu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, PR China
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McNamara IR, Rayment A, Brooks R, Best S, Rushton N. The effect of the addition of hydroxyapatite graft substitutes upon the hoop strain and subsequent subsidence of a femoral model during impaction bone grafting. J Mech Behav Biomed Mater 2011; 5:238-46. [PMID: 22100099 DOI: 10.1016/j.jmbbm.2011.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 11/25/2022]
Abstract
Impaction bone grafting using morcellised allograft can successfully restore bone stock in revision surgery. However, concerns exist regarding supply of bone and transmission of infection. Bone-graft extenders, such as tricalcium phosphate (TCP) and hydroxyapatite (HA), are used to minimise the use of donor bone. However, concerns exist around a reported increased risk of femoral fracture during impaction bone grafting with a 1:1 mixture of TCP/HA and morcellised bone graft (MBG) during impaction grafting in human cadaveric femora. Using a sawbones model, it was evaluated whether there was increased femoral cortical strain with a HA:MBG mixture during impaction grafting compared to MBG impacted at the same and a greater force. Subsequently the subsidence behaviour of the different graft mixes was compared by using a loaded femoral stem in an endurance test. It was demonstrated that the femora with the MBG:HA graft had greater cortical hoop stresses but improved subsidence behaviour compared to a graft composed of pure MBG impacted at the same force.
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Affiliation(s)
- I R McNamara
- Orthopaedic Research Unit, Addenbrooke's Hospital, Cambridge, CB1 1QQ, United Kingdom.
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Brennan SA, Brabazon D, O’Byrne JM. Effect of vibration on the shear strength of impacted bone graft in revision hip surgery. ACTA ACUST UNITED AC 2011; 93:755-9. [DOI: 10.1302/0301-620x.93b6.24544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We developed a method of applying vibration to the impaction bone grafting process and assessed its effect on the mechanical properties of the impacted graft. Washed morsellised bovine femoral heads were impacted into shear test rings. A range of frequencies of vibration was tested, as measured using an accelerometer housed in a vibration chamber. Each shear test was repeated at four different normal loads to generate stress-strain curves. The Mohr-Coulomb failure envelope from which shear strength and interlocking values are derived was plotted for each test. The experiments were repeated with the addition of blood in order to replicate a saturated environment. Graft impacted with the addition of vibration at all frequencies showed improved shear strength when compared with impaction without vibration, with 60 Hz giving the largest effect. Under saturated conditions the addition of vibration was detrimental to the shear strength of the aggregate. The civil-engineering principles of particulate settlement and interlocking also apply to impaction bone grafting. Although previous studies have shown that vibration may be beneficial in impaction bone grafting on the femoral side, our study suggests that the same is not true in acetabular revision.
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Affiliation(s)
| | - D. Brabazon
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
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Hansen TB, Meier M, Møller MCM, Larsen K, Stilling M. Primary cup fixation with different designs of trapeziometacarpal total joint trapezium components: a radiostereometric analysis in a pig bone model. J Hand Surg Eur Vol 2011; 36:285-90. [PMID: 21282215 DOI: 10.1177/1753193410394526] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High loosening rates of the trapezium components of trapeziometacarpal total joint prostheses have been reported. The purpose of this study was to compare the primary press fit fixation of two different, uncemented cup designs (MOTEC and Elektra) with the primary fixation of a cemented polyethylene cup (DLC) in a pig bone model. We did a push out test to measure the maximal load strength of the implants and a low-pressure cyclic loading test combined with radiostereometric analysis to measure the micromotion of the implants. There was no significant difference in fixation strength between the two uncemented screw cup designs or between the two uncemented screw cups and the cemented polyethylene cup. However, we found that threading of the bone before insertion of the Electra screw cup weakens the primary fixation strength of the implant. The results indicate that focus should be on the insertion technique as well as on the cup design of uncemented trapezium cup implants. Further studies of trapezium implant migration in a clinical setting are needed.
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Affiliation(s)
- T B Hansen
- Department of Orthopaedics, Section of Hand Surgery, and Orthopaedic Research Unit, Regional Hospital Holstebro, Denmark.
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McNamara I, Deshpande S, Porteous M. Impaction grafting of the acetabulum with a mixture of frozen, ground irradiated bone graft and porous synthetic bone substitute (Apapore 60). ACTA ACUST UNITED AC 2010; 92:617-23. [PMID: 20435995 DOI: 10.1302/0301-620x.92b5.23044] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The clinical and radiological results of 50 consecutive acetabular reconstructions in 48 patients using impaction grafting have been retrospectively reviewed. A 1:1 mixture of frozen, ground irradiated bone graft and Apapore 60, a synthetic bone graft substitute, was used in all cases. There were 13 complex primary and 37 revision procedures with a mean follow-up of five years (3.4 to 7.6). The clinical survival rate was 100%, with improvements in the mean Harris Hip Scores for pain and function. Radiologically, 30 acetabular grafts showed evidence of incorporation, ten had radiolucent lines and two acetabular components migrated initially before stabilising. Acetabular reconstruction in both primary and revision surgery using a 1:1 mixture of frozen, ground, irriadiated bone and Apapore 60 appears to be a reliable method of managing acetabular defects. Longer follow-up will be required to establish whether this technique is as effective as using fresh-frozen allograft.
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Affiliation(s)
- I. McNamara
- West Suffolk Hospital, NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, UK. and The Orthopaedic Research Unit Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - S. Deshpande
- West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, UK
| | - M. Porteous
- West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, UK
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Impaction bone grafting in revision hip surgery: past, present and future. Cell Tissue Bank 2010; 11:57-73. [PMID: 20077177 DOI: 10.1007/s10561-009-9147-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
Joint replacement surgery can have excellent clinical results. However, as the number of patients undergoing surgery increases, the number of failed joint replacements is set to rise. One of the greatest challenges for the revision surgeon is the restoration of bone stock. This article focuses upon revision hip surgery, with particular reference to the scope of the problem; historical and current solutions to bone loss in the femur and acetabulum; the clinical results following revision surgery; and the basic science behind impaction bone grafting, before ending with possible future directions for improving the restoration of bone stock.
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[Hip implant revision. Avoiding mistakes and managing risk]. DER ORTHOPADE 2009; 38:718-28. [PMID: 19672577 DOI: 10.1007/s00132-009-1427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hip revision surgery may lead to unexpected complications, with a negative impact on the treatment outcome. To refer to possible difficulties as"mistakes" is less helpful than defining ways to foresee such difficulties and developing possible strategies to avoid them. This approach requires a comprehensive amount of personal experience, which may follow consideration of some basic"rules" and possible surgical scenarios before an intervention. The author presents an individual risk management approach that includes hints on how to foresee the occurrence of certain intraoperative difficulties and how to help avoid errors by incorporating forward-thinking strategies into hip revision surgery.
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Blom AW, Wylde V, Livesey C, Whitehouse MR, Eastaugh-Waring S, Bannister GC, Learmonth ID. Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute. Acta Orthop 2009; 80:150-4. [PMID: 19404794 PMCID: PMC2823174 DOI: 10.3109/17453670902884767] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE One of the greatest problems of revision hip arthroplasty is dealing with lost bone stock. Good results have been obtained with impaction grafting of allograft bone. However, there have been problems of infection, reproducibility, antigenicity, stability, availability of bone, and cost. Thus, alternatives to allograft have been sought. BoneSave is a biphasic porous ceramic specifically designed for use in impaction grafting. BoneSave is 80% tricalcium phosphate and 20% hydroxyapatite. Previous in vitro and in vivo studies have yielded good results using mixtures of allograft and BoneSave, when compared with allograft alone. This study is the first reported human clinical trial of BoneSave in impaction grafting. METHODS We performed a single-institution, multi-surgeon, prospective cohort study. 43 consecutive patients underwent revision hip arthroplasty using BoneSave and allograft to restore missing bone in the acetabulum. 9 patients had cemented acetabular components implanted and 34 uncemented. 10 patients had cemented femoral components implanted and 1 had an uncemented femoral component. 32 patients did not have their femoral component revised. RESULTS No patients were lost to follow-up. At a mean follow-up of 24 (11-48) months, there were no re-revisions and there was no implant migration. 1 acetabular component had confluent lucent lines at the implant-graft interface. Complications were rare (1 fracture, 2 dislocations). Patient satisfaction with the procedure was high. INTERPRETATION Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.
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Affiliation(s)
| | - Vikki Wylde
- Department of Academic Orthopaedics, University of Bristol, BIRC Research Labs, Avon Orthopaedic CentreBristol, BS10 5NB
| | - Christine Livesey
- Department of Academic Orthopaedics, University of Bristol, BIRC Research Labs, Avon Orthopaedic CentreBristol, BS10 5NB
| | | | - Steve Eastaugh-Waring
- Department of Orthopaedics, North Bristol NHS Trust, Avon Orthopaedic Centre, Southmead HospitalBristol, BS10 5NB
| | - Gordon C Bannister
- Department of Orthopaedics, North Bristol NHS Trust, Avon Orthopaedic Centre, Southmead HospitalBristol, BS10 5NB
| | - Ian D Learmonth
- Department of Academic Orthopaedics, University of Bristol, BIRC Research Labs, Avon Orthopaedic CentreBristol, BS10 5NB
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