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Iwase T, Otsuka H, Katayama N, Fujita H. Impaction bone grafting for femoral revision hip arthroplasty with Exeter stem in Japan: An extended 10- to 15-year stem survival analysis of the previously reported series. J Orthop Sci 2024; 29:151-156. [PMID: 36610839 DOI: 10.1016/j.jos.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Femoral impaction bone grafting (IBG) was introduced in the late 1990s in Japan and has gradually become recognized as a useful option for femoral revision. The aim of the present study was to retrospectively analyze 10 to 15 years of clinical results of femoral revision arthroplasties of IBG using Exeter stem performed by experienced Japanese surgeons. METHODS We investigated radiographic and clinical records more than 2 years after surgery in 99 hips of 93 patients. The average age was 66.3 years (36-84 years) and the average follow-up period was 11 years (2-23 years and 8 months). Merle d'Aubigné and Postel hip score was used for clinical assessment, and re-operations for any reason were recorded. The survival curve was estimated using Kaplan-Meier method. RESULTS The mean Merle d'Aubigné and Postel hip score improved from 9.0 points to 14.5 points at the final follow-up. Re-operations were undertaken in 15 hips of 14 patients for aseptic acetabular component loosening (n = 1 hip), recurrent dislocation (n = 2 hips), infection (n = 4 hips), and periprosthetic femoral fracture (n = 8 hips). The survival rates at 10 and 15 years after operation were 87.1% and 81.1% with any type of re-operation as the endpoint, 92.2% and 92.2% with stem removal or exchange as the endpoint, 94.9% and 88.1% with re-operation for periprosthetic femoral fracture as the endpoint, and 99.0% and 99.0% with re-operation for aseptic stem loosening as the endpoint, respectively. CONCLUSIONS The present study showed encouraging results of femoral IBG over 10 years by experienced surgeons in Japan. Although femoral IBG is recognized as a technically complex procedure, survivorship of the stem is excellent, with a 15-year stem survival rate of 99.0% at the end point of aseptic loosening.
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Affiliation(s)
- Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka 432-8580, Japan.
| | - Hiromi Otsuka
- Department of Orthopedic Surgery, School of Medicine Aichi Medical University, Aichi, Japan
| | - Naoyuki Katayama
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Japan
| | - Hiroshi Fujita
- Center for Hip Arthroplasty, Senshunkai Hospital, Kyoto, Japan
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Park JH, Cho YJ, Son HS, Chun YS, Rhyu KH. Favorable mid-to-long-term results of impaction bone grafting using a fresh frozen allograft bone with cemented stem for the treatment of Paprosky IV femoral bone defects. J Orthop Sci 2022; 27:1257-1262. [PMID: 34696922 DOI: 10.1016/j.jos.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Femoral revision surgery in patients with substantial bone loss is challenging. Impaction bone grafting using a cemented stem can be a good solution for reconstruction of the femur with poor bone stock and extensive bone loss. This study aimed to evaluate the mid-to-long-term clinical and radiographic results of impaction bone grafting using a cemented stem for Paprosky IV femoral bone defects. METHODS Thirteen patients (13 hips) who underwent revision total hip arthroplasty with impaction bone grafting using a cemented stem and were followed up for at least 5 years were enrolled in this study. In all patients, a sufficient amount of fresh frozen bone of good quality was used. When cortical segmental defects were present, peripheral reinforcement with metal mesh and strut allograft was performed. The average follow-up duration was 11.1 (range, 5.3-15.1) years. The clinical and radiographic outcomes were reviewed at the final follow-up. RESULTS The average Harris hip score was 82.5 (range, 79-94), and the average University of California, Los Angeles activity score was 5.6 (range, 4-8) at the final follow-up. Radiographic assessment revealed an average femoral component subsidence level of 0.67 (range, 0.05-2.81) mm. There were no complications, except one case (7.6%) of periprosthetic fracture. CONCLUSIONS Impaction bone grafting using a cemented stem yielded excellent mid-to-long-term outcomes. It is a reliable technique for Paprosky IV femoral bone defects, and even when severe femoral cortical bone defects are present, long-term stability can be obtained using a metal mesh and/or strut allograft.
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Affiliation(s)
- Joon Hong Park
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea.
| | - Yoon Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea.
| | - Hyuck Sung Son
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea.
| | - Young Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
| | - Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea.
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Özdemir E, Kuijpers MFL, Visser J, Schreurs BW, Rijnen WHC. Thirty years of experience with instrumented femoral impaction bone grafting and a cemented polished Exeter stem : a prospective cohort study of 208 revision arthroplasties performed between 1991 and 2007. Bone Joint J 2022; 104-B:1039-1046. [PMID: 36047023 DOI: 10.1302/0301-620x.104b9.bjj-2022-0150.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique. METHODS We updated the outcomes of our previous study, based on 208 consecutive revisions using IBG and the X-change femoral revision system in combination with a cemented polished stem, performed in our tertiary care institute between 1991 and 2007. Kaplan-Meier survival analyses were used to determine the survival rate of the revisions with endpoint revision for any reason and aseptic loosening. Secondary outcomes were radiological loosening and patient-reported outcome measures. RESULTS Mean age at revision total hip arthroplasty (THA) was 64.9 years (30 to 86). The most prevalent diagnosis for the femoral revision was aseptic loosening. At review in May 2021, 81 patients (85 hips) were still alive and 118 patients (120 hips; 58%) had died. Three patients (3 hips; 1%) were lost to follow-up at 11, 15, and 16 years after surgery, respectively. Data of all deceased and lost patients were included until final follow-up. The mean follow-up was 13.4 years (0 to 28). During the follow-up, 22 re-revisions were performed. The most common reason for re-revision was infection (n = 12; 54%). The survival with endpoint re-revision for any reason was 86% (95% confidence interval (CI) 79 to 91) at 20 years and 74% (95% CI 43 to 89) at 25 years after surgery. The survival for endpoint re-revision for aseptic loosening was 97% (95% CI 91 to 99) after both 20 and 25 years. CONCLUSION We conclude that femoral IBG is a valuable technique that can reconstitute femoral bone loss in the long term. After 25 years of follow-up, few re-revisions for aseptic loosening were required. Also, the overall revision rate is very acceptable at a long follow-up. This technique is especially attractive for younger patients facing femoral revisions with extensive bone loss.Cite this article: Bone Joint J 2022;104-B(9):1039-1046.
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Affiliation(s)
- Erim Özdemir
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn F L Kuijpers
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jetze Visser
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B W Schreurs
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim H C Rijnen
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
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Tyson Y, Rolfson O, Kärrholm J, Hailer NP, Mohaddes M. Uncemented or cemented revision stems? Analysis of 2,296 first-time hip revision arthroplasties performed due to aseptic loosening, reported to the Swedish Hip Arthroplasty Register. Acta Orthop 2019; 90:421-426. [PMID: 31154890 PMCID: PMC6746274 DOI: 10.1080/17453674.2019.1624336] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and purpose - Uncemented stems are increasingly used in revision hip arthroplasty, but only a few studies have analyzed the outcomes of uncemented and cemented revision stems in large cohorts of patients. We compared the results of uncemented and cemented revision stems. Patients and methods - 1,668 uncemented and 1,328 cemented revision stems used in first-time revisions due to aseptic loosening between 1999 and 2016 were identified in the Swedish Hip Arthroplasty Register. Kaplan-Meier analysis was used to investigate unadjusted implant survival with re-revision for any reason as the primary outcome. Hazard ratios (HR) for the risk of re-revision were calculated using a Cox regression model adjusted for sex, age, head size, concomitant cup revision, surgical approach at primary and at index revision surgery, and indication for primary total hip arthroplasty. Results - Unadjusted 10-year survival was 85% (95% CI 83-87) for uncemented and 88% (CI 86-90) for cemented revision stems. The adjusted HR for re-revision of uncemented revision stems during the first year after surgery was 1.3 (CI 1.0-1.6), from the second year the HR was 1.1 (CI 0.8-1.4). Uncemented stems were most often re-revised early due to infection and dislocation, whereas cemented stems were mostly re-revised later due to aseptic loosening. Interpretation - Both uncemented and cemented revision stems had satisfactory long-term survival but they differed in their modes of failure. Our conclusions are limited by the fact that femoral bone defect size could not be investigated within the setting of the current study.
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Affiliation(s)
- Yosef Tyson
- Section of Orthopedic Surgery, Department of Surgical Sciences, Uppsala University Hospital, Uppsala; ,The Swedish Hip Arthroplasty Register, Gothenburg; ,Correspondence:
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nils P Hailer
- Section of Orthopedic Surgery, Department of Surgical Sciences, Uppsala University Hospital, Uppsala; ,The Swedish Hip Arthroplasty Register, Gothenburg;
| | - Maziar Mohaddes
- The Swedish Hip Arthroplasty Register, Gothenburg; ,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
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Ahmed GA, Ishaque B, Rickert M, Fölsch C. [Allogeneic bone transplantation in hip revision surgery : Indications and potential for reconstruction]. DER ORTHOPADE 2019; 47:52-66. [PMID: 29260246 DOI: 10.1007/s00132-017-3506-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The increasing number of people having joint replacements will lead to increasing numbers of revision operations. The transplantation of allogeneic bones might reconstruct bone defects and improve long-term anchorage of the implant. A sufficient primary stability of the implanted construct is necessary to achieve osseous incorporation as well as tight contact between the implanted allogeneic and host bones. Transplantation of bone can contribute to downgrading acetabular defects and so avoid bigger reinforcement implants. An improvement of bone stock due to reconstruction of femoral bony defects might also reduce the size of the stem necessary since the indication might be limited in case of extensive bone defects. According to good longterm results of modular revision stems the Impaction-Bone-Grafting has not yet generally been established.
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Affiliation(s)
- G A Ahmed
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Justus-Liebig-Universität Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
| | - B Ishaque
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Justus-Liebig-Universität Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - M Rickert
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Justus-Liebig-Universität Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - C Fölsch
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Justus-Liebig-Universität Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
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Stigbrand H, Ullmark G. A 3- to 18-Year Follow-Up of Revision Total Hip Arthroplasty With Impacted Bone Allografts and Cemented Lubinus SP II Stem. Clinical, Radiographic, and Survivorship Analysis With Comparison to the Literature. J Arthroplasty 2017; 32:2810-2814. [PMID: 28529108 DOI: 10.1016/j.arth.2017.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/21/2017] [Accepted: 04/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We present the first medium- to long-term follow-up of revision total hip arthroplasty using impaction bone grafting (IBG) combined with the matte and collared Lubinus SP II stem for cases of severe osteolysis and stem loosening. METHODS Sixty-nine femoral revisions were identified for 67 patients consecutively operated with revision femoral arthroplasty using IBG and a cemented Lubinus SP II stem. The mean age was 69 years (standard deviation, 9.9). We retrospectively analyzed 68 cases (1 was lost to follow-up). At the time of the revision surgery, all had substantial femoral bone loss. Fifteen of the revisions were performed due to deep infection. The patients were analyzed by clinical score and radiography. RESULTS At follow-up, 4 femoral components (6%) had been rerevised or assessed as failure. Of these 4, 3 were assessed as mechanical failure, and 1 for dislocation; none was for infection. Three cups (4%) had been revised for dislocation; 1 of these also had a stem exchange. Three cases (4%) had been reoperated for a periprosthetic fracture in distal femur without stem exchange. Radiologic results were excellent and the clinical Merle d'Aubignè-Postel score had improved from a mean of 12.2 preoperatively to 17.5 at follow-up. CONCLUSION IBG combined with the Lubinus SP II stem is safe and results in a low rate of periprosthetic fractures and dislocations. The medium- to long-term clinical result was excellent, with regeneration of living bone in the femur.
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Affiliation(s)
- Hampus Stigbrand
- Department of Orthopaedic Surgery, Länssjukhuset, Gävle, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Sweden
| | - Gösta Ullmark
- Department of Orthopaedic Surgery, Länssjukhuset, Gävle, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Sweden
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7
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Haddad FS. Common Hip Arthroplasty Problems-Useful Alternative Solutions From "Across the Pond". J Arthroplasty 2017; 32:S45-S46. [PMID: 28427737 DOI: 10.1016/j.arth.2017.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Fares S Haddad
- Institute of Sport, Exercise & Health, University College Hospital, London, United Kingdom
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8
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Ibrahim DA, Fernando ND. Classifications In Brief: The Paprosky Classification of Femoral Bone Loss. Clin Orthop Relat Res 2017; 475:917-921. [PMID: 27484412 PMCID: PMC5289194 DOI: 10.1007/s11999-016-5012-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/28/2016] [Indexed: 01/31/2023]
Affiliation(s)
- David A. Ibrahim
- Department of Orthopaedic Surgery, Adult Hip and Knee Reconstruction, University of Washington, 10330 Meridian Avenue N, Suite 270, Seattle, WA 98133 USA
| | - Navin D. Fernando
- Department of Orthopaedic Surgery, Adult Hip and Knee Reconstruction, University of Washington, 10330 Meridian Avenue N, Suite 270, Seattle, WA 98133 USA
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Grammatopoulos G, Alvand A, Martin H, Whitwell D, Taylor A, Gibbons CLMH. Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications. Bone Joint J 2017; 98-B:1463-1470. [PMID: 27803221 DOI: 10.1302/0301-620x.98b11.bjj-2016-0244.r1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/14/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES A possible solution for the management of proximal femoral bone loss is a modular femoral endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of their use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of using EPR for non-neoplastic indications. METHODS A retrospective review of 79 patients who underwent 80 EPRs for non-neoplastic indications was performed, including the rates of complication and survival and the mean Oxford Hip Scores (OHS), at a mean of five years post-operatively. The mean age at the time of surgery was 69 years (28 to 93) and the mean number of previous operations on the hip was 2.4 (0 to 17). The most common indications for EPR implantation were periprosthetic joint infection (PJI) (n = 40), periprosthetic fracture (n = 12) and failed osteosynthesis of a proximal femoral fracture or complex trauma (n = 11). RESULTS Salvage was achieved in all patients. A total of 25 patients (25 EPRs, 31.6%) had a complication, the most common being infection (n = 9) and dislocation (n = 3). Further surgery was required for 18 EPRs (22%), nine of which were revision procedures. The five year survival of the EPR was 87% (95%CI: 76% to 98%). The mean OHS was 28 (4 to 48). Inferior survival and outcomes were seen in EPRs which were performed for the treatment of infection. However, the eradication of infection was achieved in 33 of the 40 (82.5%) which were undertaken for this indication. CONCLUSION We recommend the continued use of proximal femoral EPRs for non-neoplastic indications, including PJI. Cite this article: Bone Joint J 2016;98-B:1463-70.
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Affiliation(s)
- G Grammatopoulos
- Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK
| | - A Alvand
- University of Oxford , Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK
| | - H Martin
- Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK
| | - D Whitwell
- Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK
| | - A Taylor
- Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK
| | - C L M H Gibbons
- Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK
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Streit MR. CORR Insights ®: Nonmodular Tapered Fluted Titanium Stems Osseointegrate Reliably at Short Term in Revision THAs. Clin Orthop Relat Res 2017; 475:193-195. [PMID: 27798790 PMCID: PMC5174067 DOI: 10.1007/s11999-016-5144-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/24/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Marcus R Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Predictors of unsuccessful outcome in cemented femoral revisions using bone impaction grafting; Cox regression analysis of 208 cases. Hip Int 2016; 26:444-450. [PMID: 27174070 DOI: 10.5301/hipint.5000370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Despite improvements in the technique of femoral impaction bone grafting, reconstruction failures still can occur. Therefore, the aim of our study was to determine risk factors for the endpoint re-revision for any reason. METHODS We used prospectively collected demographic, clinical and surgical data of all 202 patients who underwent 208 femoral revisions using the X-change Femoral Revision System (Stryker-Howmedica), fresh-frozen morcellised allograft and a cemented polished Exeter stem in our department from 1991 to 2007. Univariable and multivariable Cox regression analyses were performed to identify potential factors associated with re-revision. RESULTS The mean follow-up was 10.6 (5-21) years. The cumulative re-revision rate was 6.3% (13/208). After univariable selection, sex, age, body mass index (BMI), American Association of Anesthesiologists (ASA) classification, type of removed femoral component, and mesh used for reconstruction were included in multivariable regression analysis.In the multivariable analysis, BMI was the only factor that was significantly associated with the risk of re-revision after bone impaction grafting (BMI ≥30 vs. BMI <30, HR = 6.54 [95% CI 1.89-22.65]; p = 0.003). CONCLUSIONS BMI was the only factor associated with the risk of re-revision for any reason. Besides BMI also other factors, such as Endoklinik score and the type of removed femoral component, can provide guidance in the process of preclinical decision making. With the knowledge obtained from this study, preoperative patient selection, informed consent, and treatment protocols can be better adjusted to the individual patient who needs to undergo a femoral revision with impaction bone grafting.
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Fölsch C, Kellotat A, Rickert M, Ishaque B, Ahmed G, Pruss A, Jahnke A. Effect of thermodisinfection on mechanic parameters of cancellous bone. Cell Tissue Bank 2016; 17:427-37. [PMID: 27344440 DOI: 10.1007/s10561-016-9567-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
Revision surgery of joint replacements is increasing and raises the demand for allograft bone since restoration of bone stock is crucial for longevity of implants. Proceedings of bone grafts influence the biological and mechanic properties differently. This study examines the effect of thermodisinfection on mechanic properties of cancellous bone. Bone cylinders from both femoral heads with length 45 mm were taken from twenty-three 6-8 months-old piglets, thermodisinfected at 82.5 °C according to bone bank guidelines and control remained native. The specimens were stored at -20 °C immediately and were put into 21 °C Ringer's solution for 3 h before testing. Shear and pressure modulus were tested since three point bending force was examined until destruction. Statistical analysis was done with non-parametric Wilcoxon, t test and SPSS since p < 0.05 was significant. Shear modulus was significantly reduced by thermodisinfection to 1.02 ± 0.31 GPa from 1.28 ± 0.68 GPa for unprocessed cancellous bone (p = 0.029) since thermodisinfection reduced pressure modulus not significantly from 6.30 ± 4.72 GPa for native specimens to 4.97 ± 2.23 GPa and maximum bending force was 270.03 ± 116.68 N for native and 228.80 ± 70.49 N for thermodisinfected cancellous bone. Shear and pressure modulus were reduced by thermodisinfection around 20 % and maximum bending force was impaired by about 15 % compared with native cancellous bone since only the reduction of shear modulus reached significance. The results suggest that thermodisinfection similarly affects different mechanic properties of cancellous bone and the reduction of mechanic properties should not relevantly impair clinical use of thermodisinfected cancellous bone.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Andreas Kellotat
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
| | - Markus Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Bernd Ishaque
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Gafar Ahmed
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Axel Pruss
- University Tissue Bank, Institute of Transfusion Medicine, Charité University Medical School, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander Jahnke
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany
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