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Busanelli L, Castagnini F, Bordini B, Stea S, Calderoni PP, Toni A. The biological acetabular reconstruction with bone allografts in hip revision arthroplasty. Musculoskelet Surg 2019; 103:173-179. [PMID: 30328029 DOI: 10.1007/s12306-018-0573-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reconstructions in case of acetabular bone loss in hip revision arthroplasty are challenging. A few techniques have been proposed, with inconstant outcomes. Biological reconstructions using bone allografts may address the acetabular bone loss and restore the hip anatomy. Aim of this work was the description of the surgical technique and the evaluation of the outcomes using a regional arthroplasty register. MATERIALS AND METHODS Minor or massive bone allografting was performed in hip revision arthroplasties in a tertiary center. Bulk allografts were used in severe acetabular bone losses. Fresh-frozen femoral heads were impacted in the bone cavity and porous cups were implanted; multihole sockets were used when necessary. In DeLee A zone, no grafts were used in order to reduce overstress graft resorption. The results were evaluated using a regional arthroplasty register, and a comparison with revisions without bone grafts was performed investigating re-revision rates and reasons for further revisions. RESULTS At 10 years, acetabular revisions with bone allografts achieved a similar survival rate than revisions without bone grafts. The re-revisions occurred more frequently in revisions without bone allografts (10.8 vs. 9.7%). In the allograft cohort, septic loosening was lower (0.3 vs. 2.6%), whereas a higher rate of aseptic cup loosening was experienced (2.7 vs. 1.4%). CONCLUSIONS Bone allografts may provide a good restoration of the acetabular bone stock and the hip biomechanics. Septic loosening does not seems a major concern, whereas a higher rate of aseptic cup loosening should be expected when bone grafts are used.
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Affiliation(s)
- L Busanelli
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - F Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - B Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - S Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - P P Calderoni
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - A Toni
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Pierannunzii L, Zagra L. Bone grafts, bone graft extenders, substitutes and enhancers for acetabular reconstruction in revision total hip arthroplasty. EFORT Open Rev 2017; 1:431-439. [PMID: 28461922 PMCID: PMC5367522 DOI: 10.1302/2058-5241.160025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acetabular bone loss is a relevant concern for surgeons dealing with a failed total hip arthroplasty. Since the femoral head is no longer available, allografts represent the first choice for most reconstructive solutions, either as a structural buttress or impacted bone chips. Even though fresh-frozen bone is firmly recommended for structural grafts, freeze-dried and/or irradiated bone may be used alternatively for impaction grafting. Indeed, there are some papers on freeze-dried or irradiated bone impaction grafting, but their number is limited, as is the number of cases. Xenografts do not represent a viable option based on the poor available evidence but bioactive bioceramics such as hydroxyapatite and biphasic calcium phosphates are suitable bone graft extenders or even substitutes for acetabular impaction grafting. Bone-marrow-derived mesenchymal stem cells and demineralised bone matrix seem to act as reliable bone graft enhancers, i.e. adjuvant therapies able to improve the biological performance of standard bone grafts or substitutes. Among these therapies, platelet-rich plasma and bone morphogenetic proteins need to be investigated further before any recommendations can be made.
Cite this article: EFORT Open Rev 2016;1:431-439. DOI:10.1302/2058-5241.160025
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Affiliation(s)
| | - Luigi Zagra
- IRCCS Galeazzi Orthopedic Institute, Milan, Italy
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Development of a Three-Dimensional (3D) Printed Biodegradable Cage to Convert Morselized Corticocancellous Bone Chips into a Structured Cortical Bone Graft. Int J Mol Sci 2016; 17:ijms17040595. [PMID: 27104525 PMCID: PMC4849049 DOI: 10.3390/ijms17040595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022] Open
Abstract
This study aimed to develop a new biodegradable polymeric cage to convert corticocancellous bone chips into a structured strut graft for treating segmental bone defects. A total of 24 adult New Zealand white rabbits underwent a left femoral segmental bone defect creation. Twelve rabbits in group A underwent three-dimensional (3D) printed cage insertion, corticocancellous chips implantation, and Kirschner-wire (K-wire) fixation, while the other 12 rabbits in group B received bone chips implantation and K-wire fixation only. All rabbits received a one-week activity assessment and the initial image study at postoperative 1 week. The final image study was repeated at postoperative 12 or 24 weeks before the rabbit scarification procedure on schedule. After the animals were sacrificed, both femurs of all the rabbits were prepared for leg length ratios and 3-point bending tests. The rabbits in group A showed an increase of activities during the first week postoperatively and decreased anterior cortical disruptions in the postoperative image assessments. Additionally, higher leg length ratios and 3-point bending strengths demonstrated improved final bony ingrowths within the bone defects for rabbits in group A. In conclusion, through this bone graft converting technique, orthopedic surgeons can treat segmental bone defects by using bone chips but with imitate characters of structured cortical bone graft.
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Callado VM, de Sandes Kimura O, de Carvalho Leal D, Teixeira de Sousa Filho PG, Cury Fernandes MB, Carvalho de Almendra Freitas EH. Evaluation of the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. Rev Bras Ortop 2014; 49:364-9. [PMID: 26229828 PMCID: PMC4511618 DOI: 10.1016/j.rboe.2014.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE this study aimed to evaluate the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. METHODS twenty-three cases with minimum grading of Paprosky II-B that were operated between July 2008 and February 2013 were evaluated. These cases were evaluated based on radiographs before the operation, immediately after the operation and later on after the operation. Loss of fixation was defined as a change in the abduction angle of the component greater than 10° or any mobilization greater than 6 mm. RESULTS it was found that there was 100% fixation of the acetabula after a mean of 29.5 months. One case underwent removal of the implanted components due to infection. CONCLUSIONS there is still no consensus regarding the best option for reconstructing hips with bone loss. However, revision using a trabecular metal wedge has presented excellent short- and medium-term results. This qualifies it as an important tool for achieving a fixed and stable acetabular component.
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Lu W, Liu G, Li B, Shi N, Zhao J. Combined debridement, bone graft and articular cavity sealing using synovium in treating metaphyseal osteomyelitis involving knee joints. Exp Ther Med 2012; 5:253-256. [PMID: 23251278 PMCID: PMC3524291 DOI: 10.3892/etm.2012.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/15/2012] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate the efficacy of combined debridement, bone graft and articular cavity sealing using synovium in the treatment of metaphyseal osteomyelitis involving the knee joint. Eleven patients with metaphyseal osteomyelitis, which involved femurs in 4 patients and tibiae in 7, were included. The patients received a novel treatment, which combined debridement, bone graft and articular cavity sealing using the synovium. Of the 11 patients, 4 patients with knee joint instability received a structural allograft and 7 with a stable knee joint underwent a particulate bone graft. The 11 patients underwent regular clinical and radiological evaluation; the average follow-up was 74 months (range, 58–96). Infection recurrence in the joint and bone graft area was not observed in 10 of the 11 cases. In one patient, who underwent a lateral granular cancellous bone allograft in the right tibial plateau, the infection recurred 2 weeks later in the graft area. The infection was arrested 3 months after re-debridement and a bilateral ilium bone graft to eliminate the dead space. Combined debridement, bone graft and articular cavity sealing using the synovium may be a feasible treatment for metaphyseal osteomyelitis involving the knee joint.
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Affiliation(s)
- Weiju Lu
- Department of Orthopedic Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
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Bischel O, Seeger JB, Seeger J, Krüger M, Krüge M, Bitsch RG, Bitsch B. Multiple Acetabular Revisions in THA - Poor Outcome Despite Maximum Effort. Open Orthop J 2012. [PMID: 23193432 PMCID: PMC3504796 DOI: 10.2174/1874325001206010488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d'Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination.Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term.
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Affiliation(s)
- O Bischel
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen-Marburg, UKGM, Klinikstrasse 33, D-35392 Giessen, Germany
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Del Gaizo DJ, Kancherla V, Sporer SM, Paprosky WG. Tantalum augments for Paprosky IIIA defects remain stable at midterm followup. Clin Orthop Relat Res 2012; 470:395-401. [PMID: 22090355 PMCID: PMC3254742 DOI: 10.1007/s11999-011-2170-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Initial reports with short-term followup of porous tantalum acetabular components and augments for Paprosky IIIA acetabular defects demonstrate high hip scores, low rates of aseptic loosening, and low rates of complications. However, longer-term followup with a larger cohort is needed to determine the durability of these reconstructions. QUESTIONS/PURPOSES We therefore determined the functional scores, rates of aseptic loosening, and complications in patients with Paprosky IIIA acetabular defects treated with porous tantalum acetabular components and augments. METHODS We retrospectively reviewed 37 acetabular revisions in 36 patients (one patient with bilateral revisions) treated with a porous tantalum acetabular component and augment. All patients had defects classified as Type IIIa using the system of Paprosky et al. Harris hip scores were obtained and radiographic examination was performed before surgery and through most recent followup. The minimum followup was 26 months (mean, 60 months; range, 26-106 months). RESULTS One patient developed aseptic loosening of the acetabular reconstruction requiring revision; seven other patients required further surgery for periprosthetic femoral fracture (two), acute infection (three), and recurrent dislocation (two). Thirty-five of 37 hips had no or occasional pain at final followup. Mean Harris hip scores improved from 33.0 preoperatively (range, 12.6-58.7) to 81.5 postoperatively (range, 27.0-99.8). CONCLUSIONS Although the complication rate requiring further surgery was considerable, most patients with these reconstructions had pain relief and reasonable function with low rates of loosening at midterm followup. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel J. Del Gaizo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| | - Vamsi Kancherla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| | - Scott M. Sporer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| | - Wayne G. Paprosky
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
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Jamieson ML, Russell RD, Incavo SJ, Noble PC. Does an enhanced surface finish improve acetabular fixation in revision total hip arthroplasty? J Arthroplasty 2011; 26:644-8. [PMID: 20647161 DOI: 10.1016/j.arth.2010.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 05/18/2010] [Indexed: 02/01/2023] Open
Abstract
High-porosity "cancellous metal" coatings have been introduced to increase the fixation and biologic incorporation of acetabular cups. The strength of initial fixation provided by a cancellous metal cups vs conventional alternatives in the deficient revision acetabulum was investigated. Cancellous, plasma-sprayed, and beaded cups (n = 9) were implanted under controlled conditions into a validated model of the revision acetabulum. The greatest differences were seen in resistance to catastrophic (spin-out) failure that, for the cancellous shell, averaged 1076 ± 265 N, which was 25% greater than the plasma-sprayed implant (859 ± 214 N, P = .04) and 218% greater than the beaded implant (338 ± 123 N, P < .01). The cancellous coating also provided greater resistance to ultimate failure. These results suggest that these new cancellous metal coatings may represent a promising alternative for fixation in revision total hip arthroplasty.
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Abstract
BACKGROUND Evidence suggests a growing incidence of revision total hip arthroplasty (THA) including a subset with large acetabular defects. Revision THA for severe acetabular bone loss is associated with a relatively high rate of mechanical failure. QUESTIONS/PURPOSES We questioned whether cementing a cage to the reconstructed acetabular defect and pelvis would improve the rate of mechanical failure for patients with Type 3 defects (Paprosky et al.) with and without pelvic discontinuity in comparison to historical controls. METHODS We retrospectively collected data on 33 patients who underwent 35 revision THAs using an acetabular reconstruction cage cemented to morselized allograft and either structural allograft or trabecular metal augmentation for Type 3 defects in the presence (n = 13) and absence (n = 22) of pelvic discontinuity at a mean followup of 59 months (range, 24-92 months). The primary outcome was mechanical failure, defined as revision of the acetabular reconstruction for aseptic loosening. RESULTS Revision surgery for mechanical failure occurred in four of the 13 patients with pelvic discontinuity and two of the 22 patients without discontinuity. Radiographic loosening occurred in one patient with and one patient without pelvic discontinuity. Seven of the 35 revisions were subsequently revised for deep infection all in patients who were immunocompromised. CONCLUSIONS Cementing the cage to the pelvis can offer an advantage for treating severe acetabular defects. Trabecular metal augmentation appears to provide better initial mechanical stability than a structural allograft, but successful allograft reconstruction may restore bone stock. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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[Reconstruction of the acetabulum with structured bone graft in press-fit technique]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2011; 22:232-40. [PMID: 19562261 DOI: 10.1007/s00064-009-1710-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Reconstruction of defects of the superior acetabular rim with structured bone grafts in press-fit technique before total hip replacement. INDICATIONS Defects of the superior acetabular rim following hip dysplasia Crowe type II-IV, avascular necrosis of the femoral head Ficat stage IV, or aseptic loosening of the cup with acetabular defects Paprosky type 2a and 2b. CONTRAINDICATIONS Acetabular defects Paprosky type 2c, 3a and 3b, septic loosening, severe osteoporosis. SURGICAL TECHNIQUE Exposure of the acetabular defect and debridement with a spherical reamer to create a concave bleeding graft bed. Shaping of the bone graft with an inverted reamer of corresponding size and oscillating saw. Press-fit insertion of the bone graft into the defect and temporary fixation with Kirschner wires. Rereaming of the acetabulum with the spherical reamer. Implantation of a cemented cup of corresponding size. Removal of Kirschner wires after setting of cement. POSTOPERATIVE MANAGEMENT Full weight bearing in case of small or medium graft, 6-week non-weight bearing in case of big load-bearing graft. Mobilization on 1st day postoperatively. Stair climbing on 7th day postoperatively. Suture removal after 10 days. RESULTS In 46 patients with 55 total hip replacements with structured grafts in press-fit technique, the Harris Hip Score improved from 38.9 points to 92.3 points after 29.4 months (12.0-84.4 months). There were two cases of delayed wound healing and one cup exchange because of aseptic loosening. Radiologically, one graft sintering by 5 mm was detected.
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Johanson NA, Driftmier KR, Cerynik DL, Stehman CC. Grading acetabular defects: the need for a universal and valid system. J Arthroplasty 2010; 25:425-31. [PMID: 19375888 DOI: 10.1016/j.arth.2009.02.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 02/22/2009] [Indexed: 02/01/2023] Open
Abstract
Preoperative classification of acetabular bone loss in revision total hip arthroplasty has been problematic. An evidence-based approach involves having a validated and widely accepted system of classification. A prerequisite would be a system that describes each defect in terms that are mutually exclusive, hierarchical, surgically relevant, and corresponding to experienced clinicians' preoperative estimates of surgical complexity. Of the 6 systems reviewed, only 1 demonstrated the reliability and validity required for a standardized grading system. Although high-grade defects were seen in only 17% of the 1094 hips, the failure rate associated with them was 30%. A larger population of high grade defects is necessary to determine which treatment alternatives are successful.
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Affiliation(s)
- Norman A Johanson
- Department of Orthopaedic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania 19102, USA
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Bullens PHJ, Bart Schreuder HW, de Waal Malefijt MC, Verdonschot N, Buma P. Is an impacted morselized graft in a cage an alternative for reconstructing segmental diaphyseal defects? Clin Orthop Relat Res 2009; 467:783-91. [PMID: 19142693 PMCID: PMC2635451 DOI: 10.1007/s11999-008-0686-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Accepted: 12/15/2008] [Indexed: 01/31/2023]
Abstract
Large diaphyseal bone defects often are reconstructed with large structural allografts but these are prone to major complications. We therefore asked whether impacted morselized bone graft could be an alternative for a massive structural graft in reconstructing large diaphyseal bone defects. Defects in the femora of goats were reconstructed using a cage filled with firmly impacted morselized allograft or with a structural cortical autograft (n = 6 in both groups). All reconstructions were stabilized with an intramedullary nail. The goats were allowed full weightbearing. In all reconstructions, the grafts united radiographically. Mechanical torsion strength of the femur with the cage and structural cortical graft reconstructions were 66.6% and 60.3%, respectively, as compared with the contralateral femurs after 6 months. Histologically, the impacted morselized graft was replaced completely by new viable bone. In the structural graft group, a mixture of new and necrotic bone was present. Incorporation of the impacted graft into new viable bone suggests this type of reconstruction may be safer than reconstruction with a structural graft in which creeping substitution results in a mixture of viable and necrotic bone that can fracture. The data suggest that a cage filled with a loaded morselized graft could be an alternative for the massive cortical graft in reconstruction of large diaphyseal defects in an animal model.
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Affiliation(s)
- Pieter H. J. Bullens
- Orthopedic Research Laboratory, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands ,Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H. W. Bart Schreuder
- Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Nico Verdonschot
- Orthopedic Research Laboratory, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Pieter Buma
- Orthopedic Research Laboratory, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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van Haaren EH, Heyligers IC, Alexander FGM, Wuisman PIJM. High rate of failure of impaction grafting in large acetabular defects. ACTA ACUST UNITED AC 2007; 89:296-300. [PMID: 17356137 DOI: 10.1302/0301-620x.89b3.18080] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We reviewed the results of 71 revisions of the acetabular component in total hip replacement, using impaction of bone allograft. The mean follow-up was 7.2 years (1.6 to 9.7). All patients were assessed according to the American Academy of Orthopedic Surgeons (AAOS) classification of bone loss, the amount of bone graft required, thickness of the graft layer, signs of graft incorporation and use of augmentation. A total of 20 acetabular components required re-revision for aseptic loosening, giving an overall survival of 72% (95% CI, 54.4 to 80.5). Of these failures, 14 (70%) had an AAOS type III or IV bone defect. In the failed group, poor radiological and histological graft incorporation was seen. These results suggest that impaction allografting in acetabular revision with severe bone defects may have poorer results than have previously been reported.
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Affiliation(s)
- E H van Haaren
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
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