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.

Background and purpose Bones used in mechanical studies are frequently harvested from human cadavers that have been embalmed in a buffered formaldehyde solution. It has been reported that formaldehyde fixation or freezing hardly affects the mechanical properties of bone after a storage period of several weeks. However, human cadaver bones are usually stored for longer periods of time before use. We therefore investigated the effects of long-term embalming or freezing on the mechanical properties of cortical bone.Methods After 5 different storage periods (ranging from 0 to 12 months), goat femora and humeri were used to evaluate the effect of embalming and freezing on torsion, and on bending stiffness and strength. The effect on hardness and bone mineral density (BMD) was also evaluated.Results Even after 1 year, no statistically significant differences could be found in stiffness, strength, and energy absorption when we compared embalmed or frozen bones to a fresh reference group. In addition, although we found no significant change in BMD, there appears to be a tendency to increasing hardness.Interpretation We found that there was no effect on the mechanical properties of bone after storage periods of 1 year. We conclude that embalmed or frozen bones can safely be used for mechanical testing, at least for storage periods of up to one year.

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Alignment with MRI-based PSG is at least as good as, if not better, than that of the CT-based PSG, and is the preferred imaging modality when performing TKA with use of PSG. Cite this article: Bone Joint J 2016;98-B:786-92.

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Level III, Case Controlled Study.

Impacted morsellised allografts have been used successfully to address the problem of poor bone stock in revision surgery. However, there are concerns about the transmission of pathogens, the high cost and the shortage of supply of donor bone. Bone-graft extenders, such as tricalcium phosphate (TCP) and hydroxyapatite (HA), have been developed to minimise the use of donor bone. In a human cadaver model we have evaluated the surgical and mechanical feasibility of a TCP/HA bone-graft extender during impaction grafting revision surgery. A TCP/HA allograft mix increased the risk of producing a fissure in the femur during the impaction procedure, but provided a higher initial mechanical stability when compared with bone graft alone. The implications of the use of this type of graft extender in impaction grafting revision surgery are discussed.