A novel, multi-level approach to assess allograft incorporation in revision total hip arthroplasty

Abstract

The successful use of allografts in reconstructive orthopedic surgery, including revision total hip arthroplasty (THA), has been outlined repeatedly. Nonetheless, as previous studies were primarily based on clinical follow-ups, we aimed to create an algorithm that accurately determines the extent of allograft incorporation in the acetabulum and femur using a suite of high-resolution imaging techniques. This study is based on a large patient database including > 4,500 patient data with previous revision THA and simultaneous use of allografts. While the database was continuously matched with the deceased individuals at the local forensic medicine department, complete hips were retrieved in case of a positive match. A positive match was achieved for n = 46 hips at a mean follow-up of 11.8 ± 5.1 years. Comprehensive imaging included contact radiography, high-resolution computed tomography (HR-pQCT), undecalcified histology of ground sections and quantitative backscattered electron imaging (qBEI). We here define a histomorphometric toolkit of parameters to precisely characterize the incorporation of structural (bulk) and morselized (chip) allografts in the acetabulum (n = 38) and femur (n = 8), including the defect area and interface length, microstructural and cellular bone turnover parameters as well as overlap and fibrosis thickness. This collection of samples, through its unique study design and precise definition of incorporation parameters, will provide the scientific community with a valuable source for further in-depth investigation of allograft incorporation and, beyond that, the regenerative potential of this osteoconductive scaffold.

Allograft Chip Incorporation in Acetabular Reconstruction

“…I n the years 1987 to 2009, all patients who underwent revision THA with cement in combination with morselized allograft chips at one of the largest European centers for joint arthroplasty were included in a central registry. The study algorithm is described in detail elsewhere 18 . In the following years, all decedents in the local crematory and the Department of Forensic Medicine were matched with this registry.…”

Acetabular Reconstruction Using Multiple Porous Tantalum Augments: Three-Quarter Football Augment

“…Anatomic reconstruction of large acetabular defects is a difficult problem in revision arthroplasty, and various methods are published in the literature to address these defects [ 1 ]. Principles in the management of acetabular defects include osseous reconstruction using autologous bone graft or allograft [ 2 – 6 ], the use of metallic bone graft substitute [ 7 – 16 ], or the use of bone cement [ 17 , 18 ]. The surgical algorithm is dependent on the patient's age, size, and type of defect [ 19 ].…”