Autologous morsellised bone grafting restores uncontained femoral bone defects in knee arthroplasty

Abstract

T he properties of impacted morsellised bone graft (MBG) in revision total knee arthroplasty (TKA) were studied in 12 horses. The left hind metatarsophalangeal joint was replaced by a human TKA. The horses were then randomly divided into graft and control groups. In the graft group, a unicondylar, lateral uncontained defect was created in the third metatarsal bone and reconstructed using autologous MBG before cementing the TKA. In the control group, a cemented TKA was implanted without the bone resection and grafting procedure. After four to eight months, the animals were killed and a biomechanical loading test was performed with a cyclic load equivalent to the horse's body-weight to study mechanical stability. After removal of the prosthesis, the distal third metatarsal bone was studied radiologically, histologically and by quantitative and micro CT.Biomechanical testing showed that the differences in deformation between the graft and the control condyles were not significant for either elastic or time-dependent deformations. The differences in bone mineral density (BMD) between the graft and the control condyles were not significant. The BMD of the MBG was significantly lower than that in the other regions in the same limb. Micro CT showed a significant difference in the degree of anisotropy between the graft and host bone, even although the structure of the area of the MBG had trabecular orientation in the direction of the axial load. Histological analysis revealed that all the grafts were revascularised and completely incorporated into a new trabecular structure with few or no remnants of graft. Our study provides a basis for the clinical application of this technique with MBG in revision TKA.

Micro‐computed tomographic analysis of bone healing subsequent to graft placement

“…4,[6][7][8]11,14 It has also been shown that these calculated parameters from the lCT of bone images can be correlated with the values obtained from the traditional histological methods. [14][15][16][17][18] In the present study, the lCT analysis was used with an initial purpose of determining whether or not it would be possible to differentiate between this graft and bone material separately, on basis of gray-level (GL) values. If possible, quantitative data such as bone/graft volume, bone/graft density would be calculated and analyzed using the 20 lm resolution for correlation at a later time with histomorphometrical studies and implant treatment success.…”

The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion

“…However, porous hydroxyapatite is solid and can be compactly packed in the cages retaining its macro and micro structural excellence as scaffolds for osteoconduction. As known in other form of orthopedic surgery, compact void filling of bone defect is essential for effective bone healing [21]. And in addition, the porous hydroxyapatite is known to have affinity to some proteins, which can act in a positive way to osteogenesis providing possibility of adsorption of BMPs [25].…”

“…The local bone was cautiously prepared for grafting with removal of soft tissue and cartilage and then morselized. After thorough discectomy and preparation of interbody disc space to expose bare bone of upper and lower endplate with caution not to break it, the prepared local bone was packed in the disc space as compactly as possible following the general principle of orthopedic surgery expecting bone healing [21], however, allowing room for cages. When the harvested local bone was not enough to fill the interbody space compactly, or is less than 10 cc per level, as the volume of adult lumbar disc space is known to be 10-15 cc [26], 2-5 cc of synthetic bone chip of porous hydroxyapatite or autogenous iliac bone graft from posterior superior iliac spine (PSIS) was mixed with the local bone to fill the void of the interbody disc space in respect for the preference for additional graft material of each patient.…”

Bone Defects in Revision Total Knee Arthroplasty and Management

“…Autologous bone grafting is a technique by which bone is harvested from non-essential bones such as from the iliac crest and transplanted in the same individual to fill space and produce an osteogenic response in a very small bone defect 27 . Liu et al use single or double distal femoral osteotomic bone to reconstruct the bone defects using hollow nail internal fixation.…”