Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes

Abstract

Background: The aim of this study was to present our clinical outcomes and surgical technique in strut allografts preparation using staggered holes to enhance osteointegration and demineralised bone matrix (DBM) as an adjunct to cortical strut allografts in salvage revision arthroplasty patients. Methods: Retrospective consecutive series of patients who required strut allograft femoral reconstructions with minimum 2 years follow up between 2012 and 2018. Frozen washed irradiated, cortical struts were used and prepared adding 2 mm staggered drill holes along the length of the strut and applying DBM paste on the graft-host interface. Outcome measures included radiographic strut union, graft resorption, infection and complications. Results: 15 patients included; 3 males and 12 females with median age 72 years (range 60e93). All had significant bony defects (Paprosky III/IV in 12 cases including 3 cases of periprosthetic hip fractures and further 3 cases of periprosthetic knee fractures around revision hinged implants). At final follow up, median 3.8 years (range 2.7e7.2), 14/15 (93.3%) struts had united at a median 6 months (range 5e8), complete incorporation with cortical round-off was seen at median 12 months (range 8e48) in 12/15 (80%) struts, 2/15 (13.3%) show radiographic evidence of proximal minimal graft resorptions although the remainder of the strut had integrated and were asymptomatic. There were no cases of infection. Conclusions: Use of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months.

Permissive Weight Bearing in Patients With Surgically Treated Periprosthetic Femoral Fractures Around Total Hip Arthroplasty: A Scoping Review

“…One study presented results after surgical treatment of late PPFF in the FWB group [ 23 ]. No studies reported outcomes on Vancouver type A (OTA 32A1[IV.3A12] [ 24 ]), four studies on Vancouver type B1 (OTA 32A1[IV.3B1] [ 24 ]) [ 19 - 21 , 23 ], two studies on Vancouver type B2 (OTA 32A1[IV.3B2] [ 24 ]) [ 17 , 22 ], one study on Vancouver type B3 (OTA 32A1[IV.3B3] [ 24 ]) [ 18 ], and one study on Vancouver type C (OTA 32A1[IV.3C] [ 24 ]) fractures [ 23 ].…”

“…The final version of the charting form is available in Table 7. [17][18][19][20][21][22][23]. The flowchart of the screening process is presented in Figure 1.…”

“…One study reported outcome data on the treatment of late PPFF within the NWB group [17]. Six studies adhered to the RWB group [17][18][19][20][21][22]. No studies were included in the PWB group.…”

Revisions- und Wechselendoprothetik – Hüftschaft

“…eines Constrained Inlays in Betracht gezogen werden (Fallbeispiel 3), um auf diesem Wege Luxationen zu vermeiden. Bei größeren Knochendefekten kommt zusätzlich die Verwendung von Strut-Grafts in Betracht [31].…”

Proximal humerus reconstruction in reverse total shoulder arthroplasty with proximal humeral bone loss using a lower trapezius tendon transfer with Achilles tendon-bone allograft: surgical technique and report of 2 cases

“…Proximal humeral bone loss (PHBL) in reverse total shoulder arthroplasty (RTSA) is associated with comparatively higher complication rates and inferior clinical outcomes, which is largely due to deficient soft tissue attachments, specifically the rotator cuff, affecting both function and prosthetic stability, as well as constituting a risk for infection. 5 , 7 , 36 , 38 Current RTSA designs offer a variety of options that assist surgeons in attaining prosthetic stability and adequate deltoid tensioning, even in such difficult situations Moreover, the use of allograft-prosthesic composites (APCs), 22 , 24 cortical strut grafts, 11 , 26 or megaprostheses 25 , 28 has been proposed to address PHBL, with satisfactory results regarding active forward elevation and abduction. 7 , 8 However, in deficiency of the posterior rotator cuff, in particular teres minor, restoration of active external rotation (ER) remains unpredictable.…”