Morsellized allografts for fixation of the hip prosthesis femoral component: A mechanical and histological study in the goat

Schreurs, B.W.; Buma, P.; Huiskes, R.; Slagter, J. L. M.; Slooff, T. J. J. H.

doi:10.3109/17453679408995452

Cited by 112 publications

(60 citation statements)

References 18 publications

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“…The impaction bone grafting (IBG) technique was introduced for use in the acetabulum by Slooff et al [35] and has proven to be effective in revision surgery. Different series have confirmed excellent results using this technique [10,30,32,33] and bone graft incorporation has been reported in histologic and positron emission tomography studies [2,4,28,31,34,37]. In a goat model of impacted allograft, Schimmel et al [28] showed complete incorporation of the allograft by 48 weeks.…”

Section: Introductionmentioning

confidence: 76%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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Background Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown.Questions/purposes We therefore evaluated patients undergoing acetabular revision surgery using IBG and a cemented cup in large bone defects to determine (1) the frequency with which the hip center could be restored in hips with Paprosky 3A and 3B defects and in hips with or without the use of metallic mesh during surgery; (2) survivorship of IBG acetabular-revision reconstructions in patients with severe Paprosky 3A and 3B defects; and (3) risk factors for failure of the reconstruction, including the use of mesh and defect severity (3A versus 3B). Methods Between 1997 and 2009, we performed 226 acetabular revisions using IBG. During that time, indications for using IBG in this setting included Paprosky 3A and 3B defects without pelvic discontinuity. Of these, 204 (90.2%) were available for followup at a minimum of 5 years (mean, 10 years; range, 5-17 years). There were 100 hips with an intraoperative bone defect of Paprosky 3A and 104 with a 3B. Medial or rim acetabular uncontained defects were treated with medial and/or lateral metallic mesh in 142 hips. We determined the postoperative radiological cup position and acetabular reconstruction of the hip center according to Ranawat in both groups. We assessed the appearance of cup loosening and the possible risk factors with regression analysis. Results Mean postoperative acetabular abduction angle and vertical, horizontal, and hip rotation center distances improved (p \ 0.001 in all parameters). Nine hips showed radiological loosening in the group with bone defect 3A and 16 in Group 3B. The survival rate for loosening at 15 years was 83% (95% confidence interval [CI], 71%-95%) for Group 3A and 73% (95% CI, 60%-84%) for Group 3B (p = 0.04). The survivorship for loosening when using mesh or not at 15 years was: no mesh 89% (95% CI, 74%-99%), medial mesh 85% (95% CI, 72%-97%), lateral mesh 80% (95% CI, 67%-91%), and medial and lateral meshes

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Section: Introductionmentioning

confidence: 76%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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“…The process of incorporation of impacted morsellised bone grafts has been examined in animal experiments both in bone chamber models and in realistic models of the acetabulum and femur. [14][15][16][17] We have recently reviewed 25 human biopsy specimens taken from 24 acetabular reconstructions in 20 patients with a follow-up after surgery of one to 170 months. 11 In general, both in the animal models and in the human biopsies, there was a rapid incorporation of bone graft.…”

Section: Discussionmentioning

confidence: 99%

Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup

Schreurs

Bolder

Gardeniers

et al. 2004

The Journal of Bone and Joint Surgery. British volume

132

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This study presents the clinical and radiological results of 62 consecutive acetabular revisions in 58 patients, at a mean of 16.5 years follow-up (15 to 20). The Kaplan-Meier survivorship for the cup with end-point revisions for any reason, was 79% at 15 years (95% confidence interval (CI); 67 to 91). Excluding two revisions for septic loosening at three and six years, and one revision of a well-fixed cup after 12 years in the course of a femoral revision, the survivorship was 84% at 15 years (95% CI; 73 to 95). At review there were no additional cases of loosening, although seven acetabular reconstructions showed radiolucent lines in one or two zones. Acetabular revision using impacted large morsellised bone chips (0.7 cm to 1.0 cm) and a cemented cup, is a reliable technique of reconstruction, when assessed at more than 15 years.Loss of bone stock compromises the outcome in revision of total hip arthroplasty. The longterm results of most techniques of acetabular revision remain unclear and few reports are available on the outcome beyond ten years. [1][2][3][4] From a biological viewpoint the reconstruction of the bone stock with grafted bone is an attractive option.Following the experience of Hastings and Parker 5 and McCollum, Nunley and Harrelson 6 with protrusio acetabuli, we have used a modified technique of bone grafting for acetabular revisions using tightly impacted morsellised bone chips and cemented cups. In 1998 we described the outcome of this technique in 60 procedures followed for more than ten years. 7 We now report the outcome at 15 to 20 years.

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“…Increased cortical porosity is known to be caused by a damaged endosteal circulation that results in a necrotic endosteal cortex. This phenomena has been observed as a result of intramedullary nailing and in goats treated with THRs and impaction allografting [20,32,42]. The endosteal cancellization that results in medullary canal widening was observed in primary cemented THR and was correlated with radiological loosening [23].…”

Section: Discussionmentioning

confidence: 88%

Biological and mechanical changes of the bone graft–cement interface after impaction allografting

et al. 2005

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In impaction allografting, the host bone interface may consist of morsellized allograft alone or as a composite with bone cement. The objective of this study was to investigate the temporal changes in the interface for these two materials in a rat bone chamber model. To simulate the impaired endosteal circulation after impaction allografting, bone chambers were tightened bilaterally to the endosteal surfaces of proximal tibiae of mature rats and filled with pure allograft or cement/allograft composite. The cement/allograft composite-host bone interface strength was significantly higher at 3 weeks and was higher than the allograft construdt failure strength. Limited allograft, but extensive periosteal remodeling, was observed at 3 weeks which resulted in a significantly increased cortical porosity and cortical thickness. The allograft porosity decreased significantly at 6 weeks indicating extensive remodeling of the allograft bone. Little or no remodeling of the allograft particles in the cement was found. At 6 weeks a new medullary canal was formed, and the endosteal cortex was partially absorbed. Endosteal absorption resulting in medullary canal widening in revision THR may be responsible for clinically unstable stems after impaction allografting.

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Morsellized allografts for fixation of the hip prosthesis femoral component: A mechanical and histological study in the goat

Cited by 112 publications

References 18 publications

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup

Biological and mechanical changes of the bone graft–cement interface after impaction allografting

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