No Negative Effects of Bone Impaction Grafting with Bone and Ceramic Mixtures

Abstract

Reconstructing large loaded bone defects with ceramic bone graft extenders is tempting considering the expected future donor bone shortage. However, whether there are negative effects is unknown. Standardized large defects in the acetabulum of goats were created and subsequently reconstructed with metal mesh and impacted morselized cancellous bone grafts or a 50/50% volume mixture of tricalcium phosphate-hydroxyapatite granules and morselized cancellous bone grafts using the bone impaction grafting technique. Subsequently, a cemented total hip prosthesis was inserted. Clinically, no differences were observed between groups. Most of the morselized cancellous bone graft had been resorbed and incorporated into new bone after 15 weeks. The large tricalcium phosphate-hydroxyapatite granules were integrated, the smaller crushed tricalcium phosphate-hydroxyapatite granules were surrounded by osteoclasts or engulfed by macrophages and giant cells. The cement penetration into the reconstructive layer and the quality of the bone based on a semiquantitative score were similar in both groups. We found no suggestion of tricalcium-hydroxyapatite granule-induced third-body wear in this short-term followup study. No negative effects were observed in this study, and therefore, it seems reasonable to use tricalcium-hydroxyapatite granules in a 50/50% volume mix with morselized cancellous bone graft as a bone graft extender in acetabular revision surgery with the bone impaction grafting technique.

Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute

“…Furthermore, ovine and caprine studies have shown impaction grafting with BoneSave to be as least as good as allograft in the clinical setting with regard to function, radiographic analysis, and new bone formation (Arts et al 2005b, Blom et al 2005a). As the ceramic was mixed with allograft, it would not completely eliminate the risks of antigenicity and infection.…”

Injectable nanocrystalline hydroxyapatite paste for bone substitution: In vivo analysis of biocompatibility and vascularization

“…In the past, newly developed bone substitutes have been tested in vivo using numerous experimental models, most of them involving larger animals such as dogs,16 goats,17 or rabbits 18. In our study, we have used the dorsal skinfold chamber model of Syrian golden hamsters, which bears the advantages of convenient handling and lower costs.…”

Impaction allografting in revision total hip replacement

“…66 Graft incorporation of tricalcium phosphate/HA particles has been observed in a goat model of contained acetabular deficiencies reconstructed with a 50/50 mixture of cancellous bone and tricalcium phosphate/HA granules. 67 Although the mechanical stability may be improved with these extenders, the biological aspects of the graft incorporation and remodelling have yet to be fully studied. A denser graft may reduce cement penetration and also reduce ingrowth and lead to greater failure.…”

“…Histological retrieval analysis has confirmed that remodelling does occur with gradual but variable ingrowth. [67][68][69][70][71] Studies using positron emission tomography have shown that the initial increase in blood flow and bone remodelling following surgery reduces to baseline levels by one year, implying that incorporation is complete by this stage. 72 However, an appraisal of bone incorporation employing bone scintigraphy reported that the uptake became normal two to three years after surgery, demonstrating that slower remodelling continues for a considerably longer period.…”