Proximal femoral allografts in revision hip arthroplasty

Allan, Douglas C.; Lavoie, GJ; McDonald, Sinead; Oakeshott, R. D.; Gross, A E

doi:10.1302/0301-620x.73b2.2005146

Cited by 104 publications

(48 citation statements)

References 5 publications

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“…A transfer of results to clinical situations should be possible, as in our perception the simulated femoral bearing conditions correspond to revision situations orthopaedic surgeons are commonly confronted with [1,23]. As stabilization of transfemoral osteotomies [4,7] and uncontained femoral defects [1,2,10] with strut grafts are recommended in such cases, the management of these revision situations is also consistent with current orthopaedic practice.…”

Section: Discussionmentioning

confidence: 75%

“…In order to manage these defects, strut allografts are frequently used [2][3][4][5][6][7][8][9][10]. They are individually sized beams of non-vital bone attached to the deficient femur via tension or cable wires.…”

Section: Introductionmentioning

confidence: 99%

“…They are individually sized beams of non-vital bone attached to the deficient femur via tension or cable wires. Incorporation and remodeling of these allografts to the host bone has been shown to be successful in 80-100 % of cases in numerous studies [2][3][4][5][6][7][8][9][10][11]. Some authors solely use strut grafts to rebuild the proximal femur [7,8,10], whereas other orthopaedic surgeons also rely on these grafts for a support of the stem to achieve better stability [3,6,9].…”

Section: Introductionmentioning

confidence: 99%

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Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Kinkel

Thomsen

Nadorf

et al. 2014

International Orthopaedics (SICOT)

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Purpose In total hip arthroplasty fixation of revision stems can be demanding due to femoral bone loss. Strut grafts are often used for bone augmentation and stabilization of the newly inserted prosthesis. The aim of this study was to assess the effect of strut grafts on primary stability under various stem fixation conditions. Methods Two different revision stems (cylindrical and conical shape) were implanted into synthetic femora. Following a semicircular transfemoral osteotomy, three deficient femoral bearings were simulated (bony lid reattached with cable wires; weakened lid reattached with cable wires; strut grafts placed to the weakened lid with cable wires). Relative micromovements were measured between prostheses and bones due to an axial moment applied to the stems. Results Relative movements correlated to the stem shape. The cylindrical stem showed higher movements increasing significantly with a weakened bony lid and portrayed a slight decrease of movements with strut graft application. No unequivocal influence of the weakened lid could be detected for the conical implant. Strut graft application did not show an additional stabilizing effect. Conclusions The primary stability of the cylindrical fixation concept decreases with impaired fixation conditions of the femur. A clear restabilizing effect with strut grafts could not be proven. A decrease of primary stability due to the impaired bone could not be observed for the conical stem shape. Additionally, strut grafts do not enhance fixation for this stem shape. We conclude that surgeons should not rely on a stabilizing effect of strut grafts in revision hip surgery.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Kinkel

Thomsen

Nadorf

et al. 2014

International Orthopaedics (SICOT)

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“…The histological and mechanical response to onlay strut allografts has been well documented in the canine model [1,9,10]. A zone of highly vascularised mesenchymal tissue forms at the host-graft junction.…”

Section: Discussionmentioning

confidence: 99%

“…In an effort to provide improved screw fixation, cortical strut allografts can be used as a way of anchoring the screw to the opposite cortex, thus "sandwiching" the host shaft. The allograft struts provide stability to the fracture site, and they can incorporate [4] and ultimately increase the femoral or humeral bone stock [1,7,9,13,14,21]. Similar techniques have been described for periprosthetic fractures, hip revisions, or complex non-unions [5,11,12,14,19,22].…”

Section: Introductionmentioning

confidence: 99%

“Sandwich technique” in the surgical treatment of primary complex fractures of the femur and humerus

Göğüş

Öztürk

Tezer

et al. 2006

International Orthopaedics (SICO

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In this prospective study, our aim was to determine the clinical and radiographic outcomes of the surgical treatment of primary complex problem femoral and humeral shaft fractures treated by a new technique called "sandwich technique." A total of 45 patients with comminuted, complex and/or osteopoenic fractures of the femur or humerus (30 femoral and 15 humeral fractures) were treated using this technique. The patients were followed up for a mean of 25 months. In 24 (85.7%) of 28 patients with femoral fractures and in 14 (93.3%) of 15 patients with humeral fractures, union was achieved within 3-6 months of the operation (mean: 4.5 months). The total union rate was 88.4%. The pseudoarthrosis rate was 12%. There was no infection or implant failure seen during the follow-up period. The cortical allograft struts can be used to provide collateral support to weakened osteopoenic/ osteoporotic bone. This technique provides a union rate of about 88% in osteoporotic and/or complex primary humerus or femur fractures.

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A mechanical comparison of gluteus medius attachment methods in a canine model

Markel

Rock

Bergenthal

et al. 1993

Journal Orthopaedic Research

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Seven techniques of gluteus medius attachment were compared in vitro in a canine model. Four methods were used for tendon to tendon attachment: (a) two modified Bunnell-Mayer sutures, (b) two Kessler locking loop sutures, (c) two horizontal mattress sutures, and (d) two sutures with a looped suture technique. The two methods of tendon to bone attachment were repair with a 1 cm spiked staple and repair with a spiked washer and screw, and the method of bone to bone attachment involved two figure-eight cerclage wires. The contralateral limb served as a control. Compared with the bone to bone attachment, the four tendon to tendon attachments and the two tendon to bone attachments had significantly less strength (31 and 30% of the ultimate load for bone to bone repair, respectively) and tensile stiffness (24 and 39% of the tensile stiffness for bone to bone attachment, respectively) (p < 0.0001). The control specimens were significantly stronger and stiffer than all specimens (p < 0.05) except those that had bone to bone fixation. There were no significant differences among the four tendon to tendon suture repairs with regard to either strength or stiffness; the values ranged from 28-45% of those of the controls. Among the tendon to bone repairs, fixation with a spiked washer and screw was significantly stronger than that with a spiked staple (p = 0.032), but there was no difference between these two techniques with regard to stiffness.

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Proximal femoral allografts in revision hip arthroplasty

Cited by 104 publications

References 5 publications

Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

“Sandwich technique” in the surgical treatment of primary complex fractures of the femur and humerus

A mechanical comparison of gluteus medius attachment methods in a canine model

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