Use of Cortical Structural Homologous Bone Graft in Femoral Reconstructive Surgery

Abstract

To perform a clinical and radiographic assessment of patients undergoing surgical treatment using a cortical structural homologous bone graft for femoral reconstruction following mechanical failure of total hip arthroplasty and periprosthetic fractures. Methods: A retrospective study was conducted on 27 patients who underwent surgical treatment for femoral reconstruction following mechanical failure of total hip arthroplasty (12 cases) and periprosthetic fractures (15 cases), using a cortical structural homologous bone graft and cemented implants, between June 1999 and February 2008. Of these, 21 fulfilled all the criteria required for this study. The patients underwent pre and postoperative clinical assessments using the Harris Hip Score. Preoperative, immediate postoperative and late postoperative radiographs were also evaluated, with comparisons of fracture consolidation, radiographic signs of graft consolidation, changes to the bone stock and femoral bone quality, and femoral alignment. Results: Nine patients (42.9%) underwent femoral reconstruction following mechanical failure of total hip arthroplasty and 12 cases (57.1%) underwent femoral reconstruction following periprosthetic fracture. Regarding the postoperative clinical classification, the results were considered satisfactory in 85.7% of the cases and unsatisfactory in 14.3%. Radiographic signs of graft consolidation were seen in all cases. There was an increase in bone stock in 90.5% of the hip reconstructions, as measured by the cortical index. Furthermore, the changes to femoral bone quality were considered good in 66.7% of the cases. Conclusion: The use of cortical structural homologous bone grafts for both femoral reconstructive surgery on total hip arthroplasty and periprosthetic fractures is a good treatment option for selected cases, enabling satisfactory clinical and radiographic results.

Osteointegração e sucesso em revisão acetabular de artroplastia total de quadril com enxerto estrutural homólogo: seguimento médio de 9,6 anos

“…Our service started the use of homologous graft in THAR in the 1980s, with the subsequent publication of the results. 6 7 8 The analysis of our cases and the result of the literature allows the verification of homologous bone graft consolidation with possible osseointegration in most cases, allowing a stable reconstruction. 2 5 The use of bone graft makes it possible to restore the center of hip rotation, obtain implant stability, restore the acetabular integrity and bone stock, facilitating future revisions.…”

“…4,5 O nosso serviço iniciou o uso de enxerto homólogo em RATQ na década de 80, com a publicação subsequente dos resultados. [6][7][8] A análise dos nossos casos e dos resultados da literatura permite a constatação da consolidação do enxerto ósseo homólogo com possível osteointegração na maioria dos casos, permitindo uma reconstrução estável. 2,5 O uso de enxerto ósseo possibilita restaurar o centro de rotação do quadril, obter estabilidade do implante, restaurar a integridade do acetábulo e o estoque ósseo, facilitando futuras revisões.…”

Novel use of a trabecular metal spacer in the treatment of a long-standing ulnar fracture non-union

“…Synthetic bone graft  involves the use of calcium compounds such as tricalcium phosphate in place of harvested bone tissue 15. While they overcome some of the potential morbidity they do not possess the ideal graft characteristics of osteoinduction and osteogenesis 11.…”

“…The harvested bone is irradiated before storage and as such does not have the characteristics of osteogenesis 15. Allograft is mainly used in cases involving significant bony defect, due to the inherent limitation of available autologous graft 17.…”