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

Blom AW, Wylde V, Livesey C, Whitehouse MR, Eastaugh-Waring S, Bannister GC, Learmonth ID - Acta Orthop (2009)

Bottom Line: Complications were rare (1 fracture, 2 dislocations).Patient satisfaction with the procedure was high.Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Academic Orthopaedics, University of Bristol, BIRC Research Labs, Avon Orthopaedic Centre, Bristol. Ashley.blom@nbt.nhs.uk

ABSTRACT

Background and purpose: One of the greatest problems of revision hip arthroplasty is dealing with lost bone stock. Good results have been obtained with impaction grafting of allograft bone. However, there have been problems of infection, reproducibility, antigenicity, stability, availability of bone, and cost. Thus, alternatives to allograft have been sought. BoneSave is a biphasic porous ceramic specifically designed for use in impaction grafting. BoneSave is 80% tricalcium phosphate and 20% hydroxyapatite. Previous in vitro and in vivo studies have yielded good results using mixtures of allograft and BoneSave, when compared with allograft alone. This study is the first reported human clinical trial of BoneSave in impaction grafting.

Methods: We performed a single-institution, multi-surgeon, prospective cohort study. 43 consecutive patients underwent revision hip arthroplasty using BoneSave and allograft to restore missing bone in the acetabulum. 9 patients had cemented acetabular components implanted and 34 uncemented. 10 patients had cemented femoral components implanted and 1 had an uncemented femoral component. 32 patients did not have their femoral component revised.

Results: No patients were lost to follow-up. At a mean follow-up of 24 (11-48) months, there were no re-revisions and there was no implant migration. 1 acetabular component had confluent lucent lines at the implant-graft interface. Complications were rare (1 fracture, 2 dislocations). Patient satisfaction with the procedure was high.

Interpretation: Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.

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1 year postoperatively. Demonstrates 2-mm-thick confluent radiolucent line around the acetabular component.
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F0001a: 1 year postoperatively. Demonstrates 2-mm-thick confluent radiolucent line around the acetabular component.

Mentions: All radiographs were available for assessment. No radiographs showed any signs of component migration, as measured on plain radiographs referencing from the tear drop and the transischial line. BoneSave granules were not visible in the soft tissues on postoperative radiographs, but were clearly visible in the impaction grafting construct. There were no incidences of heterotopic ossification or accelerated polyethylene wear, as assessed by measuring femoral head concentricity. 1 radiograph showed confluent lucent lines of greater than 2 mm thickness around the acetabular component. At 3-year follow-up, this patient had an excellent clinical result and was pain-free with a normal gait (see Figures 1A and 1B). Case 2 (illustrated in Figures 2A, 2B, and 2C) was typical of our series. Of the patients who received an uncemented component, 10 of 34 had lucent lines at the component-graft interface, which were all less than 2 mm in thickness at latest review. 4 of these were in DeLee and Charnley zones 1, 2, and 3, 4 were in zone 3 only, and 2 were in zones 1 and 2. Of the patients who received a cemented component, 1 of 9 had a lucent line at the cement-graft interface, which was less than 2 mm in thickness at latest review and was present in DeLee and Charnley zones 1 and 2.


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

Blom AW, Wylde V, Livesey C, Whitehouse MR, Eastaugh-Waring S, Bannister GC, Learmonth ID - Acta Orthop (2009)

1 year postoperatively. Demonstrates 2-mm-thick confluent radiolucent line around the acetabular component.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823174&req=5

F0001a: 1 year postoperatively. Demonstrates 2-mm-thick confluent radiolucent line around the acetabular component.
Mentions: All radiographs were available for assessment. No radiographs showed any signs of component migration, as measured on plain radiographs referencing from the tear drop and the transischial line. BoneSave granules were not visible in the soft tissues on postoperative radiographs, but were clearly visible in the impaction grafting construct. There were no incidences of heterotopic ossification or accelerated polyethylene wear, as assessed by measuring femoral head concentricity. 1 radiograph showed confluent lucent lines of greater than 2 mm thickness around the acetabular component. At 3-year follow-up, this patient had an excellent clinical result and was pain-free with a normal gait (see Figures 1A and 1B). Case 2 (illustrated in Figures 2A, 2B, and 2C) was typical of our series. Of the patients who received an uncemented component, 10 of 34 had lucent lines at the component-graft interface, which were all less than 2 mm in thickness at latest review. 4 of these were in DeLee and Charnley zones 1, 2, and 3, 4 were in zone 3 only, and 2 were in zones 1 and 2. Of the patients who received a cemented component, 1 of 9 had a lucent line at the cement-graft interface, which was less than 2 mm in thickness at latest review and was present in DeLee and Charnley zones 1 and 2.

Bottom Line: Complications were rare (1 fracture, 2 dislocations).Patient satisfaction with the procedure was high.Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Academic Orthopaedics, University of Bristol, BIRC Research Labs, Avon Orthopaedic Centre, Bristol. Ashley.blom@nbt.nhs.uk

ABSTRACT

Background and purpose: One of the greatest problems of revision hip arthroplasty is dealing with lost bone stock. Good results have been obtained with impaction grafting of allograft bone. However, there have been problems of infection, reproducibility, antigenicity, stability, availability of bone, and cost. Thus, alternatives to allograft have been sought. BoneSave is a biphasic porous ceramic specifically designed for use in impaction grafting. BoneSave is 80% tricalcium phosphate and 20% hydroxyapatite. Previous in vitro and in vivo studies have yielded good results using mixtures of allograft and BoneSave, when compared with allograft alone. This study is the first reported human clinical trial of BoneSave in impaction grafting.

Methods: We performed a single-institution, multi-surgeon, prospective cohort study. 43 consecutive patients underwent revision hip arthroplasty using BoneSave and allograft to restore missing bone in the acetabulum. 9 patients had cemented acetabular components implanted and 34 uncemented. 10 patients had cemented femoral components implanted and 1 had an uncemented femoral component. 32 patients did not have their femoral component revised.

Results: No patients were lost to follow-up. At a mean follow-up of 24 (11-48) months, there were no re-revisions and there was no implant migration. 1 acetabular component had confluent lucent lines at the implant-graft interface. Complications were rare (1 fracture, 2 dislocations). Patient satisfaction with the procedure was high.

Interpretation: Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.

Show MeSH
Related in: MedlinePlus