|
1
|
Holland JDR, Webster G, Rooney P, Wilshaw SP, Jennings LM, Berry HE. Effects of Chemical and Radiation Sterilisation on the Biological and Biomechanical Properties of Decellularised Porcine Peripheral Nerves. Front Bioeng Biotechnol 2021; 9:660453. [PMID: 34150728 PMCID: PMC8209421 DOI: 10.3389/fbioe.2021.660453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022] Open
Abstract
There is a clinical need for novel graft materials for the repair of peripheral nerve defects. A decellularisation process has been developed for porcine peripheral nerves, yielding a material with potentially significant advantages over other devices currently being used clinically (such as autografts and nerve guidance conduits). Grafts derived from xenogeneic tissues should undergo sterilisation prior to clinical use. It has been reported that sterilisation methods may adversely affect the properties of decellularised tissues, and therefore potentially negatively impact on the ability to promote tissue regeneration. In this study, decellularised nerves were produced and sterilised by treatment with 0.1% (v/v) PAA, gamma radiation (25-28 kGy) or E Beam (33-37 kGy). The effect of sterilisation on the decellularised nerves was determined by cytotoxicity testing, histological staining, hydroxyproline assays, uniaxial tensile testing, antibody labelling for collagen type IV, laminin and fibronectin in the basal lamina, and differential scanning calorimetry. This study concluded that decellularised nerves retained biocompatibility following sterilisation. However, sterilisation affected the mechanical properties (PAA, gamma radiation), endoneurial structure and basement membrane composition (PAA) of decellularised nerves. No such alterations were observed following E Beam treatment, suggesting that this method may be preferable for the sterilisation of decellularised porcine peripheral nerves.
Collapse
Affiliation(s)
- James D. R. Holland
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
- School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, United Kingdom
| | - Georgina Webster
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
- School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, United Kingdom
| | - Paul Rooney
- National Health Service Blood and Transplant (NHSBT) Tissue and Eye Services, Liverpool, United Kingdom
| | - Stacy-Paul Wilshaw
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom
| | - Louise M. Jennings
- School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, United Kingdom
| | - Helen E. Berry
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
- School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
|
2
|
Green CM, Buckley SC, Hamer AJ, Kerry RM, Harrison TP. Long-term results of acetabular reconstruction using irradiated allograft bone. Bone Joint J 2018; 100-B:1449-1454. [PMID: 30418060 DOI: 10.1302/0301-620x.100b11.bjj-2018-0478.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. PATIENTS AND METHODS Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. RESULTS At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). CONCLUSION Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449-54.
Collapse
Affiliation(s)
- C M Green
- Golden Jubilee National Hospital, Glasgow, UK
| | - S C Buckley
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, UK
| | - A J Hamer
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, UK
| | - R M Kerry
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, UK
| | - T P Harrison
- Lower Limb Arthroplasty Unit, Northern General Hospital, Sheffield, UK
| |
Collapse
|
|
3
|
Assi C, Caton J, Aslanian T, Samaha C, Yammine K. The cross technique for the positioning of Kerboull plate in acetabular reconstruction surgery. SICOT J 2018; 4:20. [PMID: 29864006 PMCID: PMC5986237 DOI: 10.1051/sicotj/2018012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/17/2018] [Indexed: 11/17/2022] Open
Abstract
Acetabular reconstruction aims at filling bony defects and positioning the acetabular component in its anatomical place. To this, the use of Kerboull plate would give an automatic optimal positioning while reconstructing the acetabular cavity. We developed a technique, the cross technique, that approaches acetabular reconstruction in a systematic way. It consists of placing the KP following its cross design, in reference to a vertical plane (hook, center, palette) and a horizontal plane (horizontal flanges). The cross technique has three steps; the preparation of the acetabular cavity, the cross technique itself and cementation. We recommend a downsizing of the plate in relation to the size of the acetabular cavity in addition to another downsizing of the acetabular implant in relation to the plate size whenever a dual mobility cup is used.
Collapse
Affiliation(s)
- Chahine Assi
- Lebanese American University Medical Center-Rizk Hospital, Department of Orthopedics, Beirut, Lebanon
| | | | | | - Camille Samaha
- Lebanese American University Medical Center-Rizk Hospital, Department of Orthopedics, Beirut, Lebanon
| | - Kaissar Yammine
- Lebanese American University Medical Center-Rizk Hospital, Department of Orthopedics, Beirut, Lebanon
| |
Collapse
|
|
4
|
Singh R, Singh D, Singh A. Radiation sterilization of tissue allografts: A review. World J Radiol 2016; 8:355-369. [PMID: 27158422 PMCID: PMC4840193 DOI: 10.4329/wjr.v8.i4.355] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/05/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
Tissue substitutes are required in a number of clinical conditions for treatment of injured and diseased tissues. Tissues like bone, skin, amniotic membrane and soft tissues obtained from human donor can be used for repair or reconstruction of the injured part of the body. Allograft tissues from human donor provide an excellent alternative to autografts. However, major concern with the use of allografts is the risk of infectious disease transmission. Therefore, tissue allografts should be sterilized to make them safe for clinical use. Gamma radiation has several advantages and is the most suitable method for sterilization of biological tissues. This review summarizes the use of gamma irradiation technology as an effective method for sterilization of biological tissues and ensuring safety of tissue allografts.
Collapse
|
|
5
|
Fernandez-Valencia JÁ, Gallart X, Tomás X, Piñeros D, García S, Riba J. Radiography versus multidetector computed tomography in assessing graft integration after acetabular reconstruction. J Orthop Surg (Hong Kong) 2015; 23:370-4. [PMID: 26715721 DOI: 10.1177/230949901502300324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To compare radiography with multidetector computed tomography (MDCT) in the evaluation of graft integration following acetabular reconstruction for failed total hip arthroplasty (THA). METHODS Records of 5 men and 6 women aged 60 to 78 (mean, 71.8) years who underwent acetabular reconstruction using structural allografts for severe acetabular deficiency secondary to aseptic loosening (n=9) or septic loosening (n=2) were reviewed. The mean survival time of the THA was 136.4 (range, 12-360) months. Acetabular defects were classified as IIC (n=2), IIIA (n=3), or IIIB (n=6). Structural allografts were fixed with impaction followed by a reinforcement ring (n=10), an antiprotrusio cage (n=2), and/or an oblong cup (n=1) with gentamicineloaded cement. Cup loosening, graft integration, and graft resorption were evaluated using radiography. In addition, graft integration was evaluated using MDCT. RESULTS At a mean follow-up of 4.2 (range, 2-11) years, the survival of the acetabular reconstruction was 90.9%. No patient had any signs of infection. One patient underwent reoperation 22 months later for dislocation secondary to abductor deficiency caused by nonunion of the trochanteric fracture. According to radiography, all patients had graft integration. One patient had definitive and another had possible cup loosening. Four patients had minor graft resorption. According to MDCT, graft integration was complete in only one patient, partial >50% in 3, partial <50% in 4, and absent in 2. CONCLUSION MDCT is more accurate than radiography in evaluating graft integration following acetabular reconstruction.
Collapse
|
|
6
|
Cementless dual-mobility cup in total hip arthroplasty revision. INTERNATIONAL ORTHOPAEDICS 2014; 38:2463-8. [PMID: 25078366 DOI: 10.1007/s00264-014-2448-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Dislocation is a frequent complication in total hip arthroplasty (THA) revision. Cup fixation is the second concern. In order to know outcomes at two years, we prospectively followed a continuous series of 78 patients to demonstrate that cementless dual-mobility cup (DMC) used in revision THA is safe as regards dislocation risk and bone fixation. METHOD We enrolled 78 consecutive patients (79 cases) in a prospective study. Mean interval between index surgery and revision was 12.9 years. Mean age at revision was 75.5 years. Two types of cementless DMC were used: a standard DMC in 68 cases with low-grade bone defect (Paprosky grade 1 and 2), and a specific design reconstruction DMC in 11 cases with severe bone loss (Paprosky grade 3). RESULTS At two years of follow-up, 68 patients were reviewed; four were lost to follow-up., and six patients were deceased. We identified three types of situations at risk:standard risk (33 cases), Paprosky grade 1 or 2; medium risk (37 cases), revision for recurrent instability (21), periprosthetic fractures (14) or severe loosening Paprosky grade 3 without femorotomy (2); high risk (nine cases), revision for severe loosening with a femorotomy. One (1.3%) patient dislocated her hip at one month without recurrence. Revision rate for dislocation was 0%; two (2.7%) early mechanical failures occurred. CONCLUSION Considering outcomes of this series, cementless DMC can be suggested in THA revision surgery.
Collapse
|
|
7
|
Zagorodniy N, Nikolaev I, Nuzhdin V, Kagramanov S. Prospective cohort study of six hundred and sixty four revisions of loose failed acetabular implants. INTERNATIONAL ORTHOPAEDICS 2014; 38:2021-5. [PMID: 24943461 DOI: 10.1007/s00264-014-2396-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/25/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to determine the optimal technique of revision surgery according to the deficiency of acetabular bone to ensure maximum survival of the implant and reduce the risk of complications. METHODS From January 1992 through May 2012, 664 revisions of failed acetabular total hip components were performed in the joint replacement department of the Moscow Central Scientific and Research Institute (CITO). The patients were divided into three major groups based on the type of the revision implant: group I--cemented polyethylene cups only, group II--acetabular cages and rings, and group III--non-cemented metal cups. In each of these groups, further subdivisions were made based on the Paprosky Classification of the acetabular defects. Failures were classified as early mechanical instability, chronic pain, and deep wound infection. RESULTS The most satisfactory results--91% were obtained in patients of groups I and III with relatively minor bony acetabular defects (Paprosky classification types 1, 2A and 2B). The most unsatisfactory results--25% were in the cases with greater bone loss (Paprosky classification type 3B in group I and type 2C in group III)-of the unsatisfactory results. Infection was a significant problem in all the groups, but was the highest (8%) in group II. CONCLUSIONS The study showed that the success of acetabular revisions was directly related to the severity of the bony defects at the time of the operation and to the reconstruction technique applied.
Collapse
Affiliation(s)
- N Zagorodniy
- The Central Scientific and Research Institute of Traumatology and Orthopaedics Named After N. N. Priorov, Joint Replacement, Moscow, Russia
| | | | | | | |
Collapse
|
|
8
|
Cano JR, Santos-Ruiz L, Guerado E, Becerra J. Osteoprogenitor cell adhesiveness to a titanium mesh. A clinically relevant hypothesis for revision surgery in hip replacement. Hip Int 2014; 20 Suppl 7:S102-5. [PMID: 20512780 DOI: 10.1177/11207000100200s717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2010] [Indexed: 02/04/2023]
Abstract
Bone defects are a major problem in primary and, even worse, revision surgery of the hip. Impacted allograft contained by a metallic mesh has been used for bone reconstruction. However, since allograft has been claimed to reabsorb, and to provoke immunogenic responses with potential viral infection and loosening because of allograft and mesh interface, new bone substitutes are being searched for. In this study we have cultured committed osteoprogenitor cells within a titanium mesh. The cells not only multiplied very easily, but also adhered to the mesh surface. We believe this phenomenon may have great clinical relevance for cell therapy as an alternative to allograft for the treatment of bone defects in acetabular or femoral reconstruction in revision surgery of the hip.
Collapse
Affiliation(s)
- Juan R Cano
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella, Spain
| | | | | | | |
Collapse
|
|
9
|
Helwig P, Konstantinidis L, Hirschmüller A, Bernstein A, Hauschild O, Südkamp NP, Ochs BG. Modular sleeves with ceramic heads in isolated acetabular cup revision in younger patients-laboratory and experimental analysis of suitability and clinical outcomes. INTERNATIONAL ORTHOPAEDICS 2012; 37:15-9. [PMID: 23223972 DOI: 10.1007/s00264-012-1735-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE One possibility in hip arthroplasty revisions is to combine a modular ceramic head with an adapter or sleeve in isolated acetabular cup replacement. This study consisted of an experimental part to analyse the reliability of taper damage predictions, and a clinical part to analyse the outcomes of modular ceramic head implantation in a case series of isolated cup replacements. METHODS Analysis of scratch size on 11 explanted hip stems were examined macroscopically and by stereomicroscopy to classify damage to the conical taper. The second part consisted of a prospective analysis of isolated cup revisions using a modular ceramic head, performed in two orthopedic centres. RESULTS Analysis of scratch size on the taper yielded inter-observer correlations of 0.545-0.909; comparison with stereomicroscopic data recordings yielded a moderate correlation, with values between 0.545 and 0.090. The clinical study included 47 isolated acetabular cup revisions involving modular ceramic heads. Ceramic head failure did not occur during the average clinical and radiological observation period of 26 months. Mean Harris Hip Score (HHS) at follow-up was 70 points. CONCLUSION From these results, it can be concluded that damage to the implanted stem taper cannot be reliably predicted intraoperatively. Nevertheless, the clinical outcomes did show that there were no problems with the ceramic heads over the short observation period. The application of modular ceramic heads in younger patients requiring isolated cup replacement requires proper risk-benefit analysis, but is possible and appears to be a safe procedure.
Collapse
Affiliation(s)
- Peter Helwig
- Department of Orthopaedics and Traumatology, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
|
10
|
Mittag F, Straub M, Schäfer R, Kluba T, Ipach I. No red cell alloimmunization or change of clinical outcome after using fresh frozen cancellous allograft bone for acetabular reconstruction in revision hip arthroplasty: a follow up study. BMC Musculoskelet Disord 2012; 13:187. [PMID: 23009246 PMCID: PMC3477012 DOI: 10.1186/1471-2474-13-187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/11/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Possible immunization to blood group or other antigens and subsequent inhibition of remodeling or incorporation after use of untreated human bone allograft was described previously. This study presents the immunological, clinical and radiological results of 30 patients with acetabular revisions using fresh frozen non-irradiated bone allograft. METHODS AB0-incompatible (donor-recipient) bone transplantation was performed in 22 cases, Rh(D) incompatible transplantation in 6 cases. The mean follow up of 23 months included measuring Harris hip score and radiological examination with evaluation of remodeling of the bone graft, implant migration and heterotopic ossification. In addition, all patients were screened for alloimmunization to Rh blood group antigens. RESULTS Compared to the whole study group, there were no differences in clinical or radiological measurements for the groups with AB0- or Rh(D)-incompatible bone transplantation. The mean Harris Hip Score was 80.6. X-rays confirmed total remodeling of all allografts with no acetabular loosening. At follow up, blood tests revealed no alloimmunization to Rh blood group donor antigens. CONCLUSIONS The use of fresh frozen non-irradiated bone allograft in acetabular revision is a reliable supplement to reconstruction. The risk of alloimmunization to donor-blood group antigens after AB0- or Rh-incompatible allograft transplantation with a negative long-term influence on bone-remodeling or the clinical outcome is negligible.
Collapse
Affiliation(s)
- Falk Mittag
- Department of Orthopaedic Surgery, University Hospital Tuebingen, Hoppe-Seyler-Str 3, Tuebingen, 72076, Germany
| | - Matthias Straub
- Department of Orthopaedic Surgery, University Hospital Tuebingen, Hoppe-Seyler-Str 3, Tuebingen, 72076, Germany
| | - Richard Schäfer
- Institute of Clinical and Experimental Transfusion Medicine, University Hospital Tuebingen, Otfried-Mueller-Str 4/1, Tuebingen, 72076, Germany
| | - Torsten Kluba
- Department of Orthopaedic Surgery, University Hospital Tuebingen, Hoppe-Seyler-Str 3, Tuebingen, 72076, Germany
| | - Ingmar Ipach
- Department of Orthopaedic Surgery, University Hospital Tuebingen, Hoppe-Seyler-Str 3, Tuebingen, 72076, Germany
| |
Collapse
|
|
11
|
Mid-term results of acetabular reconstruction using a Kerboull-type acetabular reinforcement device. INTERNATIONAL ORTHOPAEDICS 2011; 36:23-6. [PMID: 21574052 DOI: 10.1007/s00264-011-1248-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the mid-term results of 32 acetabular reconstructions performed using a Kerboull-type acetabular reinforcement device and bone graft between June 1997 and January 2009. METHODS The mean age of the patients at the time of surgery was 71.4 years (range 55-85). Patients were followed-up for a mean of 7.5 years (range 2.1-13.7). The acetabular bone defects according to the American Academy of Orthopaedic Surgeons system was type III for 29 hips and type IV for three hips. Bulk allografts were performed in 30 hips and morselised autografts (iliac bone) were performed in two hips. Clinical evaluations were made according to the criteria of Postel/Merle d'Aubigné. RESULTS The mean pre-operative Postel/Merle d'Aubigné hip score was 7.0 ± 2.9, and the final follow-up hip score was 12.6 ± 2.8. Six hips showed radiographic loosening, and two hips required further revision. A Kaplan-Meier analysis showed that the five-year and ten-year survival rates were 96.9% and 92.3%, respectively, using further revision of the acetabular device as an end point. CONCLUSION Acetabular reconstruction using a Kerboull-type acetabular reinforcement device and bone graft gives satisfactory mid-term results.
Collapse
|
|
12
|
The use of fibre-based demineralised bone matrix in major acetabular reconstruction: surgical technique and preliminary results. INTERNATIONAL ORTHOPAEDICS 2010; 35:283-8. [PMID: 21057788 DOI: 10.1007/s00264-010-1145-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 10/16/2010] [Accepted: 10/16/2010] [Indexed: 10/18/2022]
Abstract
Acetabular osteolysis associated with socket loosening is one of the main long-term complications of total hip arthroplasty. In case of major bone loss, where <50% host bone coverage can be obtained with a porous-coated cementless cup, it is generally agreed that a metal ring or cage in association with a cemented component and allograft bone should be used. In order to promote allograft bone consolidation and incorporation, we have associated demineralised bone matrix (DBM, Grafton® A Flex) to the construct ion. Here we describe the technical details of major acetabular reconstruction using the Kerboull acetabular reinforcement device with allograft bone and DBM. This device has a hook that must be placed under the teardrop of the acetabulum and a plate for iliac fixation. The main advantages of this device are help in restoring the normal centre of hip rotation, guiding the reconstruction and partially unloading the graft. The Kerboull acetabular reinforcement device has provided a 92% survival rate free of loosening at 13-year follow-up in a consecutive series of 60 type III and IV deficiencies. Our preliminary results using DBM indicate faster allograft consolidation and remodelling.
Collapse
|
|
13
|
Ochs BG, Schmid U, Rieth J, Ateschrang A, Weise K, Ochs U. Acetabular bone reconstruction in revision arthroplasty: a comparison of freeze-dried, irradiated and chemically-treated allograft vitalised with autologous marrow versus frozen non-irradiated allograft. ACTA ACUST UNITED AC 2008; 90:1164-71. [PMID: 18757955 DOI: 10.1302/0301-620x.90b9.20425] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Deficiencies of acetabular bone stock at revision hip replacement were reconstructed with two different types of allograft using impaction bone grafting and a Burch-Schneider reinforcement ring. We compared a standard frozen non-irradiated bone bank allograft (group A) with a freeze-dried irradiated bone allograft, vitalised with autologous marrow (group B). We studied 78 patients (79 hips), of whom 87% (69 hips) had type III acetabular defects according to the American Academy of Orthopaedic Surgeons classification at a mean of 31.4 months (14 to 51) after surgery. At the latest follow-up, the mean Harris hip score was 69.9 points (13.5 to 97.1) in group A and 71.0 points (11.5 to 96.5) in group B. Each hip showed evidence of trabeculation and incorporation of the allograft with no acetabular loosening. These results suggest that the use of an acetabular reinforcement ring and a living composite of sterile allograft and autologous marrow appears to be a method of reconstructing acetabular deficiencies which gives comparable results to current forms of treatment.
Collapse
Affiliation(s)
- B G Ochs
- BG Trauma Centre, University of Tuebingen, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany.
| | | | | | | | | | | |
Collapse
|
|
14
|
Comba F, Buttaro M, Pusso R, Piccaluga F. Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years. INTERNATIONAL ORTHOPAEDICS 2008; 33:611-6. [PMID: 18264707 DOI: 10.1007/s00264-007-0503-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 11/16/2007] [Indexed: 11/26/2022]
Abstract
This article summarises a clinical and radiographical analysis of 30 acetabular revisions in patients younger than 55 years old, performed with impaction bone grafting and cemented cups. Preoperative Merle D'Aubigne and Postel functional score was an average 7 points. At a mean follow-up of 86.5 months (range 34-228) functional score averaged 16.3 points. Radiolucent lines with no clinical impact were observed in 7% of DeLee and Charnley acetabular zones evaluated. Massive radiological migration, consistent with clinical failure, was observed in two cups. Three patients underwent re-revision surgery (10%): two due to infection and one due to mechanical failure. Reconstruction survival rate was 89% (CI 95% 71.9-96.4) overall, and 96% (CI 95% 82.6-99.3) ruling out cases of infection. Impacted bone allograft constitutes one of the reconstructive techniques of choice in acetabular revision surgery of young patients. Restoration of bone stock is essential in this group of patients due to the possibility of future revisions.
Collapse
Affiliation(s)
- Fernando Comba
- Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital, Buenos Aires, Argentina.
| | | | | | | |
Collapse
|