Impaction allografting in revision total hip replacement

Board, Tim; Rooney, Paul; Kearney, J. N.; Kay, PR

doi:10.1302/0301-620x.88b7.17425

Cited by 42 publications

(28 citation statements)

References 71 publications

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“…Two different techniques of applying these grafts have been described [5,20,[37][38][39][40]42], with impaction and without. Impaction grafting, which is widely used in revision hip surgery on the femoral and acetabular sides with good functional and radiographic results [3], also has been described in revision knee surgery with the use of cemented stemmed implants [5,20,42], with reported survivorship rates between 95% and 100% at short-term followup. Impaction grafting, however, requires a relatively large amount of bone graft, is expensive, time consuming, and technically challenging.…”

Section: Discussionmentioning

confidence: 99%

“…These include cementing of contained defects [21,29], the use of augments [6,25,26], modular and custom hinged knee implants [27,28,34,43], and bone grafting (morselized bone [5,20,[37][38][39][40]42], structural allografts [2,12]). The use of morselized bone, although widely used in revision hip surgery [3], has not been commonly reported in revision TKA studies. Two different techniques are described in the literature (impacted [5,20,42] and loosely packed graft [37,40]).…”

Section: Introductionmentioning

confidence: 99%

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Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

Hanna

Aston

Roeck

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Addressing bone loss in revision TKA is challenging despite the array of options to reconstruct the deficient bone. Biologic reconstruction using morselized loosely-packed bone graft potentially allows for augmentation of residual bone stock while offering physiologic load transfer. However it is unclear whether the reconstructions are durable. Questions/purposes We therefore sought to determine (1) survivorship and complications, (2) function, and (3) radiographic findings of cementless revision TKA in combination with loosely-packed morselized bone graft to reconstruct osseous defects at revision TKA. Patients and MethodsWe retrospectively reviewed 56 patients who had undergone revision TKAs using cementless long-stemmed components in combination with morselized loose bone graft at our institution. There were 26 men and 30 women with a mean age of 68.3 years (range, 56-89 years). Patients were followed to assess symptoms and function and to detect radiographic loosening, component migration, and graft incorporation. The minimum followup was 4 years (mean, 7.3 years; range, 4-10 years). Results Cumulative prosthesis survival, with revision as an end point, was 98% at 10 years. The mean Oxford Knee Scores improved from 21 (36%) preoperatively to 41 (68%) at final followup. Five patients (9%) had reoperations for complications. Conclusions Our observations suggest this technique is reproducible and obviates the need for excessive bone resection, use of large metal augments, mass allografts, or custom prostheses. It allows for bone stock to be reconstructed reliably with durable midterm component fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

Hanna

Aston

Roeck

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…The short-term success of revision arthroplasty with impaction grafting is related to the initial stability of the construct [3]. The initial stability of the stem should be achievable in a predictable fashion with the use of ideal bone particles and stems and by using a well-organized surgical technique for the optimal compaction of bone particles and cementation.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing the Stability of Stems Fixed with Impaction Graft in Vitro

Ohashi

Matsuura

Ebara

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Mechanical stability of the stem is believed to be an important factor in successful impaction grafting in revision THA. We asked whether particle size, femoral bone deficiencies, stem design, graft composition, and impaction technique influenced the initial stability of the stem in vitro using model femora and human bone particles. Bone particles made with a reciprocating blade-type bone mill contained larger particles with a broader size distribution than those made by a rotating drum-type bone mill and had higher stiffness on compression testing. The stiffness on torsional testing decreased as the degree of proximal-medial segmental deficiencies increased. The stiffness and maximum torque in a stem with a rectangular cross section and wide anteroposterior surface were higher in torsional tests. Adding hydroxyapatite granules to the bone particles increased the torsional stability. To facilitate compact bone particles, we developed a spacer between the guidewire and modified femoral packers. This spacer facilitated compacting bone particles from the middle up to the proximal and the technique increased the amount of impacted bone particles at the middle of the stem and also improved the initial stability of the stem. Stem design and degree of deficiencies influenced stiffness in the torsional test and the addition of hydroxyapatite granules enhanced torsional stiffness.

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“…However, for the femur, the forces are directed mainly down the prosthesis and much smaller radial forces will compress the bone graft. The resistance to shear will be much less and hence the interlocking between particles will become of greater importance (Board et al 2006). …”

Section: Particle Gradingmentioning

confidence: 99%

“…However, this may not be the true. What may happen is that cement interdigitates with the graft so that the graft no longer behave as an aggregate but instead, acts as a solid mass (Board et al 2006). In this case, large chips with spaces in between will allow better cement interdigitation and confer a greater stability than a graded chip size can ever confer (Ullmark 2000;Arts et al 2006;Albert et al 2007) (Fig.…”

Section: Particle Gradingmentioning

confidence: 99%

Impaction bone grafting in revision hip surgery: past, present and future

McNamara

2010

Cell Tissue Bank

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Joint replacement surgery can have excellent clinical results. However, as the number of patients undergoing surgery increases, the number of failed joint replacements is set to rise. One of the greatest challenges for the revision surgeon is the restoration of bone stock. This article focuses upon revision hip surgery, with particular reference to the scope of the problem; historical and current solutions to bone loss in the femur and acetabulum; the clinical results following revision surgery; and the basic science behind impaction bone grafting, before ending with possible future directions for improving the restoration of bone stock.

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Impaction allografting in revision total hip replacement

Cited by 42 publications

References 71 publications

Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

Cementless Revision TKA with Bone Grafting of Osseous Defects Restores Bone Stock with a Low Revision Rate at 4 to 10 years

Factors Influencing the Stability of Stems Fixed with Impaction Graft in Vitro

Impaction bone grafting in revision hip surgery: past, present and future

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