Impaction grafting of the acetabulum with ceramic bone graft substitute

Abstract

Background and purpose Loss of bone stock remains a challenge in revision hip surgery. Grafting with allograft is well established, but there are problems with availability, cost, infection, antigenicity, reproducibility, and stability of the created construct. BoneSave is a biphasic porous ceramic consisting of sintered 80% tricalcium phosphate and 20% hydroxyapatite. In vitro and in vivo studies, including its use mixed with allograft, have shown good results in impaction grafting. This is the first reported series of its use alone in impaction grafting of the acetabulum.Methods Methods We conducted a retrospective review of a cohort of 43 consecutive patients undergoing impaction grafting of contained acetabular defects by multiple surgeons at a single centre. All patients received uncemented acetabular components. They were followed up radiographically, together with self-reported satisfaction scale (SAPS), Oxford hip score (OHS), and Short-Form 12 (SF12) health survey. Kaplan-Meier survivorship analysis was performed with revision of the acetabular component, revision of any part of the construct, and reoperation as endpoints.Results The fate of all cases was known. Mean follow-up was 4 years. 5 patients died during follow-up, with their constructs in situ. The survivorship of the acetabular component was 98% (95% CI: 85–100) at 7 years. 1 acetabular component was revised for infection and there was 1 radiographic acetabular failure. The median OHS was 36 (6–48), the median SF12 PCS was 36 (14–57), the median SAPS was 75 (0–100), and the median SF12 MCS was 50 (23–64). The graft material had incorporated in all 3 zones of the acetabulum in 33 out of 37 cases with complete radiographic follow-up.Interpretation Medium-term results show that BoneSave alone is a reliable material for impaction grafting of contained defects in the acetabulum at revision surgery.

Porous titanium particles for acetabular reconstruction in total hip replacement show extensive bony armoring after 15 weeks

“…These differences were even higher for the smaller-sized micro-particles (≤ 10 µm), where the volume of released micro-particles was 10,000 times larger for bioceramic particles than for titanium particles, and about 600 times larger for bioceramic particles, than for bone particles. These data should be kept in mind regarding the high incidence of radiolucent lines found in recently published medium-term results of clinical trials with impaction grafting with a mixture of bioceramic particles and bone particles (9 of 24 patients) and especially bioceramic particles alone (20 of 37 patients) ( Whitehouse et al 2013a , 2013b ).…”

Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute

“…Graft material became incorporated in all 3 zones of the acetabulum in 23 out of 24 cases that had complete radiographic follow-up. In another paper, Whitehouse reported on the use of BoneSave alone for reconstruction of contained defects of acetabulum [ 33 ]. A cohort of 43 patients was reviewed with a mean follow-up of 4 years.…”

Compensation of acetabular defects in hip arthroplasty

“…Достижение стабильности имплантата неразрывно связано с успешностью протекания остеоинтеграции. По этой причине предпочтение отдают бесцементным конструкциям, когда кость и имплантат становятся единой системой [39,40].…”