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

Abstract

Background Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. Methods Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. Results The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. Conclusion Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

An Observational Prospective Clinical Study for the Evaluation of a Collagen-Hydroxyapatite Composite Scaffold in Hip Revision Surgery

“…Stability and long-term fixation of implants in revision hip arthroplasty are determined by many factors, such as bone tissue availability, adequate implant geometry, and stable fixation. Based on the extent of the bone defect, there is a wide variety of orthopaedic implants available, including cemented or uncemented cups, porous implants with iliac fixation stem, and reinforcement devices such as cage, ring, plate, or mesh [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…Over the years, several material options have been investigated for bone repair and regeneration [ 3 , 4 ]. However, to date, autologous bone is still considered the “gold standard” for graft procedures due to its osteoconductive, osteoinductive, and osteogenic properties.…”

Effect of Lanthanum Zirconate Ceramic on the Dynamics of Hematological Parameters and the Bone Remodeling Markers: Experimental Study

“…Определение динамики эритроцитарного уровня также не выявило негативного влияния нового материала: не обнаружено признаков гемолиза эритроцитов в течение всего срока наблюдения. ТКФ хорошо известен и широко применяется в качестве остеозамещающего материала [15, 16,17]. Сравнение нового керамического материала на основе цирконата с ТКФ не выявило существенных различий между ними по основным гематологическим показателям.…”

Lumbar pedicle screw pseudoarthrosis salvage technique with moldable, bioabsorbable, calcium phosphate–based putty: illustrative case

“…Allograft is a viable and commonly used substitute but lacks some of the efficacy of autograft due to lack of growth factors. 14,15 There are multiple options for synthetic products when neither of the above is available or desirable, depending on the circumstances.…”