Particle size of bone graft and method of impaction affect initial stability of cemented cupsHuman cadaveric and synthetic pelvic specimen studies

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.

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“…The impaction of grafts of a certain size should be vigorous in order to provide early stability [1].…”

Section: Discussionmentioning

confidence: 99%

Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years

Comba

Buttaro

Pusso

et al. 2008

International Orthopaedics (SICOT)

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“…Even when using models of simple cavitary defects in experiments on axial loading, the stability of cemented cups in reconstructions with smaller bone grafts of 2 to 5 mm diameter were inferior to procedures in which larger chips were used. 23,24 This may be the explanation for the ongoing migration observed in seven of 21 cups two years after surgery in a clinical radiostereophotogrammetric analysis. 25 However, up to five years after surgery, no cup was re-revised.…”

Section: The Journal Of Bone and Joint Surgerymentioning

confidence: 99%

“…28 We compared the initial stability of the cemented cup in a simple cavitary defect model, using the same-sized bone chips both with the reversed reaming technique and the traditional method with impactors and a hammer; the former resulted in a significant higher migration of the cups. 24 A major concern is the use of bone processed in different ways, since the mechanical and biological properties of freeze-dried or irradiated bone may not be comparable with that of the freshfrozen grafts which we used. We did not wash the allograft prior to impaction, although this may be attractive.…”

Section: The Journal Of Bone and Joint Surgerymentioning

confidence: 99%

Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup

Schreurs

Bolder

Gardeniers

et al. 2004

The Journal of Bone and Joint Surgery. British volume

135

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This study presents the clinical and radiological results of 62 consecutive acetabular revisions in 58 patients, at a mean of 16.5 years follow-up (15 to 20). The Kaplan-Meier survivorship for the cup with end-point revisions for any reason, was 79% at 15 years (95% confidence interval (CI); 67 to 91). Excluding two revisions for septic loosening at three and six years, and one revision of a well-fixed cup after 12 years in the course of a femoral revision, the survivorship was 84% at 15 years (95% CI; 73 to 95). At review there were no additional cases of loosening, although seven acetabular reconstructions showed radiolucent lines in one or two zones. Acetabular revision using impacted large morsellised bone chips (0.7 cm to 1.0 cm) and a cemented cup, is a reliable technique of reconstruction, when assessed at more than 15 years.Loss of bone stock compromises the outcome in revision of total hip arthroplasty. The longterm results of most techniques of acetabular revision remain unclear and few reports are available on the outcome beyond ten years. [1][2][3][4] From a biological viewpoint the reconstruction of the bone stock with grafted bone is an attractive option.Following the experience of Hastings and Parker 5 and McCollum, Nunley and Harrelson 6 with protrusio acetabuli, we have used a modified technique of bone grafting for acetabular revisions using tightly impacted morsellised bone chips and cemented cups. In 1998 we described the outcome of this technique in 60 procedures followed for more than ten years. 7 We now report the outcome at 15 to 20 years.

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“…8e11 This study indicates that using the largest available bone chips does not necessarily produce the best results, which contradicts earlier findings previously reported when commenting on bone chip size for acetabular reconstruction. 8,9 Arts and Bolder comment that the biggest practical bone size should be used for acetabular reconstruction. Our study revealed the largest chip size (20 mm 3 ) to have an inferior mean maximal stiffness although not statistically different compared to the smaller chip size of medium (10 mm 3 ).…”

Section: Static Compressionmentioning

confidence: 99%

“…In studies of impaction grafting, a larger bone chip size has been identified as producing higher stability than a smaller chip size 8,9 and the ideal bone chip size on the acetabulum has been suggested to be between 8 and 10 mm. 3,8,10,11 However, it is not known if using the largest possible particle of bone chips size to reconstruct an acetabular defect would have a detrimental effect on the initial mechanical stability of the implanted component.…”

Section: Introductionmentioning

confidence: 99%

Impaction grafted bone chip size effect on initial stability in an acetabular model: Mechanical evaluation

Holton

Bobak

Wilcox

et al. 2013

Journal of Orthopaedics

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Bone chip size a b s t r a c tIntroduction: Acetabular bone defect reconstruction is an increasing problem for surgeons with patients undergoing complex primary or revision total hip replacement surgery.Impaction bone grafting is one technique that has favourable long-term clinical outcome results for patients who undergo this reconstruction method for acetabular bone defects.Creating initial mechanical stability of the impaction bone graft in this technique is known to be the key factor in achieving a favourable implant survival rate. Different sizes of bone chips were used in this technique to investigate if the size of bone chips used affected initial mechanical stability of a reconstructed acetabulum.Methodology: Twenty acetabular models were created in total. Five control models were created with a cemented cup in a normal acetabulum. Then five models in three different groups of bone chip size were constructed. The three groups had an acetabular protrusion defect reconstructed using either; 2e4 mm 3 , 10 mm 3 or 20 mm 3 bone chip size for impaction grafting reconstruction. The models underwent compression loading up to 9500 N and displacement within the acetabular model was measured indicating the initial mechanical stability.Results: This study reveals that, although not statistically significant, the largest (20 mm 3 ) bone chip size grafted models have an inferior maximum stiffness compared to the medium (10 mm 3 ) bone chip size.Interpretations: Our study suggests that 10 mm 3 size of bone chips provide better initial mechanical stability compared to smaller or larger bone chips. We dismissed the previously held opinion that the biggest practically possible graft is best for acetabular bone graft impaction.

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Particle size of bone graft and method of impaction affect initial stability of cemented cupsHuman cadaveric and synthetic pelvic specimen studies

Abstract: (2003) Particle size of bone graft and method of impaction affect initial stability of cemented cupsHuman cadaveric and synthetic pelvic specimen studies , Acta Orthopaedica Scandinavica, 74:6, 652-657,

Cited by 74 publications

References 16 publications

Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years

Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years

Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup

Impaction grafted bone chip size effect on initial stability in an acetabular model: Mechanical evaluation

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