Reconstruction for defects of the proximal part of the femur using allograft arthroplasty.

Jofe, Michael H.; Gebhardt, Mark C.; Tomford, W W; Mankin, Henry J.

doi:10.2106/00004623-198870040-00005

Cited by 87 publications

(48 citation statements)

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“…We suggest in vivo colonization of allografts during establishment of infection can occur preferentially in protected niches, although the timeframe of these events is likely to be longer than what we describe here. To prevent establishment of infection during the immediate postsurgical period, prophylactic antibiotic regimens have been adopted that involve the administration of antibiotics intravenously for 2 to 14 days and orally for up to 16 weeks [15,24,29]. Similarly, to prevent initial infection, physicians have empirically impregnated bone allografts with antibiotics before implantation, achieving high local concentrations of antibiotic during the initial elution [8].…”

Section: Discussionmentioning

confidence: 99%

Bacterial Colonization of Bone Allografts: Establishment and Effects of Antibiotics

Ketonis

Barr

Adams

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Bone grafts are frequently used to supplement bone stock and to establish structural stability. However, graft-associated infection represents a challenging complication leading to increased patient morbidity and healthcare costs. Questions/purposes We therefore designed this study to (1) determine if increasing initial S. aureus inoculation of bone allograft results in a proportionate increase in colonization; (2) assess if antibiotics decrease colonization and if antibiotic tethering to allograft alters its ability to prevent bacterial colonization; and (3) determine if covalent modification alters the allograft topography or its biological properties.Methods Allograft bone and vancomycin-modified bone (VAN-bone) was challenged with different doses of S. aureus for times out to 24 hours in the presence or absence of solution vancomycin. Bacterial colonization was assessed by fluorescence, scanning electron microscopy (SEM), and by direct colony counting. Cell density and distribution of osteoblast-like cells on control and modified allograft were then compared. Results Bacterial attachment was apparent within 6 hours with colonization and biofilm formation increasing with time and dose. Solution vancomycin failed to prevent bacterial attachment whereas VAN-bone successfully resisted colonization. The allograft modification did not affect the attachment and distribution of osteoblast-like cells.

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Section: Discussionmentioning

confidence: 99%

Bacterial Colonization of Bone Allografts: Establishment and Effects of Antibiotics

Ketonis

Barr

Adams

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Reconstruction options for these patients include endoprosthetic replacement or composite reconstruction using allografts and prostheses [2,3,4,7,8,13,16,18,23,25]. An osteochondral allograft rarely is indicated for reconstructing the proximal femur [14]. APCs have been used to reconstruct defects from wide tumor excisions since the late 1980s [3,7,8,15,18,23,25].…”

Section: Introductionmentioning

confidence: 99%

Proximal Femur Allograft-prosthesis with Compression Plates and a Short Stem

Múscolo

Farfalli

Aponte-Tinao

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Proximal femur allograft-prosthesis composites (APCs) performed with compression plates and a short stem theoretically could minimize the resorption or nonunion that reportedly occurs with long stems bypassing the diaphyseal osteotomy. To confirm this theoretical consideration, we retrospectively reviewed 34 patients with 38 proximal femoral APCs using a short-cemented femoral stem and compression plates for diaphyseal osteotomy fixation. In 26 patients, the plate fixation extended over at least half the femoral stem and in 12, it did not. We reinserted the abductor mechanism with two techniques: in 10 cases the host trochanter was reattached to the APC, and in 28 the host tendons were sutured to the tendinous insertion of the allograft. The overall survival of the entire series was 72% at 5 years and 69% at 10 years. Eleven of the 38 (29%) APCs were removed: three for infection, one for local recurrence of tumor, and seven for fractures. Trendelenburg gait occurred in four of 21 patients with direct tendon-to-tendon suture of the abductor mechanism and in three of six patients with trochanteric osteotomy. The overall APC survival rate was greater in patients in whom the allograft was adequately protected with internal fixation than in patients in whom it was not.

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“…The use of bone allografts is one of the most common treatment options for reconstructing segmental skeletal defects incurred from tumour, trauma, or total joint arthroplasties [5,10,15,21]. The ideal allograft incorporation involves the envelopment of the necrotic graft by the new host bone containing a remodelling unit consisting of haematopoietic cells and osteoblasts [4,7,11].…”

Section: Introductionmentioning

confidence: 99%

Zoledronate reduces unwanted bone resorption in intercalary bone allografts

Seo

Cho

Storer

et al. 2009

International Orthopaedics (SICOT)

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Bone allografts are often hampered by graft incorporation and poor host bone formation. Bisphosphonates, synthetic pyrophosphate analogs, have shown promise in inhibiting bone resorption in human and animal trials. Some in vitro studies have suggested that high dose bisphosphonate may also inhibit bone formation, leading to our hypothesis that an ideal dose of bisphosphonate in allografts could protect allografts from resorption. We transplanted intercalary allografts in to the segmental defect of the rat femurs after soaking each allograft in zoledronate solution (30 µM) and then analysed bone density of the allografts six to 12 weeks after transplantation. At six and 12 weeks, the bone mineral density was higher in the experimental group compared with the control group. Qualitative radiographic and histological analysis also revealed more allograft resorption in the control group than in the zoledronatetreated group. Our data indicate that pharmacological modification of intercalary allografts with zoledronate solution can decrease osteoclast-mediated allograft resorption.

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Reconstruction for defects of the proximal part of the femur using allograft arthroplasty.

Cited by 87 publications

References 0 publications

Bacterial Colonization of Bone Allografts: Establishment and Effects of Antibiotics

Bacterial Colonization of Bone Allografts: Establishment and Effects of Antibiotics

Proximal Femur Allograft-prosthesis with Compression Plates and a Short Stem

Zoledronate reduces unwanted bone resorption in intercalary bone allografts

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