Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects

2020 ◽  
Vol 44 (10) ◽  
pp. 1957-1964
Author(s):  
Giorgio Burastero ◽  
Luca Cavagnaro ◽  
Francesco Chiarlone ◽  
Andrea Zanirato ◽  
Lorenzo Mosconi ◽  
...  
Keyword(s):  
Clinical Study ◽  
Revision Surgery ◽  
Bone Defects ◽  
Porous Titanium ◽  
Custom Made

scholarly journals 3D Biomimetic Porous Titanium (Ti6Al4V ELI) Scaffolds for Large Bone Critical Defect Reconstruction: An Experimental Study in Sheep

Animals ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1389 ◽  
Author(s):  
Alberto Maria Crovace ◽  
Luca Lacitignola ◽  
Donato Monopoli Forleo ◽  
Francesco Staffieri ◽  
Edda Francioso ◽  
...  
Keyword(s):  
Bone Defects ◽  
Porous Titanium ◽  
Control Group ◽  
Large Animal ◽  
Sintered Titanium ◽  
Porous Hydroxyapatite ◽  
X Ray ◽  
Custom Made ◽  
Critical Defect ◽  
Large Bone

The main goal in the treatment of large bone defects is to guarantee a rapid loading of the affected limb. In this paper, the authors proposed a new reconstructive technique that proved to be suitable to reach this purpose through the use of a custom-made biomimetic porous titanium scaffold. An in vivo study was undertaken where a complete critical defect was experimentally created in the diaphysis of the right tibia of twelve sheep and replaced with a five-centimeter porous scaffold of electron beam melting (EBM)-sintered titanium alloy (EBM group n = 6) or a porous hydroxyapatite scaffold (CONTROL group, n = 6). After surgery, the sheep were allowed to move freely in the barns. The outcome was monitored for up to 12 months by periodical X-ray and clinical examination. All animals in the CONTROL group were euthanized for humane reasons within the first month after surgery due to the onset of plate bending due to mechanical overload. Nine months after surgery, X-ray imaging showed the complete integration of the titanium implant in the tibia diaphysis and remodeling of the periosteal callus, with a well-defined cortical bone. At 12 months, sheep were euthanized, and the tibia were harvested and subjected to histological analysis. This showed bone tissue formations with bone trabeculae bridging titanium trabeculae, evidencing an optimal tissue-metal interaction. Our results show that EBM-sintered titanium devices, if used to repair critical bone defects in a large animal model, can guarantee immediate body weight-bearing, a rapid functional recovery, and a good osseointegration. The porous hydroxyapatite scaffolds proved to be not suitable in this model of large bone defect due to their known poor mechanical properties.

scholarly journals A Case Report: Custom Made Porous Titanium Implants in Revision: A New Option for Complex Issues

2018 ◽  
Vol 12 (1) ◽  
pp. 525-535
Author(s):  
Giorgio Burastero ◽  
Luca Cavagnaro ◽  
Francesco Chiarlone ◽  
Bernardo Innocenti ◽  
Lamberto Felli
Keyword(s):  
Bone Loss ◽  
Optimal Solution ◽  
Bone Defects ◽  
Porous Titanium ◽  
Titanium Implants ◽  
New Device ◽  
Custom Made ◽  
Knee Revision Surgery ◽  
Surgical Options ◽  
Clinical And Radiological Results

Background: Bone loss management is considered one of the most difficult challenges for orthopaedic surgeon. In massive bone defects, few surgical options are available and they do not offer a reliable or optimal solution for knee reconstruction. Objective: The aim of this paper is to present and justify a new custom-made approach for complex metadiaphyseal bone defects management in knee revision surgery. Methods: We report a case of a 66-year-old woman who underwent a staged left total knee arthroplasty revision for infection with Anderson Orthopaedic Research Institute classification III uncontained femoral and tibial metadiaphyseal bone defects following five prior surgeries. Along with a case discussion, we describe clinical and radiological outcomes of 3 similar patients treated with this new custom-made device. Results: To manage these problems, we developed new, custom porous titanium devices for both femoral and tibial reconstruction tailored to a patient’s specific bone loss. Since, 2014, we treated four cases using custom-made porous titanium cones and we had optimal clinical and radiological results, with no instances of loosening, component migration, or mismatches between preoperative planning and intraoperative findings. Conclusion: In extremely selected cases, this new device can be considered a possible and viable surgical step between “off the shelf” reconstruction implants and knee substitution with a tumor megaprosthesis.

Use of porous custom-made cones for meta-diaphyseal bone defects reconstruction in knee revision surgery: a clinical and biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 2041-2055
Author(s):  
Giorgio Burastero ◽  
Silvia Pianigiani ◽  
Cristiana Zanvettor ◽  
Luca Cavagnaro ◽  
Francesco Chiarlone ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Bone Defects ◽  
Biomechanical Analysis ◽  
Diaphyseal Bone ◽  
Custom Made ◽  
Knee Revision Surgery ◽  
Knee Revision

scholarly journals Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Marta Medetti ◽  
Francesco Benazzo
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Type Ii ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Prospective Case Series ◽  
Acetabular Components

Abstract Background This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. Methods Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29–90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. Results Average follow-up was 91 (range 24–146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25–70; SD 9) preoperatively to 84.4 (range 46–99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan–Meier survivorship was assessed to be 88.54% (95% CI 80.18–93.52%) at 71 months, with failure of the cup for any reason as the endpoint. Conclusion Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. Level of evidence Level IV prospective case series

scholarly journals Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

2019 ◽  
Vol 25 (2) ◽  
pp. 9-18 ◽  
Author(s):  
A. A. Cherny ◽  
A. N. Kovalenko ◽  
S. S. Bilyk ◽  
A. O. Denisov ◽  
A. V. Kazemirskiy ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Scoring Systems ◽  
Bone Defects ◽  
Patient Specific ◽  
Implant Fixation ◽  
Diaphyseal Bone ◽  
Custom Made ◽  
The Stability ◽  
Valid Solution

The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

scholarly journals Reconstruction of anterior frontal wall and contours defects using bone substitute

2021 ◽  
pp. 34
Author(s):  
Keyword(s):  
Bone Substitute ◽  
Calcium Sulfate ◽  
Donor Site ◽  
Bone Defects ◽  
Autogenous Bone ◽  
Bone Void Filler ◽  
Custom Made ◽  
Cranial Implant ◽  
Bone Void ◽  
Orbital Area

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital area. Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been . A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region. Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing

scholarly journals Full regeneration of segmental bone defects using porous titanium implants loaded with BMP-2 containing fibrin gels

2015 ◽  
Vol 29 ◽  
pp. 141-154 ◽  
Author(s):  
J van der Stok ◽  
◽  
MKE Koolen ◽  
MPM de Maat ◽  
S Amin Yavari ◽  
...  
Keyword(s):  
Bone Defects ◽  
Porous Titanium ◽  
Titanium Implants ◽  
Fibrin Gels ◽  
Segmental Bone ◽  
Segmental Bone Defects

Impaction bone grafting in hip re-revision surgery

2021 ◽  
Vol 103-B (3) ◽  
pp. 492-499
Author(s):  
Eduardo Garcia-Rey ◽  
Laura Saldaña ◽  
Eduardo Garcia-Cimbrelo
Keyword(s):  
Aseptic Loosening ◽  
Acetabular Component ◽  
Revision Surgery ◽  
Bone Grafting ◽  
Bone Defects ◽  
Bone Stock ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

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