Favorable mid-to-long-term results of impaction bone grafting using a fresh frozen allograft bone with cemented stem for the treatment of Paprosky IV femoral bone defects

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

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Filling Bone Defects after Hip Arthroplasty Revision Using Hydroxyapatite/?-tricalcium Phosphate: A Case Report with Long-term Result

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2234 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Sandris Petronis ◽

Ruta Jakusonoka ◽

Viktors Linovs ◽

Andris Jumtins

Keyword(s):

Case Report ◽

Bone Defect ◽

Hip Arthroplasty ◽

Tricalcium Phosphate ◽

Periprosthetic Fracture ◽

Bone Defects ◽

Femoral Bone ◽

Left Femur ◽

Arthroplasty Revision

Introduction: The increasing number of primary total hip replacements means that there is an increased need for hip arthroplasty revisions. The periprosthetic fractures which cause bone defects can occur during removal of the femoral component and healing of these fractures can be delayed. In femoral bone defects during revisions, there are no metal augments for filling these defects. Case Report: Fifty-nine-year-old female presented with infected loosening of the left hip non-cemented endoprosthesis 5 years after surgery. The patient underwent removal of endoprosthesis. In 2 months, re-implantation of non-cemented endoprosthesis was performed and biphasic calcium phosphate (BCP) ceramic granules with hydroxyapatite/?-tricalcium phosphate (HAp/?-TCP) were implanted in the femoral bone defects. Eleven months following the arthroplasty patient had periprosthetic fracture of the distal third of the left femur. The osteosynthesis was performed and BCP ceramic granules with HAp/?-TCP were used to fill the bone defect. Long-term follow-up showed very good functional outcome and bone defect healing. Conclusion: The BCP ceramic granules with HAp/?-TCP material adjusted to the bone defect anatomy, showed effective femoral bone defect and periprosthetic fracture healing in a patient with hip arthroplasty revision and periprosthetic fracture. Keywords: Bone defect, femoral, revision.

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Processed versus fresh frozen bone for impaction bone grafting in revision hip arthroplasty

10.1002/14651858.cd006351 ◽

2007 ◽

Author(s):

Timothy N Board ◽

Susan Brunskill ◽

Carolyn Dorée ◽

Chris Hyde ◽

Peter R Kay ◽

...

Keyword(s):

Hip Arthroplasty ◽

Bone Grafting ◽

Revision Hip Arthroplasty ◽

Impaction Bone Grafting ◽

Fresh Frozen ◽

Frozen Bone

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Impaction bone grafting in hip re-revision surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1228.r1 ◽

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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