scholarly journals Vascularised bone graft is an effective technique for extracortical bone bridging to combat cemented megaprosthesis loosening at the bone–implant junction

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095816 ◽  
Author(s):  
Michelle Hilda Luk ◽  
Andy Hon-Fai Yee ◽  
Raymond Yau ◽  
Kenneth Wai-Yip Ho ◽  
Ying-Lee Lam
Keyword(s):  
Bone Graft ◽  
Aseptic Loosening ◽  
Bone Growth ◽  
Implant Loosening ◽  
Implant Fixation ◽  
Bone Implant ◽  
Radiological Score ◽  
Vascularised Bone Graft ◽  
Without Bone Graft

Introduction: The bone–implant junction is a potential site for aseptic loosening. Extracortical bone bridging at the bone–implant junction is advocated to improve implant fixation by forming a biological seal. We propose a novel technique with vascularised bone graft (VBG) to form an extracortical bone bridge at the bone–implant junction to enhance implant stability. We compared the clinical and radiological outcomes for tumour megaprostheses performed (1) with and without bone graft and (2) with non-vascularised versus VBG technique. Methods: Forty-six tumour megaprosthesis procedures from 1 June 2007 to 31 October 2017 were identified from hospital records. Twenty-eight operations incorporated bone graft at the bone–implant junction, and 18 did not. Of these 28 bone graft procedures, 13 involved VBG, and 15 did not (non-VBG). The VBG technique involves resecting a short segment of healthy bone beyond the oncological margin with its preserved blood supply, splitting it, then securing it over the junction. Clinical outcomes assessed included loosening, fracture and recurrence. Extracortical bone growth at the bone–implant junction was quantified radiologically at intervals 0–24 months post-operatively. The mean follow-up was 4.27 years. Results: There were five incidences (27.8%) of loosening in the non-bone graft group compared to zero in the bone graft group ( p = 0.03). There was a higher radiological score of extracortical bone growth in the bone graft group compared to no bone graft at 3–24 months post-operatively ( p < 0.05). Within the bone graft group, the VBG group fared superior at 6 and 12 months post-operatively compared to non-VBG ( p < 0.05), as well as a lower rate of radiological junctional resorption ( p = 0.04). Conclusions: We recommend bone grafting for its merits of less implant loosening. We propose the VBG technique to combat early aseptic loosening in megaprosthesis replacement as there was a higher radiological score compared to non-VBG.

scholarly journals Finite-element analysis of the influence of tibial implant fixation design of total ankle replacement on bone–implant interfacial biomechanical performance

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096612
Author(s):  
Jian Yu ◽  
Chao Zhang ◽  
Wen-Ming Chen ◽  
Dahang Zhao ◽  
Pengfei chu ◽  
...  
Keyword(s):  
Finite Element ◽  
Total Ankle Replacement ◽  
Implant Design ◽  
Fixation Method ◽  
Implant Loosening ◽  
Implant Fixation ◽  
Bone Resection ◽  
Bone Implant ◽  
Initial Stability ◽  
Ankle Replacement

Purpose: Implant loosening in tibia after primary total ankle replacement (TAR) is one of the common postoperative problems in TAR. Innovations in implant structure design may ideally reduce micromotion at the bone–implant interface and enhance the bone-implant fixation and initial stability, thus eventually prevents long-term implant loosening. This study aimed to investigate (1) biomechanical characteristics at the bone–implant interface and (2) the influence of design features, such as radius, height, and length. Methods: A total of 101 finite-element models were created based on four commercially available implants. The models predicted micromotion at the bone–implant interface, and we investigated the impact of structural parameters, such as radius, length, and height. Results: Our results suggested that stem-type implants generally required the highest volume of bone resection before implantation, while peg-type implants required the lowest. Compared with central fixation features (stem and keel), peripherally distributed geometries (bar and peg) were associated with lower initial micromotions. The initial stability of all types of implant design can be optimized by decreasing fixation size, such as reducing the radius of the bars and pegs and lowering the height. Conclusion: Peg-type tibial implant design may be a promising fixation method, which is required with a minimum bone resection volume and yielded minimum micromotion under an extreme axial loading scenario. Present models can serve as a useful platform to build upon to help physicians or engineers when making incremental improvements related to implant design.

Micromotions at the Bone Implant Interface Up-Regulate Osteoblasts-Mediated Activation of Osteoclasts in Ex Vivo Human Samples

2007 ◽  
Author(s):  
Vincent A. Stadelmann ◽  
Dominique P. Pioletti
Keyword(s):  
Aseptic Loosening ◽  
Ex Vivo ◽  
Fibrous Tissue ◽  
Joint Prosthesis ◽  
Implant Fixation ◽  
Bone Implant ◽  
Common Cause ◽  
Progressive Deterioration ◽  
Cemented Implants ◽  
Fibrous Tissues

A radiolucent zone at the interface of bone and implants in total joint prosthesis is frequently observed in uncemented and cemented implants. This radiolucent zone, representing a fibrous tissue, is the result of the progressive deterioration of the bone surrounding implants. Fibrous tissues affect the implant fixation, increasing then the risk of aseptic loosening. Today, aseptic loosening is the most common cause of arthroplasties revisions.

Ilizarov Frame Fixation Without Bone Graft for Atrophic Humeral Shaft Nonunion: 28 Patients With a Minimum 2-Year Follow-Up

2007 ◽  
Vol 21 (8) ◽  
pp. 549-556 ◽  
Author(s):  
Slavko Tomi?? ◽  
Marko Bumba??irevi?? ◽  
Aleksandar Le??i?? ◽  
Milorad Mitkovi?? ◽  
Henry Dushan E Atkinson
Keyword(s):  
Bone Graft ◽  
Humeral Shaft ◽  
Ilizarov Frame ◽  
Humeral Shaft Nonunion ◽  
Without Bone Graft

Long-term competing risks for overall and cause-specific failure of rotating-hinge distal femoral arthroplasty for tumour reconstruction

2021 ◽  
Vol 103-B (8) ◽  
pp. 1405-1413
Author(s):  
Koichi Ogura ◽  
Tomohiro Fujiwara ◽  
Carol D. Morris ◽  
Patrick J. Boland ◽  
John H. Healey
Keyword(s):  
Aseptic Loosening ◽  
Femoral Component ◽  
Distal Femur ◽  
Quadriceps Muscle ◽  
Competing Risk ◽  
Implant Fixation ◽  
Bone Implant ◽  
Rotating Hinge ◽  
Rotating Hinge Knee

Aims Rotating-hinge knee prostheses are commonly used to reconstruct the distal femur after resection of a tumour, despite the projected long-term burden of reoperation due to complications. Few studies have examined the factors that influence their failure and none, to our knowledge, have used competing risk models to do so. The purpose of this study was to determine the risk factors for failure of a rotating-hinge knee distal femoral arthroplasty using the Fine-Gray competing risk model. Methods We retrospectively reviewed 209 consecutive patients who, between 1991 and 2016, had undergone resection of the distal femur for tumour and reconstruction using a rotating-hinge knee prosthesis. The study endpoint was failure of the prosthesis, defined as removal of the femoral component, the tibial component, or the bone-implant fixation; major revision (exchange of the femoral component, tibial component, or the bone-implant fixation); or amputation. Results Multivariate Fine-Gray regression analyses revealed different hazards for each Henderson failure mode: percentage of femoral resection (p = 0.001) and extent of quadriceps muscle resection (p = 0.005) for overall prosthetic failure; extent of quadriceps muscle resection (p = 0.002) and fixation of femoral component (p = 0.011) for type 2 failure (aseptic loosening); age (p = 0.009) and percentage of femoral resection (p = 0.019) for type 3 failure (mechanical failure); and type of joint resection (p = 0.037) for type 4 (infection) were independent predictors. A bone stem ratio of > 2.5 reliably predicted aseptic loosening. Conclusion We identified independent risk factors for overall and cause-specific prosthetic failure after rotating-hinge knee distal femoral arthroplasty using a competing risk Fine-Gray model. A bone stem ratio > 2.5 reliably predicts aseptic loosening. An accurate knowledge of the risks of distal femoral arthroplasty after resection for tumour assists surgical planning and managing patient expectations. Cite this article: Bone Joint J 2021;103-B(8):1405–1413.

scholarly journals Is open bone graft always necessary when treating aseptic subtrochanteric nonunion with a reamed intramedullary nail?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Won Chul Shin ◽  
Jae Hoon Jang ◽  
Nam Hoon Moon ◽  
Se Bin Jun
Keyword(s):  
Bone Graft ◽  
Pathologic Fracture ◽  
Bony Union ◽  
Open Procedure ◽  
Radiological Results ◽  
Intramedullary Reaming ◽  
Closed Procedure ◽  
Without Bone Graft ◽  
Large Bone

Abstract Background This study aimed to compare the radiological results between closed nailing without bone graft (BG) and open nailing with BG for aseptic subtrochanteric nonunion and to determine when an open procedure with BG should be considered. Methods In this retrospective study, we investigated patients who underwent surgical intervention for subtrochanteric nonunion between January 2008 and March 2018 in two institutions. Patients with infection, large bone defect, pathologic fracture, open fracture, previous surgery using plate, and follow-up of less than 1 year were excluded. We compared the demographic details and radiological results between patients who underwent the open procedure with BG (BG group) and the closed procedure without BG (non-BG group) as a historical control, and risk factors for the failure of revision surgery were evaluated. Results Thirty-seven patients met the criteria and were divided into the following two groups: the BG group (n=19) who underwent open nailing with BG and the non-BG group (n=18) who underwent closed reamed nailing without BG. The mean degrees of correction of varus and flexion deformity were significantly different (p=0.001, respectively), 6.2° and 2.9° in the BG group and 4.1° and 0.6° in the non-BG group, respectively. Bony union was observed in 17 cases (89.5%) in an average of 7.4 months in the BG group and in 16 cases (88.9%) in 7.6 months in the non-BG group, with no significant differences. The factors that were significantly associated with failure of revision were atypical fracture, two or more previous surgeries, and varus and sagittal anterior angulation. Conclusions The radiological results of closed reamed nailing without BG for subtrochanteric nonunion were satisfactory. In the effort of percutaneous realignment, gap reduction, and intramedullary reaming, the radiological results of closed nailing without BG were not different from those of open nailing with BG; therefore, closed procedure without BG may be an acceptable option in appropriately selected patients.

Simultaneous Sinus Membrane Elevation and Dental Implant Placement Without Bone Graft: A 6-Month Follow-Up Study

2011 ◽  
Vol 82 (3) ◽  
pp. 403-412 ◽  
Author(s):  
Fabio L. Borges ◽  
Rafael O. Dias ◽  
Adriano Piattelli ◽  
Tatiana Onuma ◽  
Luciana Ap. Gouveia Cardoso ◽  
...  
Keyword(s):  
Bone Graft ◽  
Dental Implant ◽  
Follow Up Study ◽  
Implant Placement ◽  
Without Bone Graft ◽  
Sinus Membrane Elevation ◽  
Sinus Membrane

scholarly journals Outcome of vascularised muscle pedicle bone graft for scaphoid non-union

2018 ◽  
Vol 4 (2) ◽  
pp. 203
Author(s):  
Rajat Charan ◽  
Pankaj Kumar Verma
Keyword(s):  
Bone Graft ◽  
Screw Fixation ◽  
Proximal Pole ◽  
Hardware Failure ◽  
Non Union ◽  
Herbert Screw ◽  
Vascularised Bone Graft ◽  
Full Correction ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The objective of the study was to assess the <span lang="EN-IN">outcome of vascularised muscle pedicle bone graft for scaphoid non-union.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">14 men and 6 women aged 18-45 (mean 25) years with non-union of scaphoid involving proximal pole (n=4), waist (n=14), distal pole (n=2) were randomized to undergo vascularised muscle pedicle bone graft with Herbert screw fixation. The mean duration of non-union was 10 months (range 4-14 months)</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The mean follow up duration was 24 months. 17 of 20 achieved union. 12 of 20 achieved correction of both scapholunate and radiolunate angle. 5 of 20 did not achieve full correction of sacpholunate and radiolunate angle. 3 of 20 did not achieve union. 2 of these 3 were associated with proximal pole absorption. There was no hardware failure or any iatrogenic fracture during pedicle dissection. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The use of vascularised bone graft has proved to be an effective method for treating scaphoid non-union, especially non-union with an avascular proximal pole and those that have failed to heal after previous procedure.</span></p>

scholarly journals Surgical treatment of congenital kyphosis caused by multiple vertebral malformations

2018 ◽  
Vol 9 (1) ◽  
pp. 112-117
Author(s):  
Artem V. Kosulin ◽  
Dmitriy V. Elyakin ◽  
Ekaterina I. Okhlopkova ◽  
Olesya G. Pridatko ◽  
Yuliya V. Klybanskaya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Graft ◽  
Bone Grafting ◽  
Bone Growth ◽  
Bone Matrix ◽  
Anterior Fusion ◽  
Fusion Procedure ◽  
Lumbar Vertebral Body ◽  
Congenital Kyphosis

Clinical case of successful operative treatment of congenital kyphosis is reported. Deformation was caused by multiple lower thoracic and lumbar vertebral body abnormalities. Associated spinal abnormalities were outspread absence of laminae, hydromyelia, and diastematomyelia. Preoperative computed tomography analysis revealed absence of instrumentable bony structures within malformed lower thoracic and lumbar spine. As instrumented fusion procedure was technically impossible anterior fusion without internal fixation was performed. Autogenous rib was used as a bone graft. Bone graft was extended with calcium sulphas (osteoconductive media), demineralized allograft bone matrix (osteoinductive media), and patient’s bone marrow aspirate (osteogenic media). Resulting combined bone grafting material possessed osteoconductivity, osteoinductivity, ostegenicity, and mechanical strength. At 18 months post operation follow-up computed tomography revealed solid bony fusion formation. Some neurologic improvement also was noticed. Congenital kyphosis caused by multiple outspread vertebral malformations remains insufficiently studied clinical problem. Affected children need individual multidisciplinary surgical approach, meticulous surgical planning, and regular neurological, imaging, and orthopedic follow-up until the end of bone growth. Absence of instrumentable bony structures in desired spinal arthrodesis does not preclude successful fusion. Combination of several heterogenous bone grafting materials with different properties provides fusion in difficult clinical setting.

Modified Lapidus Procedure for Hallux Valgus

Foot & Ankle ◽  
1989 ◽  
Vol 9 (6) ◽  
pp. 262-266 ◽  
Author(s):  
Bruce J. Sangeorzan ◽  
Sigvard T. Hansen
Keyword(s):  
Bone Graft ◽  
Hallux Valgus ◽  
Medical Center ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
First Ray ◽  
Without Bone Graft

A modified Lapidus procedure was introduced at Harborview Medical Center in 1979 for the treatment of symptomatic hallux valgus with hypermobile first ray. The results of the procedures were reviewed retrospectively in 32 patients with 40 feet that were operated on between 1979 and 1984. Preoperative diagnosis was symptomatic hallux valgus complex with hypermobile first ray in 33 and failed bunion surgery in 7. Follow-up ranged from 30 months to 6 1/2 years. Union of the arthrodesis site occurred in 36 (90%). The average preoperative intrametatarsal angle was 14° (range 7.5 to 20°) and the hallux valgus angle was 26° (range 0 to 50°). At healing, the angles were as follows: intermetatarsal angle 6° (range 0 to 18°) and hallux valgus angle 11° (range −3 to 30°). The average change in the length of the first metatarsal was −5 mm for those without bone graft and +4 mm for those with bone graft. Of 33 feet operated on as a primary procedure, successful results were reported in 75% by our rating system. Of 7 feet operated on for failed previous surgery, all were improved. Best results were obtained in those with multiple screw fixation, use of bone graft, and attention to plantarflexion of the first metatarsal.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

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