Application of structural allogenous bone graft in two-stage exchange arthroplasty for knee periprosthetic joint infection: a case control study

Abstract Background: Knee prosthetic joint infection (PJI) is a common but devastating complication after knee arthroplasty. The revision surgeries for knee PJI may become more challenging when it is associated with large bone defects. The application of structural bone allograft in knee revision surgeries with large bone defects is not a new technique. However, there is a lack of literature reporting its efficacy in PJI cases. This study aimed to investigate the outcome of structural fresh frozen allogenous bone grafts in treating patients in knee PJI with large bone defects. Methods: We performed a retrospective cohort analysis of knee PJI cases treated with two-stage exchange arthroplasty at our institution from 2010 to 2016. 12 patients with structural allogenous bone graft reconstructions were identified as the study group. 24 patients without structural allograft reconstructions matched with the study group by age, gender, and Charlson comorbidity index were enrolled as the control group. The functional outcome of the study group was evaluated with the Knee Society Score (KSS). Treatment success was assessed according to the Delphi-based consensus definition. The infection relapse rate and implant survivorship were compared between groups. Results: Revision knees with structural allograft presented excellent improvement in the KSS (33.1 to 75.4). There was no significant difference between infection relapse-free survival rate and prosthesis survival rate in two groups. The 8-year prosthesis survival rate was 90.9% in the study group and 91% in the control group (p = 0.913). The 8-year infection relapse-free survival rate was 80% and 83.3% in the study group and control group, respectively (p = 0.377). Conclusion: The structural fresh frozen allogenous bone graft provided an effective way for bone defect reconstruction in knee PJI with accountable survival rate. Meanwhile, using structural allografts did not increase the relapse rate of infection.

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Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1161-9566 ◽

2020 ◽

Author(s):

Selina Gaida ◽

Uwe Schweigkofler ◽

Wibke Moll ◽

Michael Sauerbier ◽

Reinhard Hoffmann

Keyword(s):

Bone Graft ◽

Case Series ◽

Bone Defects ◽

Bone Transplantation ◽

Patient Comfort ◽

Masquelet Technique ◽

Specialized Center ◽

Free Fibula ◽

Large Bone ◽

Large Bone Defects

AbstractLarge bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise. In the following case series we describe the technique of free fibula transplantation and additional allograft. In both cases a good functional result with full mechanical strength of the affected extremity and satisfactory patient comfort has been achieved. In the second case, implant failure with the necessity of revision endoprosthetics occurred during the procedure.

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Femoral bone defect healing using two novel biocompatible degradable materials

Acta Veterinaria Brno ◽

10.2754/avb202089020163 ◽

2020 ◽

Vol 89 (2) ◽

pp. 163-169

Author(s):

Robert Srnec ◽

Andrea Nečasová ◽

Pavel Proks ◽

Miša Škorič ◽

Zita Filipejová ◽

...

Keyword(s):

Bone Defect ◽

Bone Marrow Cells ◽

Plate Osteosynthesis ◽

Bone Defects ◽

Femoral Diaphysis ◽

Control Group ◽

Histological Assessment ◽

Bone Defect Healing ◽

Large Bone ◽

Large Bone Defects

This study was conducted as an in vivo experiment in adult miniature pigs with the aim to test two new biomaterials. An iatrogenic defect was made into the central femoral diaphysis in the experimental animals and subsequently fixated by bridging plate osteosynthesis. Into the defect we implanted a cancellous autograft (control group), a pasty injectable scaffold (EXP A), and a porous 3D cylinder (EXP B). Radiological examination was performed in all animals at 0, 10, 20, 30 weeks after surgical procedure and histological assessment was performed. In the newly formed bone the osteoblastic activity was monitored. In terms of radiology, the most effective method was observed in the control group (completely healed 100%) compared to experimental groups EXP A (70.0%) and EXP B (62.5%). Histological assessment showed a higher cell count in the place of bone defect in the control group compared to experimental groups. Between the experimental groups, a higher count of bone marrow cells was found in group EXP B. Both newly developed biomaterials seem to be suitable as replacements for large bone defects, having good workability and applicability. However, compared to the control group treated with a cancellous autograft, the newly formed bone did not reach the same number of cells settling in and in some cases, full radiological healing was not reached. Nevertheless, the material was found to be grown into the original bone in all cases within the experimental groups. The new biomaterials have a great potential as a substitute in the treatment of large bone defects.

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Healing of Large Segmental Bone Defect after Implantation of Autogenous Cancellous Bone Graft in Comparison to Hydroxyapatite and 0.5% Collagen Scaffold Combined with Mesenchymal Stem Cells

Acta Veterinaria Brno ◽

10.2754/avb201079040607 ◽

2010 ◽

Vol 79 (4) ◽

pp. 607-612 ◽

Cited By ~ 5

Author(s):

Alois Nečas ◽

Pavel Proks ◽

Lucie Urbanová ◽

Robert Srnec ◽

Ladislav Stehlík ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Bone Graft ◽

Cancellous Bone ◽

Bone Defects ◽

Cancellous Bone Graft ◽

Collagen Group ◽

Significant Difference ◽

Large Bone ◽

Large Bone Defects

At present, attention is focused on research into possibilities of healing large bone defects by the method of mini-invasive osteosynthesis, using implantation of biomaterials and mesenchymal stem cells (MSCs). This study evaluates the healing of segmental femoral defects in miniature pigs based on the radiological determination of the callus: cortex ratio at 16 weeks after ostectomy. The size of the formed callus was significantly larger (p < 0.05) in animals after transplantation of an autogenous cancellous bone graft (group A, callus : cortex ratio of 1.77 ± 0.33) compared to animals after transplantation of cylindrical scaffold from hydroxyapatite and 0.5% collagen (group S, callus : cortex ratio of 1.08 ± 0.13), or in animals after transplantation of this scaffold seeded with MSCs (group S + MSCs, callus: cortex ratio of 1.15 ± 0.18). No significant difference was found in the size of callus between animals of group S and animals of group S + MSCs. Unlike a scaffold in the shape of the original bone column, a freely placed autogenous cancellous bone graft may allow the newly formed tissue to spread more to the periphery of the ostectomy defect. Implanted cylindrical scaffolds (with and without MSCs) support callus formation directly in the center of original bone column in segmental femoral ostectomy, and can be successfully used in the treatment of large bone defects.

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The use of bone-graft substitutes in large bone defects: Any specific needs?

Injury ◽

10.1016/j.injury.2011.06.011 ◽

2011 ◽

Vol 42 ◽

pp. S56-S63 ◽

Cited By ~ 236

Author(s):

G.M. Calori ◽

E. Mazza ◽

M. Colombo ◽

C. Ripamonti

Keyword(s):

Bone Graft ◽

Bone Defects ◽

Bone Graft Substitutes ◽

Large Bone ◽

Large Bone Defects

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Implantable electrical stimulation bioreactor with liquid crystal polymer based electrodes for enhanced bone regeneration at mandibular large defects in rabbit

10.1101/402719 ◽

2018 ◽

Author(s):

Chaebin Kim ◽

Hoon Joo Yang ◽

Tae Hyung Cho ◽

Beom Seok Lee ◽

Tae Mok Gwon ◽

...

Keyword(s):

Electrical Stimulation ◽

Liquid Crystal ◽

Bone Regeneration ◽

Bone Defects ◽

Control Group ◽

Sham Control ◽

Crystal Polymer ◽

Sham Control Group ◽

Large Bone ◽

Large Bone Defects

AbstractThe osseous regeneration of large bone defects is still a major clinical challenge in maxillofacial and orthopedic surgery. Our previous studies demonstrated that electrical stimulation (ES) with biphasic current pulse showed proliferative effects on bone cells and enhanced secretion of bone-forming growth factors. This study presents an implantable electrical stimulation bioreactor with electrodes based on liquid crystal polymer (LCP), which has excellent bone-binding property. The bioreactor was implanted into a critical sized bone defect and subjected to ES for one week, where bone regeneration was evaluated four weeks after surgery using micro-CT. The effect of ES via bioreactor was compared with a sham control group and positive control group that received recombinant human bone morphogenetic protein (rhBMP)-2 (20 μg). New bone volume per tissue volume (BV/TV) in the ES and rhBMP-2 groups increased to 171% (p< 0.001) and 210% (p < 0.001), respectively, compared to that in the sham control group. In the histological evaluation, there was no inflammation within bone defects and adjacent to LCP in all groups. This study showed that the ES bioreactor with LCP electrodes could enhance bone regeneration at large bone defects, where LCP can act as a mechanically resistant outer box without inflammation.

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Use of Adipose Derived Stem Cells to Treat Large Bone Defects. Addendum

10.21236/ada586568 ◽

2009 ◽

Author(s):

Barbara D. Boyan ◽

Robert E. Gulderg

Keyword(s):

Stem Cells ◽

Bone Defects ◽

Adipose Derived Stem Cells ◽

Large Bone ◽

Large Bone Defects

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Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02395-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Noboru Matsumura ◽

Kazuya Kaneda ◽

Satoshi Oki ◽

Hiroo Kimura ◽

Taku Suzuki ◽

...

Keyword(s):

Humeral Head ◽

Glenohumeral Joint ◽

Three Dimensional ◽

Clinical Results ◽

Bone Defects ◽

Symptom Duration ◽

Glenohumeral Instability ◽

Explanatory Variables ◽

Large Bone ◽

Large Bone Defects

Abstract Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

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Vascularization of Nanohydroxyapatite/Collagen/Poly(L-lactic acid) Composites by Implanting Intramuscularly In Vivo

International Journal of Polymer Science ◽

10.1155/2014/153453 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Hai Wang ◽

Xiao Chang ◽

Guixing Qiu ◽

Fuzhai Cui ◽

Xisheng Weng ◽

...

Keyword(s):

Lactic Acid ◽

Orthopaedic Surgery ◽

Bone Substitutes ◽

Bone Defects ◽

Large Defect ◽

Natural Bone ◽

Composition And Structure ◽

Large Bone ◽

Large Bone Defects

It still remains a major challenge to repair large bone defects in the orthopaedic surgery. In previous studies, a nanohydroxyapatite/collagen/poly(L-lactic acid) (nHAC/PLA) composite, similar to natural bone in both composition and structure, has been prepared. It could repair small sized bone defects, but they were restricted to repair a large defect due to the lack of oxygen and nutrition supply for cell survival without vascularization. The aim of the present study was to investigate whether nHAC/PLA composites could be vascularized in vivo. Composites were implanted intramuscularly in the groins of rabbits for 2, 6, or 10 weeks (n=5×3). After removing, the macroscopic results showed that there were lots of rich blood supply tissues embracing the composites, and the volumes of tissue were increasing as time goes on. In microscopic views, blood vessels and vascular sprouts could be observed, and microvessel density (MVD) of the composites trended to increase over time. It suggested that nHAC/PLA composites could be well vascularized by implanting in vivo. In the future, it would be possible to generate vascular pedicle bone substitutes with nHAC/PLA composites for grafting.

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