Abstract
Antibiotic carrier particles of variable size might influence mechanic properties within impacted thermodisinfected and native cancellous bone different. Herafill®G containing calciumsulfate and calciumcarbonate provides high local concentrations of gentamicin being important for revision surgery in infected joint replacements. Native and thermodisinfected cancellous bone derived from 6 to 7 months old piglets was used for in vitro impaction bone grafting and supplemented each with Herafill®G granules of two different sizes. Micromovement of implants related to shear force was measured in 29 specimens distributed in 6 groups. Thermodisinfected cancellous bone revealed a significant higher shear force resistance than native bone with a mean difference of 423.8 mdeg/Nm (p < 0.001) ranging within 95% confidence interval from 181.5 to 666.0 mdeg/Nm. Adding small granules to thermodisinfected bone did not reduce shear force resistance significantly since adding large granules to native bone improved it by 344.0 mdeg/Nm (p < 0.003). Shear force resistance was found higher at the distal region of the implant compared to a proximal point of measurement throughout all specimens. Less impaction impulses were necessary for thermodisinfected bone. Thermodisinfected cancellous bone might achieve a higher degree of impaction compared with native bone resulting in increased resistance against shear force since impaction was found increased distally. Supplementation of thermodisinfected bone with small granules of Herafill®G might be considered for application of local antibiotics. Large granules appeared more beneficial for supplementation of native bone. Heterogeneity of bone graft and technical aspects of the impaction procedure have to be considered regarding the reproducibility of femoral impaction bone grafting.
Highlights
Femoral impaction bone grafting for restoration of bone stock in revision surgery of hip joint replacement appears beneficial for good long term results (Halliday et al 2003; Howie et al 2010; ten Have et al 2012; Wilson et al 2016) and bone transplantation seems useful for reconstruction of bone defects in endoprosthetic revisions at different joints (Rudert et al 2015; Windhager et al 2017)
Allogeneic bone is necessary to match the demand for bone graft since thermodisinfected and other processed cancellous bone derived from human femoral heads might be used alternatively to unprocessed native bone (Cornu et al 2003; Folsch et al 2018; Pruss et al 2003)
Measurements were performed on 29 bone specimens (Tables 1, 2) which are shown in the movement graph of all prosthesis-cement composites in relation to the corresponding bone (Fig. 8) since 7 specimens appeared prone to failure during implant testing
Summary
Femoral impaction bone grafting for restoration of bone stock in revision surgery of hip joint replacement appears beneficial for good long term results (Halliday et al 2003; Howie et al 2010; ten Have et al 2012; Wilson et al 2016) and bone transplantation seems useful for reconstruction of bone defects in endoprosthetic revisions at different joints (Rudert et al 2015; Windhager et al 2017). The reduction of height of processed cancellous bone correlated with improvement of mechanic properties (Fosse et al 2006a; Giesen et al 1999) including an increase of rotational stiffness (Ohashi et al 2009; Oakley and Kuiper 2006). Different impaction behavior and biomechanical properties of irradiated compared with native cancellous bone regarding the size of the particles were reported (Cornu et al 2009) since good clinical results
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