Histologic Analysis of Allograft Mixed With Hydroxyapatite-Tricalcium Phosphate Used in Revision Femoral Impaction Bone Grafting

Abstract

Failed total hip arthroplasty (THA) often is accompanied by loss of bone stock. In cases in which revision THA becomes necessary, adequate stabilization of the implant can be difficult because of the bone loss. Bone can be reconstructed by using tightly packed morselized cancellous bone graft in combination with a cemented stem. However, worldwide availability of human bone is limited, and risks such as infection and antigenicity are associated with the use of allogeneic bone. These risks have led to the development of synthetic bone graft extenders. The objective of impaction bone grafting is to achieve stability of an implant and subsequently allow the restoration of living bone stock. To reduce the amount of allograft consumed, a mixture of morselized allograft and hydroxyapatite-tricalcium phosphate was used for impaction grafting in a series of 15 patients. In 2 patients who required re-revision arthroplasty, the areas of impacted graft were analyzed histologically. The results showed a complex mixture of residual hydroxyapatite-tricalcium phosphate, necrotic bone (graft), viable bone, and fibrous tissue. Although several pre-clinical studies have described the expansion of allograft with synthetic materials, this article represents the first description of histologic findings in human femoral impaction grafting with a combination of allograft and hydroxyapatite-tricalcium phosphate.