Abstract
Purpose:Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants.Methods:In each of twelve dogs, we implanted two unloaded cylindrical (10 mm x 6 mm) titanium implants into the distal femur. The implants were surrounded by a 2.5-mm gap into which morselized allograft bone with or without addition of fragmented autologous periosteum was impacted. After four weeks, the animals were euthanized and the implants were evaluated by histomorphometric analysis and mechanical push-out test.Results:Although less new bone was found on the implant surface and increased volume of fibrous tissue was present in the gap around the implant, no difference was found between treatment groups regarding the mechanical parameters. Increased new bone formation was observed in the immediate vicinity of the periosteum fragments within the bone graft.Conclusion:The method for periosteal augmentation used in this study did not alter the mechanical fixation although osseointegration was impaired. The observed activity of new bone formation at the boundary of the periosteum fragments may indicate maintained bone stimulating properties of the transplanted cambium layer. Augmenting the bone graft by smaller fragments of periosteum, isolated cambium layer tissue or cultured periosteal cells could be studied in the future.
Highlights
Due to insufficient bone stock, extensive bone grafting is often required in revision of a failed arthroplasty
Autograft bone is often regarded as the gold standard of bone grafts, but for the large quantities often needed in revision joint arthroplasty, this is not a realistic option
Histomorphometry Compared to the untreated allograft controls, the periosteum-augmented implants had an 18% reduction in ongrowth of new-bone (Table 1a) while no difference was observed in new bone formation in the gap around the implant
Summary
Due to insufficient bone stock, extensive bone grafting is often required in revision of a failed arthroplasty. It has been shown that the incorporation of bone graft into the host bone is not always complete [4, 5] This may be a contributing reason for the higher failure rates and poorer functional outcome among patients following revision surgery [6]. Autograft bone is often regarded as the gold standard of bone grafts, but for the large quantities often needed in revision joint arthroplasty, this is not a realistic option. It has been proposed, that the difference in osseointegration could be due to the difference in the cellular
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