Revision Surgery in High Grade Acetabular Defects with Thermodisinfected Allografts

Abstract

Due to new medical knowledge and legal restrictions, it is increasingly difficult to run a traditional allogenic bone bank so that alternative bone substitutes and methods of processing are being sought worldwide. In a prospective clinical study, the biological efficacy of thermodisinfected and then cryopreserved allogenic bank bone was investigated in 19 acetabular revisions in 18 patients. Simultaneously a newly developed titanium reconstruction ring was used. Any revision was regarded as an end point and the follow-up with radiological and clinical results were recorded. The mean follow-up period was 8.1 (7.9 - 9.8) years. The patients were 73.5 years old (46 - 91) at the time of the revision surgery. One case had a septic course necessitating revision surgery. The other cases showed increasing homogeneity compared to the opposite side and gradual adaptation to the radiological structures found there beforehand. Screw breakage was observed in 3 cases but no implant failure, migration tendency or change in the position of the reconstruction ring or PE-cup. Despite the low case numbers and different baseline situations, it can be concluded that thermodisinfected cancellous bone chips enable similarly good acetabular reconstruction as the routinely tried and tested cryoconserved, non-processed bone bank allograft, which is becoming increasingly difficult to obtain because of altered guidelines and legislation. The newly developed reconstruction ring has proven itself because of the improved range of sizes and the possibility of adjustment to the anatomical circumstances together with its outstanding material characteristics in clinical use.