Acetabular Bone Grafting Research Articles

A Comparison of Autogenous Cortico-Cancellous Bone Graft Obtained from the Wing of the Ilium with an Acetabular Reamer to Autogenous Cancellous Bone Graft Obtained from the Proximal Humerus in Dogs

SummaryThe incorporation of autogenous cortico-cancellous bone graft (CCBG) harvested from the wing of ilium using a powered acetabular reamer and autogenous cancellous bone graft (CBG), harvested from the proximal humerus by curettage, were compared in four young adult mixed breed female dogs. Five milliliters of CCBG or CBG were placed in bilateral, stable, 3.0 cm proximal diaphyseal ulnar defects. Humeral donor sites, and subsequent assignment of graft types of ulnar recipient sites, were alternated between dogs. Craniocaudal and lateral view radiographs were obtained immediately (day 0) and on days 16 and 35 after the operation. Photodensitometric and bone graft area measurements were made from these radiographs and the specific radiographic characteristics of the bone grafts were described at each time interval. Each dog received a series of intravenous fluorochrome label injections on days 23, 28 and 33. The dogs were humanely euthanatized on day 35. The bone graft recipient sites were harvested, processed and the descriptive histological and histomorphometric parameters were evaluated.A statistically significant difference in photodensitometric measurements was not seen between the CCBG and CBG. However, there was a statistically significant increase in the graft area of the CCBG from day 0-16. Mineral apposition rate was significantly greater, (P = 0.005) for the CCBG (mean = 4.8) than for the CBG (mean = 3.7), suggesting that the CCBG appears to be in an earlier more osteogenic phase of incorporation than the CBG. There was a trend which suggested that the percentage of trabecular bone volume was greater (P = 0.11) for the CBG (mean = 43.0) than for the CCBG (mean = 32.0). Other significant differences were not found, with respect to the other morphometric parameters measured. The descriptive histology and subjective radiographic evaluation were the most effective ways of readily distinguishing between the two types of bone graft and they demonstrated that the CBG had incorporated more completely than the CCBG by day 35.Presented at the 30th Annual Meeting of the American College of Veterinary Surgeons, Chicago, Illinois 1995 and at the 23rd Annual Meeting of the Veterinary Orthopaedic Society, Telluride, Colorado 1996

Cementless Total Hip Arthroplasty With Autologous Bone Grafting for Hip Dysplasia

The fate of autologous femoral head bone grafts in acetabular roof reconstruction for severely dysplastic hips was investigated in 25 patients (25 cementless total hip arthroplasties). Twenty patients were women and 5 were men, whose average age was 55 years old; their average followup was 58 months. The average Harris Hip Rating improved from a preoperative value of 49 points to a postoperative value of 85 points. Radiographic measurements did not indicate any vertical or horizontal socket migration >2 mm. The grafted bone was incorporated by an average time of 7 months, and the acetabular sclerosis had disappeared in 23 hips by 9.4 months. One year after operation, the grafted bone was reduced in size significantly. Radionuclide uptake at the site of the bone graft remained high for as long as 18 months after the operation, then normalized. The autologous acetabular bone grafts were incorporated completely and remodeled 18 months after surgery.

Cemented Revision of Failed Total Hip Arthroplasty

A review of 107 total hip arthroplasties performed with acrylic cement in 89 patients at Columbia-Presbyterian Medical Center by 1 surgeon from 1971 to 1990 revealed a clinical survivorship of 97% at 5 years and 76% at 10 years. The average followup was 7.7 years. Analysis of radiographs revealed a 94% success rate at 5 years and 62% at 10 years. A transtrochanteric approach was used in 99% of procedures. The 13 definite failures (12.1%) included 8 rerevisions (7.5%) and 5 failures (4.6%) pending revision. Modified Merle d'Aubigné and Postel postoperative scores increased significantly from preoperative values (pain, 2.8-5.3 points; movement, 3.2-5.2 points; function, 2.6-5.4 points). Bone grafting was required in 33% of procedures and did not affect survivorship: 24% of procedures required acetabular bone grafts; 4% femoral bone grafts; and 5% acetabular and femoral grafts. In 46% of hips, removal of the original well-fixed femoral cement and plug was deliberately incomplete. Stems of standard length were used for these partially rechannelized femurs because the old distal cement column served as a plug for the canal. Old osseointegrated polymethylmethacrylate was left behind to bond with the new cement column. Cement fracture, complete demarcation, and young age were negatively correlated with survivorship.

Femoral head autograft in simultaneous primary and revision total hip arthroplasty

Bilateral total hip arthroplasty during one anesthetic procedure can be beneficial in properly selected patients. For patients who have a failed hip arthroplasty requiring revision and a contralateral arthritic hip requiring primary arthroplasty, bilateral surgery permits the resected femoral head from the primary procedure to be used as a fresh autogenous bone—graft during the revision procedure. Four patients underwent combined primary hip arthroplasty and contralateral revision hip arthroplasty during one anesthetic procedure. The femoral head obtained during the primary procedure was used as a structural acetabular bone—graft in three patients, and bone slurry was used to fill cavitary acetabular defects in one patient. A femoral neck autograft was used to reconstruct a calcar defect in one of the patients. After an average follow-up period of 27 months, all hips were functioning well with healed bone—grafts and stable prosthetic components.

Bipolar hip arthroplasty without acetabular bone—grafting for dysplastic osteoarthritisResults after 6–9 years

The authors report the clinical and radiographic results of 36 bipolar hip arthroplasties after performing excavation of the steep and shallow acetabulum without acetabular bone-grafting for dysplastic osteoarthritis. The procedures were carried out between 1981 and 1985. Survivorship analysis showed that 84.6 of the bipolar hip arthroplasties were retained for 8 years. Twenty-nine patients, which were followed for 6-9 years after surgery, were reviewed. Severity of acetabular dysplasia was classified according to the method of Crowe. Class 1 included 17 hips and class 2 included 12 hips. The average preoperative clinical score was 49 points. The average postoperative clinical hip score improved to 87 points after 6 years. Twenty-seven of the 29 hips assessed were classified as either excellent or good by Charnley's function score. Stress fracture, due to excessive acetabular excavation at the time of surgery, and femoral component loosening were major symptomatic complications. The cessation of radiographic evidence of migration of the bipolar socket was recognized in 25 of 29 procedures at 6 years after surgery (86.2%). Cineradiographic study demonstrated that the abduction motion under standing position for 20 of 24 hip joints functioned dominantly at the inner-bearing and metallic-stem interface.

Bipolar hip arthroplasty without acetabular bone—grafting for dysplastic osteoarthritis: Results after 6–9 years

The authors report the clinical and radiographic results of 36 bipolar hip arthroplasties after performing excavation of the steep and shallow acetabulum without acetabular bone—grafting for dysplastic osteoarthritis. The procedures were carried out between 1981 and 1985. Survivorship analysis showed that 84.6 of the bipolar hip arthroplasties were retained for 8 years. Twenty-nine patients, which were followed for 6–9 years after surgery, were reviewed. Severity of acetabular dysplasia was classified according to the method of Crowe. Class 1 included 17 hips and class 2 included 12 hips. The average preoperative clinical score was 49 points. The average postoperative clinical hip score improved to 87 points after 6 years. Twenty-seven of the 29 hips assessed were classified as either excellent or good by Charnley's function score. Stress fracture, due to excessive acetabular excavation at the time of surgery, and femoral component loosening were major symptomatic complications. The cessation of radiographic evidence of migration of the bipolar socket was recognized in 25 of 29 procedures at 6 years after surgery (86.2%). Cineradiographic study demonstrated that the abduction motion under standing position for 20 of 24 hip joints functioned dominantly at the inner-bearing and metallic—stem interface.

変形性股関節症に対するｂｉｐｏｌａｒ型人工骨頭置換術 臼蓋及び移植骨のＸ線学的変化

We performed bipolar hip arthroplasty combined with bone grafting acetabuloplasty on 26 hips since 1986 and reviewed them clinically and roentgenographically in this study.The average follow-up period was 4.5 years (range 3-6.3 years). Clinical results using JOA score were excellent in all cases with marked relief of pain; preoperative total average score of 52.7 points was improved to 85.8 points postoperatively. Outer head migration was frequently detected in cases which had insufficient post-operative coverage of the original acetabulum and a significant relationship was found between the post-operative CE angle by the original acetabulum and outer head migration (p<0.01), however, no relationship was found between post-operative CE angle involved with grafted bone and outer head migration. These results appeared to show that acetabular bone grafting did not prevent migration and outer head migration was stopped with the appearance of a sclerotic line in the acetabulum.These results suggest that special care should be paid to the operative indications of bipolar arthroplasty for osteoarthritis with acetabular dysplasia.

Bipolar Endoprosthesis with Acetabular Bone Graft in Dysplasia of the Hip: Report of eight cases

Bipolar Endoprosthesis with Acetabular Bone Graft in Dysplasia of the Hip: Report of eight cases

Bone-grafting for acetabular deficiency during primary and revision total hip arthroplasty: A radiographic and clinical analysis

The use of bone-graft to augment the deficient acetabulum in primary and revision total hip arthroplasty (THA) is controversial. To identify factors affecting cup loosening in patients who received a bone-graft during THA, two orthopaedic surgeons retrospectively examined sequential radiographs. The surgeons alos obtained independent computer measurements of hip center and cup abduction migration from preoperative, initial, and, latest postoperative radiographs. Variables studied included host factors, graft factors, and technique factors. All conclusions were based on Kaplan-Meier long-rank analysis to account for differing lengths of follow-up periods among the cases. The authors report a series of 74 consecutive cases with a minimum 24-month follow-up period (mean, 40 months). All grafts appeared to unite. The clinicians found 80% stable cups, 8% possibly loose cups, and 12% (n=9) definitely loose cups. In retrospect, technical errors were seen in six loose cups. Five revisions for loosening (6.7% of cases) were performed. Computer measurement found cup loosening in a higher percentage of cases than detected by the clinicians and did so an average of 18 months sooner. Acelabular cup loosening was associated with the Ameircan Academy of Orthopaedic surgeons type III defects, use of allograft versus autograft, and initial cup abduction of 50° or more. Kaplan-Meier survivorship analysis found 31% of cups radiographically loose and 15% revised at 5 years or more since surgery. Acetabular bone-grafting is technically demanding and should be employed when alternative reconstructions will not give a durable result.

Severe metallosis due to abnormal abrasion of the femoral head in a dual bearing hip prosthesis: A case report

The authors report on a patient with a case of severe metallosis due to an abnormal abrasion of the femoral head. A primary arthroplasty was performed using a dual bearing hip prosthesis with acetabular bone grafting by ceramic screws. At the time of the revision surgery the synovia was black, and an analysis using a scanning electron microscope and scanning electron microscope-electron probe micro-analyzer revealed numerous small particles of small alumina ceramic on the inner surface of the bearing insert of high-density polyethylene. These particles, which came from the broken ceramic screws due to proximal migration of the prosthesis, scraped the femoral head away. A line and area analysis of the black synovia revealed that the synovia contained metal particles of a cobalt-chromium alloy as well as a cobalt ion. The patient's serum showed elevated concentrations of cobalt, chromium, and molybdenum that dramatically reduced 2 months after the revision surgery.

臼蓋形成不全を伴う変形性股関節症に対して臼蓋縁に骨移植を併用したＤｕａｌ Ｂｅａｒｉｎｇ型人工骨頭置換術の成績と問題点

臼蓋形成不全を伴う変形性股関節症に対して臼蓋縁に骨移植を併用したＤｕａｌ Ｂｅａｒｉｎｇ型人工骨頭置換術の成績と問題点

TOTAL HIP ARTHROPLASTY FOR PROTRUSIO ACETABULI: A 3- TO 9-YEAR FOLLOW UP OF THE HEYWOOD TECHNIQUE

Thirty-five total joint arthroplasties (34 patients) were performed in patients who had protrusio acetabuli. Twenty-nine percent of the patients had acetabular protrusio of grade I, while 71% had grade II and grade III protrusio. The mean follow up was 4 years (range: 3 to 9). Cemented acetabular components were used in 11 hips; 24 hips received an uncemented porous coated acetabular component. The patient evaluations included preoperative and postoperative Harris Hip Ratings and standard radiographs. In all cases, the medial wall defect was reconstructed with the solid autogenous femoral head as described by Heywood. The mean preoperative Harris Hip Rating was 45 (range: 30 to 60 points), and the postoperative mean was 85 (range: 70 to 100 points). Radiographically, the preoperative protrusio measured a mean of 8.8 mm (range: 6 to 18 mm), and the mean postoperative placement of the femoral head was 10 mm lateral to Kohler's line (range: 6 to 13 mm). There were no acetabular component failures and no acetabular bone graft resorptions. All autogenous grafts were incorporated to the host radiographically by 1 year post-surgery. This study corroborates previous work which suggests that medial-placed bone grafting is not resorbed and consolidates with the host bone. We find this technique extremely useful in dealing with this technical problem.

Bone grafting for acetabular protrusion in hip arthroplasty: 27 cases of rheumatoid arthritis followed for 2–8 years

An acetabular bone graft with spongious bone chips was performed in 27 primary total hip arthroplasties in 23 patients with rheumatic disease. There were no major complications. After 5 (2-8) years, the grafts were well incorporated; after 1 year, remodeling had produced a normal cancellous bone structure. Clinical assessment showed overall good results.

ＲＡとＯＡに対するｂｉｐｏｌａｒ型人工骨頭置換術の経験

We have treated the hip joints with osteoarthrosis (OA) and reumatoid arthritis (RA) by bipolar arthroplasty (OMNIFIT UHR), adding the acetabular bone grafts in cases of severe bone defects. Migrations of implants were survayed roentgenographically. Of 17 coxarthroses, 4 hips were grafted bone using resected femoral head to the lateral side of the acetabulum, and of 16 hips with reumatoid arthritis, 8 hips were grafted the ilium or resected head to the acetabulum. In OA cases without bone graft, some outer heads of artificial joints have migrated both to the center and superior, and only superior migration was noted in RA cases. On the other hand, almost all outer heads of bone grafted cases have migrated from the result of collapse in the grafted bone. Sinking of stems was noticed slightly.In conclusion, it is necessary to graft solid bone and avoid full weight bearing of the hips for at least six months for the prevention of bone collapse.

Results of Cementless Revisions of Total Hip Arthroplasties Using the Harris???Galante Prosthesis

Sixty patients were treated with Harris-Galante prosthesis for failed, nonseptic, cemented total hip arthroplasties. The minimum follow-up period was 12 months, although 23 patients were followed for two or more years. Acetabular bone grafting was done in 86% and femoral bone grafting in 57% of the patients. The average postoperative hip score was 84 (range, 48-100). Seventy-one percent of the patients were rated good or excellent. Among those with a minimum two-year follow-up examination, 73% had good or excellent results. Ninety-six percent had no, slight, or only mild pain. None of the components has required revision. No pads have become loose or displaced and no sepsis has occurred. One femoral component has subsided, but the patient is asymptomatic. No socket has migrated. The results are excellent for this group of patients.

Coxarthrosis after congenital dysplasia. Treatment by total hip arthroplasty without acetabular bone-grafting.

Between 1970 and 1982, cemented total hip replacement without acetabular bone-grafting was performed on fifty-three patients (sixty-six hips) who had had severe congenital dysplasia and coxarthrosis. Of these patients, forty-eight (sixty-one hips) were followed for an average of 8.5 years (range, two to fourteen years). Two have required a revision procedure because of deep infection. No revisions have been performed for aseptic loosening of the prosthesis, but six hips have shown radiographic evidence of loosening. Inadequate medialization of the acetabular component increased the incidence of loosening substantially, but variations in the thickness of the cement, in the volume of cement used, and in the extent of acetabular coverage were not found to be associated with radiographic evidence of loosening. We concluded that the addition of a large, solid, superolateral bone graft above a cemented acetabular component does not decrease the likelihood of loosening and may increase it.

Principles and techniques of acetabular bone grafting for cementless total hip revision arthroplasty

Principles and techniques of acetabular bone grafting for cementless total hip revision arthroplasty

Assessment of Bone Grafts Used for Acetabular Augmentation in Total Hip Arthroplasty

Total hip arthroplasty was performed in 13 hips with acetabular bone grafts for secure component fixation. The incorporation and healing of acetabular bone grafts were investigated with the aid of roentgenograms, planar bone scans, and a newer scintigraphic technique, three-dimensional single photon emission computed tomography (SPECT). Conventional roentgenograms proved unreliable in evaluating bone graft reconstitution because of overlapping trabecular bone patterns of the graft and iliac wing. There was no evidence of graft failure or acetabular loosening. Bone grafts in the late follow-up group (four to seven years postoperation) exhibited normal radionuclide activity, whereas grafts less than one year postsurgery demonstrated patterns of increased activity. SPECT was helpful in producing an anatomic reconstruction of the acetabulum. The observation that bone grafts exhibited normal biological viability is crucial for ensuring secure acetabular component fixation on a long-term basis.

Total Hip Arthroplasty and Acetabular Bone Grafting for Unreduced Fracture-Dislocation of the Hip

Functional restoration after chronic persistent fracture-dislocation of the hip was achieved by total hip arthroplasty (THA) in two patients with history of severe multiple injuries. Acetabular deficiency was corrected by use of the femoral head as an autologous bone graft. A 24-year-old man and a 42-year-old woman were treated for persistent fracture-dislocation of the hip two years and one year, respectively, after the accidents. In both, total hip arthroplasty in combination with acetabular bone grafts, with the femoral head, produced satisfactory clinical results at follow-up periods of 59 and 55 months.

Lateral Acetabular Bone Graft in Total Hip Arthroplasty

A series of 20 total hip arthroplasties were performed on 17 patients with significant acetabular deficiencies. Autogeneic femoral head bone grafting was performed without internal fixation. There was one failure caused by inadequate support of the graft, and this operation was revised. All grafts united within six months of surgery. Long-term follow-up evaluation revealed no evidence of progressive radiolucency or graft resorption.