Allogeneic Bone Grafts Research Articles

Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting

IntroductionPatients with widened or misplaced tunnels may require bone grafting prior to revision anterior cruciate ligament (ACL) reconstruction. Utilising reamer-irrigator-aspirator (RIA) harvested bone from the femur showed promising filling rates. Nevertheless, the procedure has neither been validated in a larger population nor been assessed with regards to radiological and clinical outcome of the subsequently conducted revision ACL reconstruction. Therefore, the aim of this study was to evaluate tunnel filling rates, positioning of the revision tunnels and outcome parameters of such two-staged revision ACL reconstructions. Material and methodsA total of 15 consecutive patients were prospectively enrolled in this case series. CT scans were analysed before and after autologous RIA harvested bone grafting. Tunnel volumes and filling rates were calculated based on manual segmentation of axial CT scans. Revision ACL reconstruction was carried out after a mean interval of 6.2 months (±3.7) and positioning of the revision tunnels was assessed by plane radiographs. The mean follow-up was 19.8 months (±8.4) for objective evaluation and 37.1 months (±15.4) for patient reported outcomes. The clinical outcome was assessed by the quantification of the anterior tibial translation, the IKDC objective score, the Tegner activity scale and the Lysholm score. ResultsInitial CT scans revealed mean tunnel volumes of 3.8cm3 (±2.7) femoral and 6.1cm3 (±2.4) tibial. Filling rates of 76.1% (±12.4) femoral and 87.4% (±5.9) tibial were achieved. Postoperative radiographs revealed significantly improved tunnel positioning with anatomical placement in all but one case at the femur and in all cases at the tibia. At follow up, patients showed significantly improved anterior tibial translations with residual side-to-side differences of 1.7 mm (±0.8) and significantly improved IKDC objective scores. Furthermore, significantly higher values were achieved on the Tegner activity scale (5.3 ± 1.4 vs. 2.8 ± 0.5) and the Lysholm score (85.4 ± 7.9 vs. 62.5 ± 10.5) compared to the preoperative status. ConclusionAutologous RIA harvested bone grafting ensures sufficient bone stock consolidation allowing for anatomical tunnel placement of the subsequently conducted revision ACL reconstruction. The two-staged procedure reliably restores stability and provides satisfying subjective and objective outcomes. Thus, RIA harvested bone grafting is an eligible alternative to autologous iliac crest or allogenic bone grafting.

Experimental substantiation of osteotransplant application in traumatic vertebral defects

Objective. To analyze the features of bone tissue formation during plasty of vertebral body defect or fracture with an allogeneic bone graft in an experiment in vitro. Material and Methods. Models of the vertebral body defect (fracture of the cranioventral part with penetration into the nucleus pulposus) were created in an experiment on 20 mini-pigs of the same age. Plasty of traumatic defects was performed with allogeneic bone graft or autologous bone. CT, histological, and spectrometric studies of microscopic specimens were carried out at 14, 30, 90, and 180 day. Reparative osteogenesis, X-ray density, Ca and P content, and microhardness were studied. Results. After implantation of allogeneic bone graft, an organ-specific bone similar to the recipient’s bone in morphological structure, X-ray density, mineral composition and microhardness, was formed on the 90th day (P = 0.01). After transplantation of autobone, the regenerate formed by this day in the central part was in a phase of resorption and restructuring with lower indices of X-ray density, content of Ca and P, and microhardness (P = 0.01). Conclusion. Аfter plasty of vertebral body traumatic defects with allogeneic bone graft, the organ-specific bone tissue is formed at an earlier time and reliably exhibits greater mineralization and strength.

Using allogeneic cortical graft preserved in glycerin as spacer in the advancement of tibial tuberosity in 34 dogs

ABSTRACT: Cranial cruciate ligament is the main responsible for knee stability by preventing cranial tibial displacement regarding the femur. Deficiency in this ligament (CCLD) may cause subluxation of the tibia and dysfunction of the pelvic member due to overloading. Tibial osteotomies are among the more current surgical techniques for treating CCLD in dogs and they proportionate the dynamic stability by means of modifying bone geometry and the distribution of forces acting on the articulation. The objective of this work is to describe the use of the allogeneic cortical bone graft conserved in glycerin as a spacer on the tibial tuberosity advancement (TTA) for treating the CCLD. In order to do that, 34 dogs submitted to TTA surgery correction were evaluated, being 23 males (67.35%) and 11 females (32.35%). Surgical procedures happened from May 2011 to October 2015. Regarding the surgical procedure after osteotomy of the tibial tuberosity, a disk of allogeneic cortical disk, sawn wedge-hapsed, conserved in glycerin, proportions of 2x1mm was applied as spacer, enabling TTA. Advancements from 3 to 12 mm were executed, depending on the need of the patient. For animals with patella dislocation, trochleoplasty and TTA were executed in order to correct the deviation. The mean ± SD age of animals was 6.67±3.58 and weight was 15.16±12.97 kg. Mongrel dogs, Poodles and Yorkshire terriers were the most affected ones. From the 36 evaluated knees, 11 (30.56%) were associated with some traumatic process and in 25 (69.44%) there was no relation with previous trauma. From those wounds, 20 (55.56%) happened in the right limb and 16 (44.44%) in the left limb and two animals had CCLD bilaterally. Animals had continuous support, discreet drawer movement and negative tibial compression 15 days after surgery. At 30 days, 26 cases (72.22%) had firm support (FS); at 45 days, 24 cases (66 test at 7 and 67%) had FS and eight cases (22.22%) without claudication (WC). During subsequent radiographic evaluations the progressive incorporation of the graft and osteotomy union were observed. In this study, most of the diagnosed CCLD occurred in males diverging from results obtained by other authors that found greater frequency in females. Support without claudication it was observed in most of the cases of implants at 60 days. We concluded that the conserved allogeneic cortical bone graft was able to promote bone union in TTA of dogs with CCLD. None of the animals had signs of contamination, infection of the surgical wound or rejection related with the presence of the graft, demonstrated by the complete graft-bone incorporation observed early at 45 days in some animals. The glycerin was a good conservation medium for those fragments intended for grafting because, besides being of low cost, it kept bone fragments free of contamination, reducing antigenicity and preserving the functions of osteoinduction and osteoconduction. The possibility of molding the graft to the animal need is a characteristic favorable to executing the modified technique that could be molded according to the size of the animal, allowing perfect adaptation to the osteotomized local in different breeds. Intercurrences commonly observed in TTA with patellar dislocation, meniscal lesions, tibial crest fracture and displacement were not found in the animals of this study, probably due to the better distribution of forces between the pass screw in TT and the TTA plate confirming that it has good adaptation to the technique conferring to the modified TTA advantages regarding the conventional TTA.

The Role of Allograft Bone in Foot and Ankle Arthrodesis and High-Risk Fracture Management.

Allogenic bone graft has long been accepted as a standard of care in the surgical arthrodesis of the foot and ankle and treatment of certain high-risk, comminuted fracture types that have greater potential for delayed union or nonunion. It has been shown in multiple studies to be equivalent to autograft in regard to union rates without the morbidity associated with bone graft harvest. We present a retrospective study on the efficacy of an allogenic cancellous/periosteal cellular bone matrix with mesenchymal stem cells and angiogenic growth factors. The study includes a cohort of 41 procedures and 40 patients who underwent foot and ankle arthrodesis, fracture fixation, or a simultaneous combination of both. Radiographic consolidation of the fracture/fusion site was reviewed at regular intervals (first postoperative visit at 1 week and 4, 8, and 12 weeks and at regular intervals until healing was confirmed). Age, workmen's compensation insurance, diabetes, and nicotine use were evaluated as potential risk factors. Our retrospective study indicated that allograft bone has the potential to positively affect union rates in foot and ankle arthrodesis and certain high-risk fracture types that have potential for delayed union/nonunion. Levels of Evidence: Level IV.

Biological Compatibility Profile on Biomaterials for Bone Regeneration.

Large non-union bone fractures are a significant challenge in orthopedic surgery. Although auto- and allogeneic bone grafts are excellent for healing such lesions, there are potential complications with their use. Thus, material scientists are developing synthetic, biocompatible biomaterials to overcome these problems. In this study, we present a multidisciplinary platform for evaluating biomaterials for bone repair. We combined expertise from bone biology and immunology to develop a platform including in vitro osteoclast (OC) and osteoblast (OB) assays and in vivo mouse models of bone repair, immunogenicity, and allergenicity. We demonstrate how to perform the experiments, summarize the results, and report on biomaterial biocompatibility. In particular, we tested OB viability, differentiation, and mineralization and OC viability and differentiation in the context of β-tricalcium phosphate (β-TCP) disks. We also tested a β-TCP/Collagen (β-TCP/C) foam which is a commercially available material used clinically for bone repair in a critical-sized calvarial bone defect mouse model to determine the effects on the early phase of bone healing. In parallel experiments, we evaluated immune and allergic responses in mice. Our approach generates a biological compatibility profile of a bone biomaterial with a range of parameters necessary for predicting the biocompatibility of biomaterials used for bone healing and repair in patients.

Use of Recombinant Human Bone Morphogenetic Protein-2 at the C1-C2 Lateral Articulation without Posterior Structural Bone Graft in Posterior Atlantoaxial Fusion in Adult Patients

Posterior atlantoaxial fusion is an important armamentarium for neurosurgeons to treat several pathologies involving the craniovertebral junction. Although the potential advantages of recombinant human bone morphogenetic protein-2 (rhBMP-2) are well documented in the lumbar spine, its indication for C1-C2 fusion has not been well characterized. In our institution, we apply rhBMP-2 to the C1-C2 joint either alone or with hydroxyapatite, locally harvested autograft chips, and/or morselized allogenic bone graft for selected cases-without conventional posterior structural bone graft. We report the clinical outcomes of the surgical technique to elucidate its feasibility. We performed a single-center, retrospective review of data from 2008 to 2016 and identified 69 patients who had undergone posterior atlantoaxial fusion with rhBMP-2. The clinical records of these patients were reviewed, and the baseline characteristics, operative data, and postoperative complications were collected and statistically analyzed. The average age of the 69 patients was 60.8± 4.5 years, and 55.1% were women. With an average follow-up period of 21.1 ± 4.2 months, the C1-C2 fusion rate was 94.3% (65 of 69), and the average time to fusion was 11.4 ± 2.6 months (range, 5-23). The overall reoperation rate was 10.1% (7 of 69), with instrumentation failure in 7 patients (10.1%), adjacent segment disease in 2 (2.9%), and postoperative dysphagia and dyspnea in 2 patients (2.9%). No ectopic bone formation or soft tissue edema developed. Although retrospective and from a single center, our study has shown that rhBMP-2 usage at the C1-C2 joint without posterior structural bone grafting is a safe and reasonable surgical option.

Comparison of allogeneic and autogenous bone grafts for augmentation of alveolar ridge defects-A 12-month retrospective radiographic evaluation.

ObjectivesThe aim of this study was to compare three‐dimensional alterations following the use of autogenous versus allogeneic onlay grafts for augmentation at single tooth defects.Materials and methodsAlveolar bone width at specific implant sites were assessed using sagittal and cross‐sectional CBCT images prior grafting and at three subsequent time points. Twenty‐one patients received autogenous bone blocks harvested from the retromolar region and another 21 patients received freeze‐dried cancellous allogeneic bone blocks.ResultsThe vertical and horizontal dimensions did not significantly differ between autogenous and allogeneic bone grafts at any time point. In addition, there were no statistically significant differences in graft remodeling rates between autogenous (mean shrinkage rate after 12 months: 12.5% ± 7.8%) and allogeneic onlay grafts (mean shrinkage rate after 12 months: 14.4% ± 9.8%).ConclusionsFreeze‐dried cancellous allogeneic bone blocks showed equivalent volumetric shrinkage rates as autogenous bone blocks when used for treating circumscribed bone defects classified as Type‐II to Type‐IV according to the ITI‐treatment guide categories. Therefore, it is not necessary to over‐contour the alveolar ridge when using allogeneic blocks for treating single tooth defects, but to apply the same procedure as when using autogenous blocks.

Biomimetic matrices for rapidly forming mineralized bone tissue based on stem cell-mediated osteogenesis

Bone regeneration, following fracture, relies on autologous and allogenic bone grafts. However, majority of fracture population consists of older individuals with poor quality bone associated with loss and/or modification of matrix proteins critical for bone formation and mineralization. Allografts suffer from same limitations and carry the risk of delayed healing, infection, immune rejection and eventual fracture. In this work, we apply a synergistic biomimetic strategy to develop matrices that rapidly form bone tissue - a critical aspect of fracture healing of weight bearing bones. Collagen matrices, enhanced with two selected key matrix proteins, osteocalcin (OC) and/or osteopontin (OPN), increased the rate and quantity of synthesized bone matrix by increasing mesenchymal stem/stromal cell (MSC) proliferation, accelerating osteogenic differentiation, enhancing angiogenesis and showing a sustained bone formation response from MSC obtained from a variety of human tissue sources (marrow, fat and umbilical cord). In vivo assessment of OC/OPN mineralized scaffolds in a critical sized-defect rabbit long-bone model did not reveal any foreign body reaction while bone tissue was being formed. We demonstrate a new biomimetic strategy to rapidly form mineralized bone tissue and secure a sustained bone formation response by MSC from multiple sources, thus facilitating faster patient recovery and treatment of non-union fractures in aging and diseased population. Acellular biomimetic matrices elicit bone regeneration response from MSC, obtained from multiple tissue sources, and can be used in variety of scaffolds and made widely available.

Dual-functional 3D-printed composite scaffold for inhibiting bacterial infection and promoting bone regeneration in infected bone defect models

Infection is one of the pivotal causes of nonunion in large bone defect after trauma or tumor resection. Three-dimensional (3D) composite scaffold with multifunctional-therapeutic properties offer many advantages over allogenic or xenogenic bone grafting for the restoration of challenging infected bone defects. In the previous study, we demonstrated that quaternized chitosan (HACC)-grafted polylactide-co-glycolide (PLGA)/hydroxyapatite (HA) scaffold (PLGA/HA/HACC) via 3D-printing technique exhibited significantly improved antimicrobial and osteoconductive property in vitro, together with good biocompatibility in vivo. Hence, the present study further investigated whether such an innovative bone substitute could effectively inhibit the bacterial biofilm formation and promote bone regeneration in vivo. To evaluate the bone repairing effects of the 3D-printed scaffolds on infected cortical and cancellous bone defects scenarios, eighty female Sprague Dawley rats and thirty-six female New Zealand white rabbits were used to establish infected femoral shaft defect and condyle defect model, respectively. X-ray, micro-CT, microbiological and histopathological analyses were used to assess the anti-infection and bone repairing potential of the dual-functional porous scaffolds. We observed that HACC-grafted PLGA/HA scaffolds exhibited significantly enhanced anti-infection and bone regeneration capability in different infected bone defect models. In addition, the degradation rate of the scaffolds appeared to be closely related to the progress of infection, influencing the bone repairing potential of the scaffolds in infected bone defects models. In general, this investigation is of great significance as it demonstrates promising applications of the 3D-printed dual-functional PLGA/HA/HACC scaffold for repairing different types of bone defect under infection. Statement of SignificanceCurrently, it is clinically urgent to exploit bone substitutes with potential of bacterial inhibition and bone regeneration. However, bone scaffolds with relatively low risks of bacterial resistance and tissue toxicity used for combating infected bone defects remain to be developed. We have reported that quaternized chitosan (HACC)-grafted 3D-printed PLGA/HA composite scaffold had enhanced in vitro antimicrobial and osteoconductive property, and well cytocompatibility in our published study. This continuing study further confirmed that HACC-grafted PLGA/HA scaffolds exhibited significantly enhanced anti-infection and bone regeneration efficacy in both cortical bone defect in rat and cancellous bone defect in rabbit under infection. Meanwhile, we also found that the degradation rate of the scaffolds seemed to be closely related to the progress of infection, influencing the bone repairing potential of the scaffolds in infected bone defects models. In conclusion, this study provides significant opportunities to develop a 3D-printed bone scaffold with dual functions used for infected bone defects in future plastic and orthopaedic surgery.

Growth Dynamic of Allogeneic and Autogenous Bone Grafts in a Vertical Model.

Several techniques have been proposed for vertical bone regeneration, and many of them use bone autogenous and allogeneic grafts. The purpose of this study was to compare demineralised freeze-dried bone allografts (DFDBA), fresh-frozen (FF) allografts, autogenous bone grafts to find differences between volumetric and histological quantity of bone formation and vertical bone growth dynamic. A vertical tissue regeneration bone model was performed in rabbit calvarias under general anaesthesia. Four hollow cylinders of pure titanium were screwed onto external cortical bone calvarias in eight rabbits. Each one of the cylinders was randomly filled with one intervention: DFDBA, FF, autogenous bone, or left to be filled with blood clot (BC) as control. Allogeneic grafts were obtained from a ninth animal following international standardised protocols for the harvesting, processing, and cryopreservation of allografts. Autogenous graft was obtained from the host femur scraping before adapting hollow cylinders. Animals were euthanized at 13 weeks. Vertical volume was calculated after probe device measurements of the new formed tissue inside the cylinders and after titanium cylinders were removed. Histomorphometry and fluorochrome staining were used to analyse quantity and dynamic of bone formation, respectively. Results showed that DFDBA and fresh-frozen bone improved the velocity and the quantity of bone deposition in distant portions of the basal plane of grafting. Remaining material in allograft groups was more intense than in autogenous group. Both allografts can be indicated as reliable alternatives for volume gain and vertical bone augmentation.

Peri-Implant Bone Loss at Implants Placed in Preserved Alveolar Bone Versus Implants Placed in Native Bone: A Retrospective Radiographic Study.

Objectives:The aim of our study was to compare peri-implant bone loss at implants placed in alveolar sockets filled with a particulate allogenous bone graft (DFDBA 300-500 µm) and platelet concentrates versus at implants placed in the native bone.Materials and Methods:A retrospective clinical study was performed. A total of 84 patients were included with 247 implants for the restoration of mono and pluri-radicular teeth: 169 implants in native bone and 78 in socket-grafted bone. The peri-implant bone loss was measured by 2 independent operators at 6 and 12 months.Results:The overall mesial and distal peri-implant bone losses were 0.9 ± 0.7 mm and 0.9 ± 0.8 mm at 6 months, respectively, and 1 ± 0.65 mm and 1.2 ± 0.9 mm at 12 months, respectively. In the tested group, the bone loss was 0.8 ± 0.8 mm at 6 months and 1.2 ± 0.9 mm at 12 months. In the control group, the bone loss was 1.0 ± 0.7 mm at 6 months and 0.95 ± 0.6 mm at 12 months. There were no statistically significant differences in bone loss between the two groups. Taking both groups together, there were no statistically significant difference in bone loss between patients with or without histories of periodontitis, but there was a statistically significant difference in bone loss between the mandible and maxilla as well as between unitary and total edentations and between partially and total edentulous patients.Conclusion:At 6 and 12 months, the peri-implant bone loss in sockets preserved with DFDBA and platelet concentrates was similar to the peri-implant bone loss in native bone.

Reconstruction of atrophic maxilla with the use of allogenic bone graft and platelet concentrate – clinical case report

Introduction: The use of allogenic bone has the advantage of not producing donor area in the patient, which can decrease the morbidity. However, there is an important vascularization demand for this type of graft, which can be increased with the use of platelet concentrate. Objective: To report a case of atrophic maxilla reconstruction with particle allogenic bone associated with Platelet Rich Fibrin (PRF). Case report: A female patient, who presented a maxilla with a reduced alveolar ridge and pneumatization of the maxillary sinuses, underwent surgery to lift the maxillary sinuses and reconstruct thealveolar ridge, with macro and micro particulate allogenic bone associated with fluid/injectable PRF (i-PRF), and total covering of the graft with PRF membranes, for better accommodation and graft protection. The graft was osseointegrated and able to receive the implants. Conclusion: The technique was effective, presenting several advantages in relation to reconstruction with autologous bone, such as shorter surgical time, amount of material for the graft, and less surgical trauma.

Efficacy of vancomycin impregnated deep freeze irradiated allogenic bone graft in osteoreconstructive surgery

Aim of study was to use the allogenic bone graft with or without vancimpregnation in osteoreconstrutive surgery and compare the results with respect to: • Efficacy and safety in prevention of graft related and surgical site infection. • Effect on bone healing and osteointegration. Materials & Methods: In our study a total of 30 patients who required allogenic bone grafting for varied indications and gave informed consent for participation in the study were included. Patients with active osteoarticular infection at the proposed surgical site and with any medical contraindication to the use of vancomycin were excluded from the study. Broadly three indications for which allogenic bone graft was used included fractures, benign osteolytic lesions and miscellaneous indications which included allograft use for lumbar spinal fusion and for augmenting acetabular reconstruction. Observation & Result Infection: An overall infection rate of 3.3% (1 out of 30 cases) was found in this study which is much lower than what is mentioned in the literature as infection rates ranging from 4-12% have been reported by different workers Osteointegration: The overall success rate in terms of adequate osteointegration in our study was 83.33% (5 failure cases out of 30) with 12 cases (80%) out of 15 in study group and 13 cases (86.7%) out of 15 achieving adequate osteointegration and there was no significant difference (p value=1) between the two groups. Bone Healing: Fractures: In cases of fractures a good overall union rate of 88.8% was obtained with 16 out of 18 patients achieving adequate union. The two failure cases brought down the union rate to about 77.7% in the study group as compared to 100% union rate in the control group but this difference was not statistically significant with p value of 0.384 Thus vancomycin impregnation was not found to affect fracture union in our study. Benign bone lesion: A total of eight patients (3 each of SBC and GCT and 2 of ABC) were included. After random allocation five patients (2 each of SBC and GCT and 1 of ABC) came under the study group and three patients (1 patient each of SBC, GCT and ABC) under control group. The mean age of patients in the study group and control groups was 25.2 years and 34.1 years respectively and thus were comparable. There was no significant difference in terms of lesion healing between the two groups (p value= 0.684) as all the eight patients (100%) showed adequate healing as defined by Neer’s classification [1].

Treatment of a bilaterally severely resorbed posterior mandible due to early tooth loss by Guided Bone Regeneration using customized allogeneic bone blocks: A case report with 24 months follow‐up data

The use of allogeneic bone grafts for alveolar ridge reconstruction has become an often-discussed alternative to augmentation procedures using autografts. Nevertheless, there still is a lack of literature concerning long-time experiences of allografts for alveolar ridge reconstruction. Especially the results of the use of allogeneic bone blocks for mandible reconstructions need to be further investigated. In this case report, we present the use of customized allogenic bone blocks in Guided Bone Regeneration (GBR) procedures for severely deficient mandibulary bones, the implantation after a healing period of 5 month and the 24-month follow-up data. Customized allogeneic bone blocks seem to be a successful alternative to augmentations with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges, showing highest volume stability and no signs of bone resorption after implant loading. The application of customized allogeneic bone blocks has shown to be a successful augmentation technique even compared with with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges demonstrating no compromises regarding clinical outcome, functionality and esthetics.

Proximal humerus internal locking system combined with allogeneic femoral head bone graft for osteoporotic proximal humeral fractures in the elderly

Objective To evaluate the efficacy of proximal humerus internal locking system (PHILOS) combined with allogeneic femoral head bone graft for the treatment of osteoporotic proximal humerus fractures in the elderly patients. Methods A total of 36 osteoporotic proximal humerus fractures were analyzed retrospectively which had been treated at Department of Orthopaedics, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from April 2015 to April 2017. They involved 14 men and 22 women, aged from 60 to 78 years(average, 67 years). By the Neer classification, 20 cases were two-part fractures, 11 three-part fractures and 5 four-part fractures. They were all treated by PHILOS plating combined with allogeneic femoral head bone grafting. The outcomes were assessed using Neer evaluation system for shoulder function. Results All the 36 cases were followed up for 3 to 18 months (average, 12 months). All the incisions healed postoperatively by the first intention, with no postoperative infection, nonunion, humeral head varus, screw cut-out, humeral head necrosis, or loosening of implants. Clinical healing of the fractures was achieved after 8 to 24 weeks (average, 12 weeks). According to the Neer evaluation, shoulder function was excellent in 18, good in 15 and poor in 3 cases. Conclusion In the treatment of osteoporotic proximal humerus fractures in the elderly, combination of PHILOS plating and allogeneic femoral head bone grafting can effectively prevent such postoperative complications as humeral head varus, screw cut-out and loosening of implants. Key words: Humerus fractures, proximal; Bone plate; Osteoporosis; Bone graft

PC332: Clinical and histological results of allogeneic cellular bone graft with titanium‐reinforced nonresorbable membrane for ridge augmentation: a case report

PC332: Clinical and histological results of allogeneic cellular bone graft with titanium‐reinforced nonresorbable membrane for ridge augmentation: a case report

Efficacy of Allogenic Bone Graft Per Se and when Augmented with Various Adjuvants in Fracture Healing

Efficacy of Allogenic Bone Graft Per Se and when Augmented with Various Adjuvants in Fracture Healing

Acetabular revision using a Kerboull-type reinforcement device through direct anterior approach.

The direct anterior approach has gained popularity in total hip arthroplasty (THA) over the past decade. However, there are few reports that describe the use of this approach for cases of complex revision. The purpose of this study was to report the surgical procedure and early clinical results of acetabular revision in the presence of bone defects using a Kerboull-type reinforcement device through the direct anterior approach. Eleven patients who had undergone acetabular reconstruction using a Kerboull-type reinforcement device for aseptic or septic loosening bone defects were enrolled. All procedures were performed using the direct anterior approach on a standard operating table. The mean age was 71.8 years, the mean period from initial surgery to revision THA was 14.5 years, and the mean follow-up period was 19.8 months. The Kerboull-type acetabular reinforcement device with cemented cup combined with allogenic femoral head bone grafts was used in all hips. The mean operative time and intraoperative blood loss were 148 min and 743 g, respectively. None of the patients required allogeneic blood transfusion. One patient required revision surgery 11 months postoperatively because of device displacement. No other major or minor orthopedic complications were observed. The direct anterior approach allows for less invasive acetabular reconstruction using a Kerboull-type reinforcement device.

Adolescent idiopathic scoliosis correction by instrumented vertebral arthrodesis with autologous bone graft from local harvesting without bone substitute use: results with mean 3year follow-up.

Bone substitutes' advantage is enhancing arthrodesis biologic support without further autologous bone graft harvested from other skeleton sites, as from posterior iliac crests; however, in our experience, bone substitutes' integration is often incomplete. From 2012 to 2017, we operated 108 patients by posterior instrumented vertebral arthrodesis in adolescent idiopathic scoliosis (AIS) correction, mean main curve 80° Cobb, and mean age 12years and 6months, with all pedicle screws instrumentation in main curve/curves area and hooks at upper tip of implant; bone graft has been harvested only at vertebral level, without bone substitutes or autologous graft from other patient sites or allogenic bone graft. We matched this group with 98 patients previously operated in which we used calcium triphosphate. At 3year mean follow-up, all patients in group treated with autologous bone graft only have complete and stable arthrodesis without loss of correction (mean curve 27° Cobb) or instrumentation failure. At 6year mean follow-up in the group treated with autologous bone graft augmented by calcium triphosphate, 96 patients have stable arthrodesis without loss of correction (mean curve 24°), 1 case has implant break, and 1 case has 8° Cobb loss of correction. Bone substitutes are a further cost in arthrodesis surgery and suboptimal integration leaves foreign bodies on vertebras. Our experience shows that all pedicle screw instrumentation and bracing after surgery obtain stable correction showing in time a solid arthrodesis with autologous bone only, harvested at local site, without bone substitutes or further bone graft.

An infantile alantoaxial dislocation with patent foramen ovale managed with titanium cabling and allogenic bone grafts.

Atlantoaxial dislocation is a disorder that is characterized with loss of stability of the atlas and axis (C1-C2) with consequential loss of usual articulation. Although this condition is very common, no one has reported a case as young as our patients. We present a 7-month infant with bilateral paralysis of the lower limbs for four (4) months with no history of trauma. Computer tomographic (CT-scan) imaging revealed alantoaxial dislocation with severe cervical spinal cord compression. The odontoid process is displaced outwardly with no bone destruction. Doppler echocardiogram done revealed patent foramen ovale. Thorough physical examination as well as radiological evaluation revealed no feather malformations. Electrophysio - logical studies reveal normal compound muscle action potentials (CMAP) and sensory nerve action potentials (SNAPs) in all the limbs. Electromyography (EMG) also revealed normal nerves in the limbs and the trunk. We attained a stable fusion and anatomical reduction using a posterior titanium wire and an iliac bone graft harvested from his mother. This is the youngest patient reported in literature. Infantile alantoaxial dislocation should be managed at early stage to prevent long-term neurologic disorders.