Fresh-frozen Femoral Head Allograft Research Articles

Arthroscopic-Assisted Reduction of Depressed Lateral Tibial Plateau Fracture Using Precision Drill Guide and Fresh-Frozen Femoral Head Allograft

In the patient with osteoporosis, tibial plateau fractures can occur after high-energy trauma or low-energy trauma. Arthrosis will rapidly progress if the depressed articular surface is left untreated. Therefore, the depressed articular surface should be treated by anatomical reduction. This Technical Note describes an arthroscopic-assisted reduction depressed lateral tibial plateau fracture using a precision drill guide and fresh-frozen femoral head allograft.

Biologic Augmentation of Tibiotalocalcaneal Arthrodesis With Allogeneic Bone Block Is Associated With High Rates of Fusion.

The orthopaedic conditions and systemic comorbidities that occur in patients who require bone block tibiotalocalcaneal (TTC) arthrodesis have made this procedure associated with a higher-than-normal risk of nonunion, graft collapse, hardware failure, and amputation. Here, we present a novel approach to bone block TTC arthrodesis using adjunctive osteoinductive agents and a prolonged course of protected weightbearing to assess if we could improve on historical outcomes. We also evaluated the efficacy of a vascularized medial femoral condyle (MFC) free flap to augment TTC arthrodesis. Fourteen adult patients underwent bone block TTC arthrodesis biologically augmented with fresh-frozen femoral head allograft, bone marrow aspirate concentrate, and demineralized bone matrix cortical fibers. Three patients with soft tissue defects underwent vascularized reconstruction with an MFC free flap. Radiographic union, the Foot Function Index (FFI), and PROMIS pain interference (PI), and physical function (PF) scores were assessed at follow-up. TTC fusion was documented on plain radiograph in 13 of 14 patients (92.9%) and CT in 10 of 11 patients (90.9%). Mean time to fusion was 183.2 ± 83.2 days. One patient (7.1%) experienced nonunion and persistent infection requiring amputation. Patients who underwent vascularized bone grafting had significantly shorter time to fusion (112.3 ± 31.7 days vs 204.4 ± 82.7 days, P = .05). Patient-reported outcomes revealed mild to moderate pain and dysfunction after 1 year (mean FFI = 41.0% ± 23.1%, PROMIS PI = 58.3 ± 1.8, PROMIS PF = 39.0 ± 2.2). In this relatively small series, the biologic augmentation of bone block TTC arthrodesis with osteoinductive agents and protective weightbearing resulted in excellent rates of fusion, modest pain, and preserved function of the lower extremity in almost all those treated. Osseous healing appears to be enhanced and accelerated with application of an MFC flap. We believe that this approach offers a viable salvage option for these challenging clinical problems. Level IV, case series.

Biologic Augmentation of Tibiotalocalcaneal Arthrodesis with Autologous Bone Block is Associated with High Rates of Fusion

Category:Ankle; HindfootIntroduction/Purpose:Tibiotalocalcaneal (TTC) arthrodesis is an established salvage procedure for severe deformities of the hindfoot. Despite its prevalence, end-stage pathology, systemic comorbidities, and the physical demands of surgery often precipitate unsuccessful outcomes, with nonunion rates as high as 85% in medically complex patients. Given the considerable morbidity associated with TTC arthrodesis, there has been recent interest in maximizing the physiologic potential of fusion by means of surgical technique, osteoinductive and osteoconductive biological agents, and vascularized bone flaps. Here, we present a novel approach to TTC arthrodesis using femoral head allograft bone block, bone marrow aspirate, and demineralized bone matrix (DBM) in the absence of tourniquet. Additionally, we explore the role of the medial femoral condyle (MFC) free flap as a reconstructive adjunct to arthrodesis.Methods:The sample consisted of 14 patients presenting to a tertiary care facility for reconstructive limb salvage. TTC arthrodesis was performed without tourniquet and biologically augmented with fresh-frozen femoral head allograft, pelvic bone marrow aspirate, and DBM. Three patients with severe soft tissue defects also underwent vascularized osseous reconstruction with MFC free flap. Recovery protocol included three months of prolonged non-weightbearing mechanical stabilization followed by conversion to weightbearing AFO boot for one year. Post-operative plain radiographs and computed tomography (CT) scans were assessed for fusion at regular follow-up. After fusion, participants completed a survey on patient-reported outcomes, which included the modified Foot Function Index (FFI) and Patient-Reported Outcomes Measurement Information System (PROMIS) scales for pain and physical function.Results:Successful TTC fusion was documented on plain radiograph in 13 patients (92.9%) and confirmed via CT in 10 patients (90.9%). The mean time-to-fusion was 183.2 +- 83.2 days. One patient (7.1%) failed to achieve fusion and underwent amputation secondary to infectious wound complications. Patients who underwent vascularized bone grafting had more robust healing and significantly shorter time-to-fusion (112.3 +- 31.7 days vs. 204.4 +- 82.7 days, p = 0.05). The mean patient-reported FFI score was found to be 40.96% +- 23.08%, indicating mild-to-moderate impairment in foot function. Similarly, PROMIS data revealed that patients who underwent TTC arthrodesis had a pain T-score of 58.34 (z = 0.83) and a physical function T-score of 39.00 (z = - 1.10), corresponding to mild pain and moderate impairment, respectively.Conclusion:We sought to biologically optimize the osteoinductive and osteoconductive potential of TTC arthrodesis using femoral head allograft bone block, bone marrow aspirate, and DBM in the absence of tourniquet. This approach resulted in excellent rates of fusion with minimal pain and preserved function of the lower extremity. Osseous healing was significantly enhanced by MFC flap in patients with soft tissue defects. We, therefore, recommend biologic augmentation of TTC arthrodesis as a viable salvage option for patients facing amputation or other undesirable outcomes.

Wrist Arthrodesis With Femoral Head Structural Allograft After Failed Total Wrist Arthroplasty.

The failed total wrist arthroplasty represents a challenging reconstructive problem for the upper extremity surgeon. Bone loss, poor bone quality, and soft tissue defects all present technical challenges when considering revision procedures. Our purpose is to describe a technique for wrist arthrodesis after failed total wrist arthroplasty utilizing fresh-frozen femoral head allograft and dorsal plate fixation. We describe a simple method of allograft preparation for this procedure, as graft preparation and implantation can be time consuming and technically challenging.

Femoral Head Allograft for First Metatarsal Phalangeal Joint Fusion Using a Reamer Technique to Limit Graft Length

The use of interpositional bone grafting for arthrodesis of the first metatarsophalangeal joint can be a technically challenging procedure. A fresh-frozen femoral head allograft can provide an appropriate graft for lengthening and ultimate fusion. It has been well-documented in published studies that larger grafts at this site increase the risk of complications. When the joint is resected in a “square” fashion, length is actually lost from the first metatarsal head. We present a technique using a reamer applied to 1 side of the graft and the first metatarsal head in a “cup-and-cone” fashion, thereby limiting the total length of the actual graft size. This technique allows for easy positioning and lengthening, increasing the chance of graft incorporation at the fusion sites.

Les allogreffes de têtes fémorales congelées intercorporéales vertébrales permettent un taux de fusion élevé sans enfoncement de la greffe

Summary Background Circumferential lumbar spinal fusion is widely used to increase fusion rate, but little data is available using fresh-frozen femoral head allograft (FFFHA) as a structural interbody graft alternative. Hypothesis Circumferential lumbar arthrodesis using FFFHA as interbody graft material could be an alternative to achieve interbody fusion without graft subsidence. Methods A retrospective review of 47 patients (56 levels) treated with lumbar circumferential fusion using FFFHA as interbody material. Consolidation was independently assessed by the two authors using a 3-type scale; interbody bone graft subsidence was also evaluated. Results Forty-four of the 47 patients (93.6%), and 53 of the 56 levels (94.6%) obtained consolidation, without differences between smokers and nonsmokers. Three levels (in three patients) did not fuse; one of them (2.1%) required revision. No patient presented graft dislodgment, signs of infection or graft subsidence at the last follow-up. Discussion FFFHA use as lumbar interbody graft in circumferential arthrodesis exhibited a 94% fusion rate, without graft subsidence. FFFHA may be considered a valid alternative to achieve interbody fusion. Level of evidence Level IV. Retrospective study.

Fresh-frozen femoral head allograft as lumbar interbody graft material allows high fusion rate without subsidence

Circumferential lumbar spinal fusion is widely used to increase fusion rate, but little data is available using fresh-frozen femoral head allograft (FFFHA) as a structural interbody graft alternative. Circumferential lumbar arthrodesis using FFFHA as interbody graft material could be an alternative to achieve interbody fusion without graft subsidence. A retrospective review of 47 patients (56 levels) treated with lumbar circumferential fusion using FFFHA as interbody material. Consolidation was independently assessed by the two authors using a 3-type scale; interbody bone graft subsidence was also evaluated. Forty-four of the 47 patients (93.6%), and 53 of the 56 levels (94.6%) obtained consolidation, without differences between smokers and nonsmokers. Three levels (in three patients) did not fuse; one of them (2.1%) required revision. No patient presented graft dislodgment, signs of infection or graft subsidence at the last follow-up. FFFHA use as lumbar interbody graft in circumferential arthrodesis exhibited a 94% fusion rate, without graft subsidence. FFFHA may be considered a valid alternative to achieve interbody fusion. Level IV. Retrospective study.

Subtalar Distraction Arthrodesis Using Fresh-Frozen Allogeneic Femoral Head Augmented With Local Autograft

Tricortical autograft has been commonly used in subtalar distraction arthrodesis (SDA) for severe calcaneal malunion. Structural allograft enriched with orthobiological agents is an alternative. This study was performed to evaluate the results of SDA using fresh-frozen allogeneic femoral head without the addition of orthobiological agents. We retrospectively reviewed 15 consecutive SDA procedures (13 patients) with allogeneic femoral head augmented with local autograft for the treatment of severe calcaneal malunion. Clinical outcome was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) pain score, Short Form-12 (SF-12), range of motion (ROM) of the ankle joint, and patient satisfaction rate. Radiographic assessment included the talar declination angle (TDA), calcaneal inclination angle (CIA), lateral talocalcaneal angle (LTCA), heel height, calcaneal length, and union time. At a median follow-up of 36.0 months (range, 24-47 months), all 15 feet (100%) achieved union, at a median of 13.0 weeks (range, 12-18 weeks). The AOFAS score and VAS pain score improved significantly, with a satisfaction rate of 93.3%. The TDA, CIA, LTCA, and heel height improved significantly. The median increase in heel height was 8.6 mm (range, 1.9-20.1 mm). There was a significant reduction in calcaneal length. Complications included 1 varus malalignment, 1 complex regional pain syndrome, 1 hardware irritation, and 1 sural neuralgia. This study found that SDA using fresh-frozen femoral head allograft without an orthobiological agent was cost-effective and may have outcomes comparable to those using autograft or allograft enriched with orthobiological agents.

Circumferential thoracolumbar corrective fusion with an anterior interbody fresh-frozen femoral head allograft for osteoporotic lower acute kyphosis: a case report

IntroductionLower acute kyphosis (LAK) is a postural deformity caused by severe osteoporotic vertebral collapse at the thoracolumbar junction. Corrective surgery is indicated for severe cases, but no case report using a fresh-frozen femoral head allograft was found in the English literature.Case presentationA 69-year-old Japanese woman with severe LAK with osteoporotic vertebral fractures from T11 to L2 complained of severe back pain and difficulty in walking. The rigid kyphosis measured 74° from T10 to L3. The patient underwent an anterior release and interbody fusion using a fresh-frozen femoral head allograft (T11-L3) and a posterior instrumented fusion (T10-L3). Postoperatively, kyphosis was corrected to 28°, and the patient's symptoms were alleviated. The allograft bone was fully incorporated 1 year postoperatively. A new vertebral fracture at T10 occurred after 2 years, resulting in a slight loss of correction. A kyphosis angle of 35° at 2 years was maintained at 12 years (age, 81 years). She remained free of back pain and able to walk without a cane over the 12-year follow-up.ConclusionFor treatment of severe osteoporotic LAK, anterior reconstruction is essential to obtain good spinal alignment and prevent recurrence. A fresh-frozen femoral head allograft, in combination with rigid posterior instrumented fixation, fulfills this function.

Strain imparted during impaction grafting may contribute to bony incorporation

In order to investigate the osteoinductive properties of allograft used in impaction grafting and the effect of strain during impaction on these properties, we designed an in vitro experiment to measure strain-related release of bone morphogenetic protein-7 (BMP-7) from fresh-frozen femoral head allograft. A total of 40 10 mm cubes of cancellous bone were cut from ten samples of fresh-frozen femoral head. The marrow was removed from the cubes and the baseline concentrations of BMP-7 were measured. Specimens from each femoral head were allocated to four groups and subjected to different compressive strains with a material testing machine, after which BMP-7 activity was reassessed. It was present in all groups. There was a linear increase of 102.1 pg/g (95% confidence interval 68.6 to 135.6) BMP-7 for each 10% increase in strain. At 80% strain the mean concentration of BMP-7 released (830.3 pg/g bone) was approximately four times that released at 20% strain. Activity of BMP-7 in fresh-frozen allograft has not previously been demonstrated. This study shows that the freezing and storage of femoral heads allows some maintenance of biological activity, and that impaction grafting provides a source of osteoinductive bone for remodelling. We have shown that BMP-7 is released from fresh-frozen femoral head cancellous bone in proportion to the strain applied to the bone. This suggests that the impaction process itself may contribute to the biological process of remodelling and bony incorporation.

Impaction bone-grafting in revision joint replacement surgery.

The standard graft material for impaction bone-grafting is fresh-frozen femoral head allograft morselized to a particle size as large as is practical to ensure stability and allow new bone formation. The graft must be sufficiently compacted to provide immediate mechanical stability; this requires containment of the graft and substantial impaction energy. Diaphyseal bone fracture and excessive implant migration are the most common complications of the operation. Impaction bone-grafting in revision total hip replacement has produced good medium-term results on both the acetabular and the femoral side. The use of compacted morselized bone graft is a relatively new technique in revision knee surgery and requires longer-term follow-up with larger numbers of patients to assess its value.

Use of the anterior interbody fresh-frozen femoral head allograft in circumferential lumbar fusions.

Many studies in the literature have documented the outcome of circumferential lumbar fusions. However, no study has specifically evaluated the performance of the anterior fresh-frozen femoral head allograft as a structural interbody graft material. All office and hospital records, including charts and radiographs, were reviewed to obtain pertinent clinical and radiographic information. The cases included 23 single-level fusions, 22 two-level fusions, and 5 fusions of three or more levels. In all, 88 fusion levels were analyzed radiographically. The mean follow-up time was 28 months (range, 24 to 36 months). All procedures were performed in a single stage. At the latest follow-up, clinical outcome was graded good to excellent in 39 (78%) cases, fair in 8 (16%) cases, and poor in 3 (6%) cases. The average time to anterior radiographic fusion was 6 months (range, 4 to 8 months). The overall fusion rate was 98%. The average preoperative anterior disk space height was 10 mm, 14 mm immediately after operation, and 13 mm at follow-up. The posterior disk space height averaged 5 mm before operation, 7 mm immediately after operation, and 6 mm at follow-up. The average segmental lordosis was 7 degrees before operation, 10 degrees immediately after operation, and 10 degrees at follow-up. Late postoperative disk space collapse of 3 mm or more was noted in 17% of the fused disk spaces examined. Seventy-eight percent of the disk spaces maintained a disk space height greater than that of their preoperative value at the latest follow-up. Segmental lordosis did not change significantly at follow-up. The occurrence of collapse did not correlate with the clinical result, smoking history, or surgical indication (p < 0.05). Perioperative complications included one pleural effusion, two urinary tract infections, and one deep wound infection. Late complications included five painful graft sites and two patients with pseudarthrosis. Fresh-frozen femoral head allograft fulfills its desired function as an anterior structural graft in combination with rigid posterior transpedicular fixation, maintaining the disk space height achieved at surgery while reliably allowing remodeling and incorporation into a solid anterior fusion.