Reconstruction Of Bone Loss Research Articles

Improvements in Pediatric Bone Loss Reconstruction With the Induced Membrane Technique.

The induced membrane technique is now widely used for pediatric diaphyseal bone loss due to various etiologies. Although consolidation rates remain satisfactory, complications, and healing delays may occur requiring additional procedures. We studied a series of induced membrane bone reconstructions in which the second stage included an embedded endomembranous non vascularized fibular shaft, in addition to iliac bone grafts. The purpose of this study was to analyze the results in terms of bone consolidation and complications. This is a retrospective comparative and multicentric study of 32 children with large bone loss treated with the induced membrane reconstruction technique. Patients were divided into 2 groups according to the graft used during the second stage. The first group (G1) of 16 patients had a nonvascularized fibula embedded inside the membrane in addition with the corticocancellous grafts from the iliac crest. The second group (G2) of 16 patients underwent reconstruction using the original technique, with iliac crest graft only. The 2 groups were similar in terms of etiologies of bone loss and follow-up (mean: 44mo for G1 and 49mo for G2). Mean bone losses were 15.4cm (range: 2 to 25; SD: 5.6) for G1 and 10.6cm (range: 3 to 19; SD: 5.2) for G2. In the first group, all patients healed primarily, with a mean time of 5.9 months (range: 4 to 8; SD: 1.6). In the second group, 2 of 16 patients did not healed; for the others 14, healing mean time was 6.9 months (range: 3 to 12; SD: 2.7). The short-term and long-term complications rates were 38% to 19% for G1 and 50% to 31% for G2, respectively. Regarding the donor site, the fibulas reconstructed spontaneously with a mean time of 4.8 months (range: 3 to 6; SD: 1.2). The integration of a nonvascularized fibula during the second stage of the induced membrane technique appears to improve the consolidation rate in the pediatric population. Level III-Retrospective comparative study.

SILVER-COATED MEGAPROSTHESES IN RECONSTRUCTION FOR ORTHOPAEDIC ONCOLOGY AND BONE LOSS

Rates of prosthetic joint infection in megaprostheses are high. The application of silver ion coating to implants serves as a deterrent to infection and biofilm formation.A retrospective review was performed of all silver-coated MUTARS endoprosthetic reconstructions (SC-EPR) by a single Orthopaedic Oncology Surgeon. We examined the rate of component revision due to infection and the rate of infection successfully treated with antibiotic therapy. We reviewed overall revision rates, sub-categorised into the Henderson groupings for endoprosthesis modes of failure (Type 1 soft tissue failure, Type 2 aseptic loosening, Type 3 Structural failure, Type 4 Infection, Type 5 tumour progression).283 silver-coated MUTARS endoprosthetic reconstructions were performed for 229 patients from October 2012 to July 2022. The average age at time of surgery was 58.9 years and 53% of our cohort were males. 154 (71.3%) patients underwent SC-EPR for oncological reconstruction and 32 (14.8%) for reconstruction for bone loss following prosthetic joint infection(s). Proximal femur SC-EPR (82) and distal femur (90) were the most common procedures. This cohort had an overall revision rate of 21.2% (60/283 cases). Component revisions were most commonly due to Type 4 infection (19 cases), Type 2 aseptic loosening/culture negative disease (15 cases), and Type 1 dislocation/soft tissue (12 cases).Component revision rate for infection was 6.7% (19 cases). 15 underwent exchange of implants and 4 underwent transfemoral amputation due to recalcitrant infection and failure of soft tissue coverage. This equates to a limb salvage rate of 98.3%. The most common causative organisms remain staphylococcus species (47%) and polymicrobial infections (40%).We expand on the existing literature advocating for the use of silver-coated endoprosthetic reconstructions. We provide insights from the vast experience of a single surgeon when addressing patients with oncological and bone loss-related complex reconstruction problems.

Reconstruction of Bone Loss in an Open Fracture of the Tibia with a Contralateral Free Tibial Graft: A Case Report and Outcome 10 Years Later

Reconstruction of Bone Loss in an Open Fracture of the Tibia with a Contralateral Free Tibial Graft: A Case Report and Outcome 10 Years Later

Methylmetacrylate (PMMA) cranioplasty technique: Technical interest of intraoperative modeling and review of the literature

Reconstruction of bone loss in the cranial vault may be necessary for functional or aesthetic reasons following trauma, decompression craniectomy, or craniofacial malformations. Many techniques have been described in the literature, using various materials, each with its own advantages and drawbacks. Reconstruction with polymethylmetacrylate cement has the advantage of a durable result and relative ease of use. In this article we present our cement cranioplasty technique through 4 clinical cases of cranial vault reconstruction, by direct intraoperative modeling on the bone defect. This accessible, effective method, applicable to all sizes of defect, remains an attractive option in the arsenal of techniques available today.

Translated article] Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes

IntroductionAnterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short term functional and radiological results of an arthroscopic bone block metal-free fixation or Bone Block Cerclage (BBC). Materials and methodsRetrospective study of patients with glenohumeral instability and >15% glenoid bone loss operated during 2019 with follow-up (FU) of at least 12 months. Radiography and computed tomography (CT) studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index (WOSI) and Rowe score. ResultsA total of 21 patients with a median age of 30.6 (SD-7.1) were included. All showed radiographic consolidation at 3 months FU. 90.4% of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statistically significant (p<0.001) for WOSI (35.6–86.9) and Rowe Score (25.2–96.4). No serious complications were reported. ConclusionsThe Bone Block Cerclage (BBC) is a safe, metal-free technique that achieves total consolidation of the bone graft and favourable functional and radiological outcomes at 12 months FU. Further studies with a larger number of patients and follow-up time are needed.

Minimum 10\u2009years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute

BackgroundAseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions.MethodsBetween September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint.ResultsThe average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%.ConclusionBone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo

IntroductionAnterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. Material and methodsRetrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. ResultsA total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. ConclusionThe bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.

Glenoid reconstruction in revision shoulder arthroplasty

The aim of the surgical technique is the stable fixation of aglenoid baseplate and reconstruction of bone loss with correction of version, inclination, and medialization of the joint line. Significant glenoid bone loss due to glenoid loosening or wear in revision shoulder arthroplasty. Active infection, inoperability due to poor health condition. Reconstruction of advanced glenoid bone stock in case of glenoid loosening of total shoulder arthroplasty can be performed either with autografts and allografts or metallic augmentation together with reverse baseplates in aone- or two-stage procedure. The preferred fixation mode was atransfixation technique using autograft and baseplates with extra-long coated or threaded post with 2-4locking screws. Baseplates with an extended post and locking screws adjustable in various inclination are required to achieve fixation along the "3-column concept" which is used by the authors based on a recently introduced classification algorithm, which is based on the remaining bone stock available for fixation of the post in native bone stock. The standard protocol with an abduction brace for 6weeks and passive exercises is modified, depending on the extent of reconstruction on the humeral and glenoid side, and the type of implant. In all, 145 cases of revision total shoulder arthroplasty suffering from moderate or advanced bone loss were retrospectively evaluated and 95followed up for a mean of 2.7years (range 1-7years). We classified the remaining bone stock as grade 4 or 5 in 61patients and grade 2 and 3 in 84patients. Our preferred surgical technique was cementless fixation of structural bone grafts using areverse baseplate in transfixation technique. In all, 56cases required substantial iliac crest bone grafts, of which 36patients were operated on in a2-stage procedure. In 20patients the bone defect in the iliac crest was secured by alocking plate in order to avoid afatigue fracture of the anterior iliac spine. Only in 5cases with intact rotator cuff was an anatomical "platform" component used; the remaining cases were converted to reverse shoulder arthroplasty. Asuccess rate of more than 90% for both one- and two-stage reconstructions, which is mainly related to the high rate of incorporation of autografts taken from the iliac crest, is comparable to the majority of data published in the literature.

Osteochondral coronoid allograft in chronic coronoid process bone loss reconstruction: an original technique with encouraging clinical and radiological outcomes at a mid-term follow-up

ObjectivesUlnar coronoid apophysis is a primary stabiliser of the elbow; a relatively small amount of bone loss, quantifiable in 40%, could be sufficient to make an elbow incongruent. If coronoid fixation is not possible, the only way of achieving a stable elbow is to reconstruct it. This case series describes the senior author’s original surgical technique in reconstructing the coronoid with a fresh-frozen osteochondral coronoid allograft, reporting a mid-term follow-up (average of 55.5 months, minimum of 26 months) of four patients (described one by one) with subjective and objective outcomes.MethodsThe senior author operated on four patients with his original surgical technique, fully explained in the text. The mean follow-up at the time is 55.5 months (up to 10 years in one case). Preoperatively and postoperatively, the patients were asked to answer three types of validated scales: Visual Analogue Scale (VAS), Quick-Disabilities of the Arm Shoulder and Hand (Quick-DASH) and Mayo Elbow Performance Index (MEPI). All patients underwent preoperative X-rays and CT scans. Afterwards, they were asked to have further X-rays and a dual- energy CT scan in the last-follow up.ResultsThree patients achieved 100 points on the MEPI scale. Three patients achieved full range of motion (ROM), while the fourth one easily achieved functional ROM. The VAS score mean improvement was 50%, and two patients were completely pain-free; the Quick-DASH average improvement score was 56.82 points.ConclusionsThis case series presents an original technique using a coronoid allograft. Three of four patients achieved full ROM, and two were pain-free at follow up. Everyone resumed previous levels at work and in sports. The good outcomes suggest that this procedure seems to be safe and does not necessarily require autologous structures. The lack of registered cases of graft reabsorption may encourage the use of an osteochondral coronoid allograft.Level of evidenceLevel IV.

Biological Facet of Segmental Bone Loss Reconstruction.

The management of long bone defects continues to be associated with significant challenges for optimum and timely bone repair. When bone grafting is needed, essential parameters to be addressed include adequate volume, optimum density, and structural capacity as well as potent biological properties. Although the autologous iliac crest bone graft remains the gold standard, its reduced availability and donor site morbidity have made the clinicians to seek for other alternative options. Reamer irrigator aspirator graft with materials used as graft expanders along with inductive molecules and cellular augmentation constitute the current trend for optimum bone regeneration. This article presents the contemporary thinking of the biological facet of segmental bone loss reconstruction.

The use of metaphyseal sleeves in revision total knee arthroplasty

BackgroundBone loss in revision total knee arthroplasty is common. Various reconstruction options are available. The purpose of our study is to report on one such reconstruction option, titanium metaphyseal sleeves. MethodsWe describe a series of 45 patients (46 knees) who underwent revision total knee arthroplasty and were treated with a porous metaphyseal sleeve between August 2000 and September 2009 at two centers. Patients were followed for a minimum of four years, and at final follow-up, 40 patients (40 knees) were available for review. Patients were evaluated using The Knee Society's Knee Scoring System at each follow-up. Radiographs (standing anteroposterior, lateral, and sunrise views) were taken at six weeks, three months, and final evaluations. ResultsMean Knee Society Scores increased from 36 (range 10 to 69) pre-operatively to 90 (range 38 to 100) at final follow-up. Mean alignment on final radiographic evaluation was 5° (range 3° to 8° valgus). Mean pre-operative alignment was 6° (range 15° varus to 18° valgus). Mean range of motion was 125° (range 80° to 140°) pre-operatively and 115° (range 95° to 130°) postoperatively. One device failed to achieve ingrowth and was revised at two years. All other knees were radiographically stable and ingrown. ConclusionsMetaphyseal sleeves provide an alternative for bone loss reconstruction in revision total knee arthroplasty. Level of EvidenceIII

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

Background:The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation. The effect of CAL release on superior stability following the Latarjet is unknown; therefore, our purpose was to compare the effect of two Latarjet techniques and allograft reconstruction on superior instability.Materials and Methods:Eight cadaveric specimens were tested on a simulator. Superior translation was monitored following an axial force in various glenohumeral rotations (neutral, internal, and external) with and without muscle loading. Three intact CAL states were tested (intact specimen, 30% glenoid bone defect, and allograft reconstruction) and two CAL deficient states (classic Latarjet (classicLAT) and congruent-arc Latarjet (congruentLAT)).Results:In neutral without muscle loading, a significant increase in superior translation occurred with the classicLAT as compared to 30% defect (P = 0.046) and allograft conditions (P = 0.041). With muscle loading, the classicLAT (P = 0.005, 0.002) and the congruentLAT (P = 0.018, 0.021) had significantly greater superior translation compared to intact and allograft, respectively. In internal rotation, only loaded tests produced significant results; specifically, classicLAT increased translation compared to all intact CAL states (P < 0.05). In external rotation, only unloaded tests produced significant results with classicLAT and congruentLAT allowing greater translations than intact (P ≤ 0.028). For all simulations, the allograft was not significantly different than intact (P > 0.05) and no differences (P = 1.0) were found between classicLAT and congruentLAT.Discussion:In most simulations, CAL release with the Latarjet lead to increased superior humeral translation.Conclusion:The choice of technique for glenoid bone loss reconstruction has implications on the magnitude of superior humeral translation. This previously unknown effect requires further study to determine its clinical and kinematic outcomes.

Revision Total Knee Arthroplasty With the Use of Trabecular Metal Cones: A Randomized Radiostereometric Analysis With 2 Years of Follow-Up

“Trabecular Metal Cone” (TM Cone) (Zimmer, Inc, Warsaw, Ind) for reconstruction of bone loss in the proximal tibia during revision total knee arthroplasty is now optional. Forty patients were randomized to receive revision total knee arthroplasty with or without TM Cone (No TM Cone). The Anderson Orthopaedic Research Institute bone loss classification and NexGen revision system were used. Radiostereometric analysis was performed with 24 months of follow-up. Maximum total point motion: stable migration was seen in the TM Cone group. No statistically significant difference was found. Segment motion analysis at 24 months showed the same net direction of rotation for the groups around the y-, z-axis and around the x-, y-axis for translation. Tibial revision implants with TM Cone result in an early stable situation with less irregular migration pattern than revision without TM Cone.

Bone mineral density changes of the proximal tibia after revision total knee arthroplasty. A randomised study with the use of porous tantalum metaphyseal cones

Forty patients were enrolled in a prospective randomised study using conventional method or "Trabecular Metal Cone" (TM Cone) (Zimmer inc., Warsaw, USA) for reconstruction of bone loss of the proximal tibia during revision total knee arthroplasty (rTKA). The aim was to evaluate changes in bone mineral density (BMD) at the proximal tibia. Thirty-six patients [median 67 years (range: 40-85 years)] received rTKA with NexGen® (Zimmer Warsaw, USA) revision system. Knee Society´s Knee Scoring System and the Anderson Orthopaedic Research Institute (AORI) bone classification was used. Changes in BMD were measured by dual energy X-ray absorptiometry (DEXA). Knee and function score improved in both groups. No significant changes between the groups were found. Changes in BMD within the two groups were quite similar. Overall decreases in BMD of 0.1 - 5.4 % were found in both groups (ROI 1-6) postoperative to 12 months of follow-up, except that ROI 7 showed an increase in BMD (0.8 - 1.3 %). After 24 months of follow-up, an increase in BMD was found along the stem (ROI 2-5) of 1.9 - 6.3 % , with significant changes in the TM Cone Group (ROI 3, 4, 5) . No significant changes in BMD between the groups were found. The bone remodelling pattern was almost the same in the two groups after two years.

Comparison of four techniques for craniofacial bone loss reconstruction

Comparison of four techniques for craniofacial bone loss reconstruction

Utilisation de la crête tibiale vascularisée au poignet et à la main

The choice of a technique for reconstruction of bone loss to the lower end of the forearm is often difficult, especially in cases of nonunion. Vascularized bone is essential in these indications. We present cases of post-traumatic hand and wrist reconstruction with upper tibial corticocancellous transfer. It is a reliable reconstructive procedure for forearm bone loss to cover limited size bone defects, leaving no complication to the donor site.

Predictors of Bone Loss in Revision Total Knee Arthroplasty

Revision total knee arthroplasty (RTKA) requires preoperative planning to enable the reconstruction of bony deficiencies. The objective of this project was to identify predictors of bone loss management at RTKA based on the preoperative failure mode and patient demographics known preoperatively. We retrospectively reviewed 245 consecutive RTKA procedures in which the same revision knee system was utilized. Patient demographic and treatment data were recorded, and locations of bone loss were identified based on the reconstructive management. We identified significant predictors for use of femoral augments at all four positions. Several predictors significantly predisposed to use of a thick (>19 mm) polyethylene; however, no predictors of tibial augments were significant. Although the reconstruction of bone loss is primarily based on the intraoperative assessment, these findings may provide additional information to help the surgeon prepare for difficult revision procedures.

Algorithmic Approach for Reconstruction of Proximal Femoral Bone Loss in Revision Total Hip Arthroplasty

Reconstruction of the femur depends on the quantity of bone loss and the quality of the remaining bone stock. Multiple classifications and reporting systems can be used to characterize the bone defect. We present a simple algorithmic approach for proximal femoral bone loss reconstruction during revision total hip arthroplasty. Quantity of bone loss is assessed using radiographs based on different classification systems, whereas quality of the remaining bone stock is assessed intraoperatively. Based on the type of proximal bone loss and the quality of the available bone, we describe our preferred reconstruction technique. For minor bone loss, the metaphysis is expanded but intact with partially absent calcar. There is minimal bone loss anteriorly and posteriorly, and the diaphysis is intact. For significant bone loss, the metaphysis is compromised, and there is no calcar. There is minimal bone loss anteriorly and posteriorly. The available proximal bone may be thin, sclerotic, and incapable of support. However, the diaphysis is intact. For massive bone loss, there is complete circumferential bone loss in the metaphysis, extending to the diaphysis. The anterolateral bone and supporting subtrochanteric metaphyseal bone are absent. The metaphysis is not stable and will not offer rotational stability. There is massive bone loss anteriorly and posteriorly. The stability of the implant is dependent on distal diaphyseal fixation. For complete proximal bone loss, there is extensive circumferential segmental bone loss proximally and extensive cavitary loss involving the entire diaphysis. Additionally, there is extensive ectasia of the diaphysis.

Quantification of bone mass gain in response to the application of biphasic bioceramics and platelet concentrate in critical-size bone defects

Biphasic bioceramics have been widely indicated for bone reconstruction; however, the real gain in bone mass due to the presence of such biomaterials has not been established yet nor the advantages of its association with platelet concentrate. This study aims at quantifying the volume of bone matrix, osteoblasts, osteocytes, blood vessels and adipose tissue after the application of a biphasic bioceramics composed of 65% hydroxyapatite and 35% beta-tricalcium phosphate. Critical-size bone defects were produced in rabbit femora and reconstructed with bioceramics only, with bioceramics combined with platelet concentrate, with platelet concentrate alone, and with no treatment (blood clot). The quantitative evaluation was performed on histological sections using histomorphometry. Our data provide original evidence that consolidates the indication of bioceramics for clinical bone loss reconstruction. The application of biphasic bioceramics alone led to major bone mass gain and was followed by its association with platelet concentrate. On the other hand, platelet concentrate can contribute to the augmentation and maintenance of the adipose tissue, representing a new field for future applications in plastic surgery.

Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty — results of a multicentre study

The advantages of Unicompartmental Knee Replacement (UKR) over Total Knee Replacement (TKR) includes the preservation of soft tissue as well as bone stock, and better function with improved range of motion and more natural gait. It is therefore believed that the revision of failed UKR to TKR is technically easier than revision of failed TKR. In our study we tested this hypothesis by assessing the reconstruction requirements and early clinical and radiological outcome following the revision of UKR to TKR. During a 15-year period 1060 primary Oxford medial UKR procedures were performed at three centres, 36 of which underwent revision to TKR due to aseptic failure. The mean operating time for revision surgery was 113 min. Among the revision prostheses used, 28 were standard TKRs, six were constrained, and two were semi-constrained. Thirty had no intramedullary stems whereas six had intramedullary stems. In 30 cases reconstruction for bone loss was not required whereas metal augmentation was used in two knees, contained peg defects in the femur were filled with cement in two knees and contained keel defects in the tibia were grafted using the bone from revision cuts in two knees. After a mean follow-up of 2 years, the mean ‘total knee score’ was 86.3 and the mean functional score was 78.5. These findings suggest that the complexity of operation and complications encountered during Oxford medial UKR revision and the clinical outcome compare favorably with those of TKR revision.