Acetabular bone reconstruction in revision arthroplasty - A comparison of freeze-dried, irradiated and chemically-treated allograft vitalised with autologous marrow versus frozen non-irradiated allograft
Deficiencies of acetabular bone stock at revision hip replacement were reconstructed with two different types of allograft using impaction bone grafting and a Burch-Schneider reinforcement ring. We compared a standard frozen non-irradiated bone bank allograft (group A) with a freeze-dried irradiated bone allograft, vitalised with autologous marrow (group B). We studied 78 patients (79 hips), of whom 87% (69 hips) had type III acetabular defects according to the American Academy of Orthopaedic Surgeons classification at a mean of 31.4 months (14 to 51) after surgery. At the latest follow-up, the mean Harris hip score was 69.9 points (13.5 to 97.1) in group A and 71.0 points (11.5 to 96.5) in group B. Each hip showed evidence of trabeculation and incorporation of the allograft with no acetabular loosening. These results suggest that the use of an acetabular reinforcement ring and a living composite of sterile allograft and autologous marrow appears to be a method of reconstructing acetabular deficiencies which gives comparable results to current forms of treatment.
"Concentrated or unconcentrated mononuclear cells can be mixed in the operating room with a synthetic or natural osteo-conducting matrix (e.g., allogeneic bone graft or coral) before implantation. Few published studies assessed the combined use of concentrated or unconcentrated BM with a biomaterial   . This method is a valid option for everyday practice, provided CE-marked (that is, approved for clinical use in Europe) biomaterials are used and concentration (if used) is achieved via an approved procedure. "
[Show abstract][Hide abstract] ABSTRACT: Bone fracture healing impairment related to mechanical problems has been largely corrected by advances in fracture management. Better protocols, more strict controls of time and function, hardware and surgical technique evolution have contributed to better prognosis, even in complex fractures. However, atrophic nonunion persists in clinical cases where, for different reasons, the osteogenic capability is impaired. When this is the case, a better understanding of basic mechanisms under bone repair and augmentation techniques may put in perspective the current possibilities and future opportunities. Among those, cell therapy particularly aims to correct this insufficient osteogenesis. However, the launching of safe and efficacious cell therapies still requires substantial amount of research, especially clinical trials. This review will envisage the current clinical trials on bone healing augmentation based on cell therapy, with the experience provided by the REBORNE Project, and the insight from investigator-driven clinical trials on advanced therapies towards the future.
Bone 08/2014; 70. DOI:10.1016/j.bone.2014.07.033 · 3.97 Impact Factor
"Bone ingrowth can be enhanced by osteoinduction. The use of stem cells in combination with allograft bone may improve incorporation and therefore survival of the implant . In-vitro and animal studies with biogenetic agents like osteogenetic proteins or bone morphogenetic protein have shown advanced integration but clinical data is missing . "
[Show abstract][Hide abstract] ABSTRACT: A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d’Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination.
Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term.
The Open Orthopaedics Journal 11/2012; 6:488-94. DOI:10.2174/1874325001206010488
[Show abstract][Hide abstract] ABSTRACT: The TIROS Operational Vertical Sounder (TOVS) instruments are described
along with the techniques for deriving atmospheric temperature profiles.
The soundings produced are very useful for studying the broadscale
structure of the atmosphere, but tend to be relatively smooth in the
vertical and unable to resolve shallow vertical features. When applied
to investigations around the coast of the Antarctic the TOVS retrievals
show the movement of low-level bariclinic zones and mesoscale fronts,
which provides insight into the evolution of vortices at the edge of the
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