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

ArticleinThe Bone & Joint Journal 90(9):1164-71 · October 2008with2 Reads
DOI: 10.1302/0301-620X.90B9.20425 · Source: PubMed
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.
    • "Different management approaches for stabilization of the acetabular component using dual plates and cages have been described in the literature . In the case of a structural bone defect, allograft treatment has been at- tempted [11][12][13][14][15][16]. Nevertheless, the results of revision surgery in HA or THA with acetabular gle-stable screw holes. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization. Indications: Acetabular fracture with or without previous hemi- or total hip arthroplasty. Contraindications: Non-displaced acetabular fractures. Surgical technique: Watson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components. Postoperative management: Full weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended. Results: Of 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery. Limitations: In case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.
    Full-text · Article · Apr 2016
    • "Although there are numerous in vitro and in vivo studies published to date on the use of MSCs for regenerative medicine purposes, clinical trials using MSC-based approaches are limited due to medical and regulatory reasons [55]. As of September 2014, ten clinical trials were in process or completed investigating either autologous or allogeneic MSCs for fracture repair ( Most of the clinical trials used autologous MSCs that were culture expanded [56, 57] or bone marrow aspirate, concentrated using centrifugation [60, 61]. "
    [Show abstract] [Hide abstract] ABSTRACT: It is estimated that, of the 7.9 million fractures sustained in the United States each year, 5% to 20% result in delayed or impaired healing requiring therapeutic intervention. Following fracture injury, there is an initial inflammatory response that plays a crucial role in bone healing; however, prolonged inflammation is inhibitory for fracture repair. The precise spatial and temporal impact of immune cells and their cytokines on fracture healing remains obscure. Some cytokines are reported to be proosteogenic while others inhibit bone healing. Cell-based therapy utilizing mesenchymal stromal cells (MSCs) is an attractive option for augmenting the fracture repair process. Osteoprogenitor MSCs not only differentiate into bone, but they also exert modulatory effects on immune cells via a variety of mechanisms. In this paper, we review the current literature on both in vitro and in vivo studies on the role of the immune system in fracture repair, the use of MSCs in the enhancement of fracture healing, and interactions between MSCs and immune cells. Insight into this paradigm can provide valuable clues in identifying cellular and noncellular targets that can potentially be modulated to enhance both natural bone healing and bone repair augmented by the exogenous addition of MSCs.
    Full-text · Article · May 2015
    • "To increase the number of injected mononuclear cells and consequently of MSCs, it is possible to separate by centrifugation the mononuclear cells and concentrate them 3-fold to 6-fold [64] with good results in pseudarthrosis [65] 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 biomaterial666768. 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.
    Full-text · Article · Aug 2014
Show more