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
Abstract
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 (http://www.clinicaltrials.gov)555657585960. Most of the clinical trials used autologous MSCs that were culture expanded [56, 57] or bone marrow aspirate, concentrated using centrifugation [60, 61]. "
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    • "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. "
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