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Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective in surgical technique.

ABSTRACT: BACKGROUND:Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. METHODS:This was a retrospective study of a case series of five patients with a young age (?50?years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79?months. We describe the surgical technique in detail. RESULTS:Improvement was significant on the WOMAC and SF-36 scales (p?

SUBMITTER: De la Torre-Escuredo B

PROVIDER: S-EPMC7453526 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective in surgical technique.

De la Torre-Escuredo Basilio B Gómez-García Eva E Álvarez-Villar Salvador S Bujan Julia J Ortega Miguel A MA

BMC musculoskeletal disorders 20200827 1

<h4>Background</h4>Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results.<h4>Methods</h4>This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.<h4>Results</h4>Improvement was significant on the WOMAC and ...[more]

PMID: 32854683

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Treatment of large acetabular defects: a surgical technique utilizing impaction grafting into a metallic mesh.

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Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects.

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Impaction Bone Grafting for Treatment of Unstable Osteochondritis Dissecans (OCD) Lesions.

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Impaction technique influences implant stability in low-density bone model.

Project description:AimsCementless acetabular components rely on press-fit fixation for initial stability. In certain cases, initial stability is more difficult to obtain (such as during revision). No current study evaluates how a surgeon's impaction technique (mallet mass, mallet velocity, and number of strikes) may affect component fixation. This study seeks to answer the following research questions: 1) how does impaction technique affect a) bone strain generation and deterioration (and hence implant stability) and b) seating in different density bones?; and 2) can an impaction technique be recommended to minimize risk of implant loosening while ensuring seating of the acetabular component?MethodsA custom drop tower was used to simulate surgical strikes seating acetabular components into synthetic bone. Strike velocity and drop mass were varied. Synthetic bone strain was measured using strain gauges and stability was assessed via push-out tests. Polar gap was measured using optical trackers.ResultsA phenomenon of strain deterioration was identified if an excessive number of strikes was used to seat a component. This effect was most pronounced in low-density bone at high strike velocities. Polar gap was reduced with increasing strike mass and velocity.ConclusionA high mallet mass with low strike velocity resulted in satisfactory implant stability and polar gap, while minimizing the risk of losing stability due to over-striking. Extreme caution not to over-strike must be exercised when using high velocity strikes in low-density bone for any mallet mass.Cite this article: Bone Joint Res 2020;9(7):386-393.

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