Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups.
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ABSTRACT:
SUBMITTER: Pereira GC
PROVIDER: S-EPMC2267649 | biostudies-other | 2007 Aug
REPOSITORIES: biostudies-other
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Project description:Hydroxyapatite (HA) coating is believed to improve bone-implant ingrowth and long-term survival of prostheses. Recent studies, however, have challenged this view. Furthermore, HA particles may produce third-body wear and initiate aseptic loosening of implants. We report the performance of HA- and porous-coated acetabular cups in a prospective randomized trial.This was an 8-year follow-up study of our previously published prospective randomized study to compare clinical outcomes, survival, periprosthetic bone mineral density, migration, and wear rates of HA- and porous-coated acetabular cups. Dual X-ray absorptiometry (DXA) and Ein Bild Roentgen Analyse (EBRA) measurements were used. 100 patients who underwent unilateral cementless total hip arthroplasty were randomized to either porous-coated cups or HA-coated cups. Patients were examined preoperatively and at 3, 6, and 9 months, and also 1, 3, and 8 years after surgery. 81 patients were available for 8-year follow-up, 40 with porous-coated cups and 41 with HA-coated cups.Age, sex, bone mineral density, and clinical results (Harris hip score) were similar in the 2 groups. The survival, wear, and migration patterns of the cups were also similar in both groups. The results of periprosthetic bone mineral density scans in region of interest 2 was in favor of the porous-coated cups, but there were no differences between the 2 groups in all the remaining regions of interest.HA coating had no statistically significant effect on clinical results, survival, wear, or migration at the 8-year follow-up.
| S-EPMC3851667 | biostudies-literature
Project description:Management of large acetabular bone defects is challenging. The Masquelet technique has successfully reconstructed segmental defects in long bones arising from trauma, tumors, or infection but not been described for large acetabular defects. We present 3 cases of large acetabular bone defects arising from chronic prosthetic joint infection, treated via a novel induced membrane bone grafting technique, drawn from the Masquelet technique. All cases showed satisfactory clinical and radiological outcomes at midterm follow-up. This technique holds promise and can be an alternative means when treating large acetabular bone defects.
| S-EPMC7267680 | biostudies-literature
Project description:BackgroundAutogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures to enhance fusion potential, and frequently in revision situations where bone loss and osteolysis may be a feature. The tibial metaphysis is a common donor site for bone graft, with the procedure typically performed using a curette or trephine to harvest the cancellous bone. Some limitations of this technique include suboptimal harvest of the marrow portion in particular, incomplete graft harvest, and loss of graft material during the harvest process. We describe a novel vacuum-assisted bone harvesting device to acquire cancellous bone and marrow from the proximal tibia.MethodsThis is a retrospective study of a single surgeon's consecutive patients who underwent foot and ankle arthrodesis procedures using proximal tibia autograft obtained using a vacuum-assisted bone harvesting device. Descriptive statistics were used to summarize patient and operative characteristics and outcomes. We identified 9 patients with a mean age of 51 years, 4 of whom were female.ResultsOn average, the skin incision was slightly more than 2 cm, and 27 mL of solid graft and 16 mL of liquid phase aspirate were collected. At 6 weeks after the procedure, there was minimal to no pain at the donor site, and we did not observe any fractures or other complications.ConclusionsWe report the use of a novel vacuum-assisted curette device to harvest bone graft from the proximal tibial metaphysis for use in foot and ankle fusions. This device has been reliable and efficient in clinical practice.Level of evidenceLevel IV, retrospective case series.
| S-EPMC8702698 | biostudies-literature
Project description:BackgroundUncemented press-fit acetabular cups without screws rely on the elastic recoil of the bone for its primary stability and tend to leave polar gaps with its use. The clinical significance of these gaps and the functional outcome of the patients with polar gaps is evaluated in this study.MethodsThis comparative analysis was done on 224 cementless primary THA using Deltamotion® Hip System from January 2010 to December 2017. Patients were divided into two groups based on the presence or absence of polar gaps on immediate post-operative radiographs. Patients were observed for their clinical, radiological and functional outcomes with regular follow ups. At each follow-up, patients' clinical outcome was evaluated using the Harris Hip Score (HHS) and Patient Reported Outcome Measures (PROMs).Results14 of 224 patients(6.25%) demonstrated polar gaps in their immediate post-operative radiographs. No statistically significant difference was noted in the final mean HHS between the two groups. The polar gaps ranged from 0.5 to 1.8?mm (mean-1.09?mm). None of the patients showed progression of the polar gaps. All patients showed bony ingrowth into the gaps at a mean of 8.57 months.ConclusionThe presence of polar gaps in the immediate post-operative radiographs are not of a major clinical significance provided a secure peripheral fit is achieved intra-operatively. The functional outcome and rehabilitation in such patients is at par with that seen in the patients without polar gaps. Disappearance of these polar gaps is a rule rather than an exception.
| S-EPMC6985010 | biostudies-literature
Project description:Background and purpose - Impaction bone grafting (IBG) is an established method in hip revision surgery to reconstruct loss of bone stock. There is limited knowledge concerning the actual bone remodelling process within the allograft. We investigated with repeated bone mineral density (BMD) measurements the biological process of bone remodelling in the allograft in vivo. We hypothesized that an initial decrease in BMD would be followed by an increase towards baseline values. Patients and methods - Dual-energy X-ray absorptiometry (DXA) was used to measure BMD values in 3 regions of interest (ROI) in 20 patients (average age at surgery 70 years, 11 males) after an acetabular reconstruction with IBG and a cemented cup. A postoperative DXA was used as baseline and DXA was repeated at 3 and 6 months and at 1 and 2 years. The Oxford Hip Score (OHS), the 12-Item Short Form Health Survey (SF12), and a 0 to 100?mm visual analogue scale (VAS) for pain and satisfaction were obtained simultaneously. Results - The overall mean BMD in the IBG regions increased significantly by 9% (95% CI 2-15) at 2 years' follow-up. In the cranial ROI BMD increased 14% (CI 6-22), whereas the BMD in the medial and caudal ROI showed an increase of 10% (CI 1-18) and 4% (CI -6-16), respectively. The OHS, SF12-mental, and VAS for pain all improved statistically significantly 2 years after surgery, with a mean VAS for satisfaction of 77 (CI 63-90) out of 100 points. The SF12-physical showed non-significant improvement. Interpretation - The BMD in the allograft gradually increased after IBG for acetabular reconstruction arthroplasties, particularly in the cranial ROI. An initial decrease in the BMD was not encountered. These BMD changes, as proxy measurements for bone remodeling, may indicate progressive apposition of vital new host bone in the grafted area.
| S-EPMC6055772 | biostudies-literature
Project description:ObjectivesAcetabular bone defect quantification and classification is still challenging. The objectives of this study were to suggest and define parameters for the quantification of acetabular bone defects, to analyze 50 bone defects and to present the results and correlations between the defined parameters.MethodsThe analysis was based on CT-data of pelvises with acetabular bone defects and their reconstruction via a statistical shape model. Based on this data, bone volume loss and new bone formation were analyzed in four sectors (cranial roof, anterior column, posterior column, and medial wall). In addition, ovality of the acetabulum, lateral center-edge angle, implant migration, and presence of wall defects were analyzed and correlations between the different parameters were assessed.ResultsBone volume loss was found in all sectors and was multidirectional in most cases. Highest relative bone volume loss was found in the medial wall with median and [25, 75]-percentile values of 72.8 [50.6, 95.0] %. Ovality, given as the length to width ratio of the acetabulum, was 1.3 [1.1, 1.4] with a maximum of 2.0, which indicated an oval shape of the defect acetabulum. Lateral center-edge angle was 30.4° [21.5°, 40.4°], which indicated a wide range of roof coverage in the defect acetabulum. Total implant migration was 25.3 [14.8, 32.7] mm, whereby cranial was the most common direction. 49/50 cases showed a wall defect in at least one sector. It was observed that implant migration in cranial direction was associated with relative bone volume loss in cranial roof (R = 0.74) and ovality (R = 0.67).ConclusionWithin this study, 50 pelvises with acetabular bone defects were successfully analyzed using six parameters. This could provide the basis for a novel classification concept which would represent a quantitative, objective, unambiguous, and reproducible classification approach for acetabular bone defects.
| S-EPMC6797127 | biostudies-literature
Project description:UNLABELLED: In vitro studies demonstrating excessive wear in polyethylene cups sterilized using gamma irradiation and stored in air led to the abandonment of this sterilization technique. We evaluated the clinical wear performance of a metal femoral component on a polyethylene cup in a hip prosthesis from a selected subset of implants in a group of patients followed for at least 20 years and assessed the time dependency of variation in penetration rates. We measured penetration in 33 polyethylene cups in 25 patients who had a Charnley low-friction arthroplasty between 1982 and 1984. All patients had Charnley Ogee cups implanted for more than 20 years and sterilized using the gamma irradiation in air technique. If degradation occurred over time in vivo, it was not reflected by an increased penetration rate with increasing time in vivo; even after 20 years of implantation, the degree of wear remained low. This suggests gamma irradiation affects wear on ultra-high-molecular-weight polyethylene by reducing wear secondary to the crosslinking, by increasing wear as shown through in vitro studies of heavily oxidized samples, or by oxidation resulting from prolonged shelf life. The effect of progressive oxidation in vivo does not appear to affect wear in vivo. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2505130 | biostudies-other
Project description:Sclerostin antibody (Scl-Ab) stimulates bone formation, which with long-term treatment, attenuates over time. The cellular and molecular mechanisms responsible for the attenuation of bone formation are not well understood, but in aged ovariectomized (OVX) rats, the reduction in vertebral cancellous bone formation is preceded by a reduction in osteoprogenitor (OP) number and significant induction of signaling pathways known to suppress mitogenesis and cell cycle progression in the osteocyte (OCy) (Taylor et al., 2016). To determine if the reduction in OP number is associated with a decrease in proliferation, aged OVX rats were administered vehicle or Scl-Ab for 9 or 29?days and implanted with continuous-delivery 5-bromo-2'-deoxyuridine (BrdU) mini-osmotic pumps 5?days prior to necropsy. The total number of BrdU-labeled osteoblasts (OB) was quantified in vertebral cancellous bone to indirectly assess the effects of Scl-Ab treatment on OP proliferation at the time of activation of modeling-based bone formation at day 9 and at the time of maximal mineralizing surface, initial decrease in OP number, and transcriptional changes in the OCy at day 29. Compared with vehicle, Scl-Ab resulted in an increase in the total number of BrdU-positive OB (+260%) at day 9 that decreased with continued treatment (+50%) at day 29. These differences in proliferation occurred at time points when the increase in total OB number was significant and similar in magnitude. These findings suggest that reduced OP proliferation contributes to the decrease in OP numbers, an effect that would limit the OB pool and contribute to the attenuation of bone formation that occurs with long-term Scl-Ab treatment.
| S-EPMC6020110 | biostudies-literature
Project description:Total hip arthroplasty (THA) is a surgical procedure for the replacement of hip joints with artificial prostheses. Several approaches are currently employed in the treatment of this kind of defect. Overall, the most common method involves using a quite invasive metallic support (a Burch-Schneider ring). Moreover, valid alternatives and less invasive techniques still need to be supported by novel material development. In this work, we evaluated the performance of SmartBone®, a xenohybrid bone graft composed of a bovine bone matrix reinforced with biodegradable polymers and collagen, as an effective support in acetabular prosthesis reconstruction. Specifically, the material's mechanical properties were experimentally determined (E = ~1.25 GPa, Ef = ~0.34 GPa, and Et = ~0.49 GPa) and used for simulation of the hip joint system with a SmartBone® insert. Moreover, a comparison with a similar case treated with a Burch-Schneider ring was also conducted. It was found that it is possible to perform THA revision surgeries without the insertion of an invasive metal support and it can be nicely combined with SmartBone®'s osteointegration characteristics. The material can withstand the loads independently (?max = ~12 MPa) or be supported by a thinner titanium plate in contact with the bone in the worst cases. This way, improved bone regeneration can be achieved.
| S-EPMC6963854 | biostudies-literature
Project description:Background:The ability to utilize magnetic resonance imaging (MRI) to assess bony fixation in 3 dimensions may allow a better understanding of the implant design and bony integration. We hypothesized that a new 3-dimensionally printed cementless highly porous acetabular component (Stryker Trident II TritaniumTM) would show better fixation than an earlier cup from the same manufacturer as assessed by the noninvasive technique of multispectral MRI. Methods:Multiacquisition variable-resonance image combination selective metal suppression MRI was performed in 19 patients implanted with a new 3-dimensionally printed cup and 20 patients who had received a previous-generation cup from the same manufacturer at 1-year follow-up. Each cup was graded globally as well as by 9 specific zones. Integration grades were performed for each zone: 0, full bone integration; 1, fibrous membrane present; 2, osteolysis; and 3, fluid present. A mixed-effects logistic regression model was used to compare fixation between the 2 groups. Results:All cups in both cohorts showed greater than 90% estimated global bony integration (3-dimensionally printed cups, 99.4%; regular cups 91.6%) with no osteolysis or fluid observed in any cup. The 3-dimensionally printed cup had 1 of 171 zones (0.6%) graded as fibrous membrane present, while the 2-dimensional group had 15 of 180 zones (8.3%) graded as fibrous. Of note, screw hole regions were omitted but may be read as fibrous membrane areas. Conclusion:Using multiacquisition variable-resonance image combination selective MRI, our analysis showed greater osteointegration and less fibrous membrane formation in the 3-dimensionally printed cups than the control group at 1-year follow-up.
| S-EPMC7475047 | biostudies-literature