International Orthopaedics

, Volume 42, Issue 4, pp 783–789 | Cite as

Bone morphogenic protein-2 use in revision total hip arthroplasty with acetabular defects

  • Scott R. Nodzo
  • Keely K. Boyle
  • Sonja Pavlesen
  • Sridhar Rachala
Original Paper

Abstract

Introduction

The restoration of acetabular bone stock during revision hip arthroplasty remains a challenge. There have been no clinical series reporting the efficacy of bone morphogenic protein-2 (rhBMP-2) in the revision hip setting.

Methods

We retrospectively reviewed the radiographs and records of 15 patients who received rhBMP-2 mixed with allograft bone chips (+BMP), and 14 who received allograft bone chips alone (−BMP) for their acetabular defect during revision total hip arthroplasty with a mean two-year follow up. Radiographs were evaluated for acetabular defect size, superior cup migration, and changes in the lateral cup abduction angle. Modified Harris hip scores were used for evaluation of clinical outcomes.

Results

Patients in the +BMP group compared to the –BMP group had significantly larger amounts of cancellous bone chips used (72.1 ± 35.5 cc vs. 38.6 ± 14.1 cc; p = 0.003). Mean rhBMP-2 used per case was 7.4 ± 3.1 mg in the +BMP group. Three patients in the –BMP group had cup migration which was not observed in the +BMP group. Mean Harris hip scores (HHS) improved post-operatively in both groups (40.1 ± 20.9 to 71.9 ± 19, p < .0001). No local adverse reaction was noted in the +BMP group.

Conclusion

rhBMP-2 had modest clinical benefit in the setting of revision THA. Cost of this synthetic biologic versus the added clinical benefit should be carefully considered when being used in the revision hip setting.

Keywords

Revision total hip Arthroplasty Bone morphogenic protein Bone graft Acetabular defects 

Notes

Compliance with ethical standards

Conflict of interest

No funding or company participation was received for this work. None of the authors have a conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Sporer SM, Paprosky WG (2006) Acetabular revision using a trabecular metal acetabular component for severe acetabular bone loss associated with a pelvic discontinuity. J Arthroplast 21:87–90.  https://doi.org/10.1016/j.arth.2006.05.015 CrossRefGoogle Scholar
  2. 2.
    Sporer SM, Paprosky WG (2006) The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. J Arthroplast 21:83–86.  https://doi.org/10.1016/j.arth.2006.05.008 CrossRefGoogle Scholar
  3. 3.
    Van Kleunen JP, Lee GC, Lementowski PW, Nelson CL, Garino JP (2009) Acetabular revisions using trabecular metal cups and augments. J Arthroplast 24:64–68.  https://doi.org/10.1016/j.arth.2009.02.001 CrossRefGoogle Scholar
  4. 4.
    Grabowski G, Cornett CA (2013) Bone graft and bone graft substitutes in spine surgery: current concepts and controversies. J Am Acad Orthop Surg 21:51–60.  https://doi.org/10.5435/JAAOS-21-01-51 CrossRefPubMedGoogle Scholar
  5. 5.
    Nodzo SR, Kaplan NB, Hohman DW, Ritter CA (2014) A radiographic and clinical comparison of reamer-irrigator-aspirator versus iliac crest bone graft in ankle arthrodesis. Int Orthop 38:1199–1203.  https://doi.org/10.1007/s00264-014-2348-4 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3–15.  https://doi.org/10.1016/j.injury.2011.06.015 CrossRefPubMedGoogle Scholar
  7. 7.
    Bostrom MP, Seigerman DA (2005) The clinical use of allografts, demineralized bone matrices, synthetic bone graft substitutes and osteoinductive growth factors: a survey study. HSS J 1:9–18.  https://doi.org/10.1007/s11420-005-0111-5 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gamradt SC, Lieberman JR (2003) Bone graft for revision hip arthroplasty: biology and future applications. Clin Orthop Relat Res:183–194.  https://doi.org/10.1097/01.blo.0000096814.78689.77
  9. 9.
    Wu LD, Xiong Y, Yu HC (2007) Effects of rhBMP-2 on cortical strut allograft healing to the femur in revision total hip arthroplasties: an experimental study. Int Orthop 31:605–611.  https://doi.org/10.1007/s00264-006-0235-3 CrossRefPubMedGoogle Scholar
  10. 10.
    McGee MA, Findlay DM, Howie DW, Carbone A, Ward P, Stamenkov R, Page TT, Bruce WJ, Wildenauer CI, Toth C (2004) The use of OP-1 in femoral impaction grafting in a sheep model. J Orthop Res 22:1008–1015.  https://doi.org/10.1016/j.orthres.2004.01.005 CrossRefPubMedGoogle Scholar
  11. 11.
    Bormann N, Pruss A, Schmidmaier G, Wildemann B (2010) In vitro testing of the osteoinductive potential of different bony allograft preparations. Arch Orthop Trauma Surg 130:143–149.  https://doi.org/10.1007/s00402-009-0908-7 CrossRefPubMedGoogle Scholar
  12. 12.
    Pountos I, Georgouli T, Henshaw K, Bird H, Jones E, Giannoudis PV (2010) The effect of bone morphogenetic protein-2, bone morphogenetic protein-7, parathyroid hormone, and platelet-derived growth factor on the proliferation and osteogenic differentiation of mesenchymal stem cells derived from osteoporotic bone. J Orthop Trauma 24:552–556.  https://doi.org/10.1097/BOT.0b013e3181efa8fe CrossRefPubMedGoogle Scholar
  13. 13.
    Kanakaris NK, Mallina R, Calori GM, Kontakis G, Giannoudis PV (2009) Use of bone morphogenetic proteins in arthrodesis: clinical results. Injury 40(Suppl 3):S62–S66.  https://doi.org/10.1016/S0020-1383(09)70014-2 CrossRefPubMedGoogle Scholar
  14. 14.
    Seeherman H, Li R, Bouxsein M, Kim H, Li XJ, Smith-Adaline EA, Aiolova M, Wozney JM (2006) rhBMP-2/calcium phosphate matrix accelerates osteotomy-site healing in a nonhuman primate model at multiple treatment times and concentrations. J Bone Joint Surg Am 88:144–160.  https://doi.org/10.2106/JBJS.D.02453 PubMedGoogle Scholar
  15. 15.
    Aro HT, Govender S, Patel AD, Hernigou P, Perera de Gregorio A, Popescu GI, Golden JD, Christensen J, Valentin A (2011) Recombinant human bone morphogenetic protein-2: a randomized trial in open tibial fractures treated with reamed nail fixation. J Bone Joint Surg Am 93:801–808.  https://doi.org/10.2106/JBJS.I.01763 CrossRefPubMedGoogle Scholar
  16. 16.
    Karrholm J, Hourigan P, Timperley J, Razaznejad R (2006) Mixing bone graft with OP-1 does not improve cup or stem fixation in revision surgery of the hip: 5-year follow-up of 10 acetabular and 11 femoral study cases and 40 control cases. Acta Orthop 77:39–48.  https://doi.org/10.1080/17453670610045687 CrossRefPubMedGoogle Scholar
  17. 17.
    Cook SD, Barrack RL, Shimmin A, Morgan D, Carvajal JP (2001) The use of osteogenic protein-1 in reconstructive surgery of the hip. J Arthroplast 16:88–94CrossRefGoogle Scholar
  18. 18.
    Cheng H, Jiang W, Phillips FM, Haydon RC, Peng Y, Zhou L, Luu HH, An N, Breyer B, Vanichakarn P, Szatkowski JP, Park JY, He TC (2003) Osteogenic activity of the fourteen types of human bone morphogenetic proteins (BMPs). J Bone Joint Surg Am 85-A:1544–1552CrossRefPubMedGoogle Scholar
  19. 19.
    Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplast 9:33–44CrossRefGoogle Scholar
  20. 20.
    Malchau H, Karrholm J, Wang YX, Herberts P (1995) Accuracy of migration analysis in hip arthroplasty. Digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand 66:418–424CrossRefPubMedGoogle Scholar
  21. 21.
    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 20–32Google Scholar
  22. 22.
    Fernandez-Fairen M, Murcia A, Blanco A, Merono A, Murcia A Jr, Ballester J (2010) Revision of failed total hip arthroplasty acetabular cups to porous tantalum components: a 5-year follow-up study. J Arthroplast 25:865–872.  https://doi.org/10.1016/j.arth.2009.07.027 CrossRefGoogle Scholar
  23. 23.
    Termaat MF, Den Boer FC, Bakker FC, Patka P, Haarman HJ (2005) Bone morphogenetic proteins. Development and clinical efficacy in the treatment of fractures and bone defects. J Bone Joint Surg Am 87:1367–1378.  https://doi.org/10.2106/JBJS.D.02585 PubMedGoogle Scholar
  24. 24.
    Graham SM, Leonidou A, Aslam-Pervez N, Hamza A, Panteliadis P, Heliotis M, Mantalaris A, Tsiridis E (2010) Biological therapy of bone defects: the immunology of bone allo-transplantation. Expert Opin Biol Ther 10:885–901.  https://doi.org/10.1517/14712598.2010.481669 CrossRefPubMedGoogle Scholar
  25. 25.
    Robinson DE, Lee MB, Smith EJ, Learmonth ID (2002) Femoral impaction grafting in revision hip arthroplasty with irradiated bone. J Arthroplast 17:834–840CrossRefGoogle Scholar
  26. 26.
    Zara JN, Siu RK, Zhang X, Shen J, Ngo R, Lee M, Li W, Chiang M, Chung J, Kwak J, Wu BM, Ting K, Soo C (2011) High doses of bone morphogenetic protein 2 induce structurally abnormal bone and inflammation in vivo. Tissue Eng A 17:1389–1399.  https://doi.org/10.1089/ten.TEA.2010.0555 CrossRefGoogle Scholar
  27. 27.
    Muchow RD, Hsu WK, Anderson PA (2010) Histopathologic inflammatory response induced by recombinant bone morphogenetic protein-2 causing radiculopathy after transforaminal lumbar interbody fusion. Spine J 10:e1–e6.  https://doi.org/10.1016/j.spinee.2010.06.020 CrossRefPubMedGoogle Scholar
  28. 28.
    Valentin-Opran A, Wozney J, Csimma C, Lilly L, Riedel GE (2002) Clinical evaluation of recombinant human bone morphogenetic protein-2. Clin Orthop Relat Res 110–120Google Scholar
  29. 29.
    Kwong LM, Jasty M, Harris WH (1993) High failure rate of bulk femoral head allografts in total hip acetabular reconstructions at 10 years. J Arthroplast 8:341–346CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Department of OrthopaedicsUniversity at Buffalo Department of OrthopaedicsBuffaloUSA
  2. 2.University at Buffalo Department of OrthopaedicsBuffaloUSA

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