Bone Grafts Using Fibrin Glue for Posterolateral Spinal Fusion and Total Hip Replacement with Central Migration

Abstract

Bone grafting is frequently used as a surgical procedure for various pathologies in orthopedics. However, whether or not transplanted bone is functional depends on several factors on the part of the recipient and on the varying conditions of the transplanted bone and the bone bed. We investigated the state of transplanted bone in 136 patients in whom we used fibrin glue (FG) in bone transplantation. The purpose of this study is to estimate the usefulness of FG in bone transplantation.

From January 1985 to December 1991, 104 patients underwent posterolateral spinal fusion (PLF); 32 patients either underwent total hip replacement (THR) or bone transplantation for rheumatoid arthritis (RA) involving protrusio acetabuli. In addition, 58 patients in whom FG was not used underwent PLF, and in 19 patients THR and bone transplantation were performed without FG. These served as controls. In these cases, the state of junction and the transplanted bone were evaluated by postoperative clinical findings, X-ray examination, CT and MR imaging etc. In the patients who underwent PLF, bone fusion was observed in 46 of 58 patients (79.3%) in the group operated without FG, but in 89 out of 104 (85.6%) in the group treated with FG. Absorption of transplanted bone was observed in five patients (8.9%) in the group without FG and in four patients (3.8%) in the group treated with FG. Clinical findings included 12 lumbagos among the cases with bone adhesion insufficiency of all cases (7.4%). Recurrence of radiculopathy was observed in only one case. In patients in whom bone transplantation was performed in addition to THR and for RA with protrusio acetabuli, absorption of the transplanted bone occurred in three out of 19 patients (16.8%) in the group without FG, but in one out of 32 patients (3.1%) in the group treated with FG. It is known that FG has an osteogenic potential accelerating osseous incorporation of grafts. This has been confirmed by the clinical results of our present study. Thus, the use of FG during bone transplantation constitutes an additional advantage.