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Impaction Grafting and Cement in Acetabular Revision Arthroplasty

  • Tom J. J. H. Slooff
  • P. Buma
  • J. W. Schimmel
  • J. Gardeniers
  • R. Huiskes

Summary

Animal experiments were performed to restore bony defects with morsellized allograft chips. Acetabular defects were created in the Dutch milk goat and impacted with fresh frozen allograft bone chips. The speed of consolidation with the host bone bed, the mechanism and completeness of incorporation and the processes at the graft cement interface were studied in detail with histological and biomechanical procedures.

Histology showed that the graft had consolidated with the trabecular host bone bed within three weeks. In the subsequent period a front of vascular sprouts infiltrated the graft. Graft resorption, new bone formation and bone remodelling resulted in a new trabecular structure with optimal trabecular orientation for load bearing. After twelve weeks only scarce remnants of the original dead graft material remained in the incorporated area of the graft. At revascularized areas of the graft-cement interface, graft resorption and new bone formation had resulted in direct vital bone-cement contact sites and in areas with a soft tissue interface. After longer follow-up periods progressive interface formation and loosening of the cup was found in most of the animals.

The histological results were confirmed by biomechanical stability tests. In the first postoperative weeks the stability of the reconstruction increased, but at later follow-up periods, interface formation at the new bone-cement layer compromised the stability of the reconstruction.

The results indicated that reconstruction with morsellized graft material leads to rapid consolidation, incorporation and remodelling of the graft. Problems at the graft-cement interface are probably not related to the use of the morsellized graft, but to the goat model used.

Keywords

Bone Graft Cement Layer Bone Transplantation Impaction Grafting Graft Incorporation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Albee FH (1923) Fundamentals in bone transplantation. Experiences in three thousand bone grafts. J Am Med Assn 81: 1429 – 1432Google Scholar
  2. 2.
    Albee FH (1912) Discussion of the preservation of tissues and its application in surgery. J Am Med Assn 59: 527Google Scholar
  3. 3.
    Axhausen G (1911) Arbeiten aus dem Gebiet der Knochenpathologie und Knochenchirurgie.l. Kritische Bemerkungen und neue Beitrage zur freien Knochentransplantation. Arch Klin Chir 94: 241 – 281Google Scholar
  4. 4.
    Barth A (1908) Ueber Osteoplastik. Arch Klin Chir 86: 859 – 872Google Scholar
  5. 5.
    Brooks DB, et al (1963) Immunological factors in homogenous bone transplantation. IV. The effect of various methods of preparation and irradiation on antigenicity. J Bone Joint Surg 45-A: 1617 – 1625PubMedGoogle Scholar
  6. 6.
    Buma P, Schreurs BW, Versleyen D, Huiskes R, Slooff TJ (1992) Histologic evaluation of allograft incorporation after cemented and non-cemented hip arthroplasty in the goat. In: Older J (ed) Bone implant grafting. London: Springer, 12Google Scholar
  7. 7.
    Burchardt H, Busbee OA, Enneking WF (1975) Repair of experimental autologous grafts of cortical bone. J Bone Joint Surg 57-A: 814PubMedGoogle Scholar
  8. 8.
    Burchardt H (1989) Biology of cortical bone graft incorporation. In: Aebi M, Regazzoni P (eds) Bone transplantation. Berlin: Springer, pp 23 – 29Google Scholar
  9. 9.
    Burwell RG, Gowland G (1962) Studies in the transplantation of bone. The immune response of lymph nodes draining components of fresh homogenous bone treated by different methods. J Bone Joint Surg 44-B: 131 – 148Google Scholar
  10. 10.
    Burwell RG (1969) The fate of bone grafts. In: Apley GA (ed) Recent advances in orthopaedics. London: Churchill, pp 115 – 207Google Scholar
  11. 11.
    Bush LF (1947) The use of homogenous bone grafts. A preliminary report on the bone bank. J Bone Joint Surg 29: 620 – 628PubMedGoogle Scholar
  12. 12.
    Campbell CJ (1953) Experimental study of the fate of bone grafts. J Bone Joint Surg 35-A: 332 – 346PubMedGoogle Scholar
  13. 13.
    Curtis BF (1892) Bone transplantation for nonunited fractures. Medical Record, Jan 2Google Scholar
  14. 14.
    Enneking WF, Mindell ER (1991) Observation on massive retrieved human allografts. J Bone Joint Surg 73-A: 1123 – 1142PubMedGoogle Scholar
  15. 15.
    Friedlaender GE (1991) Bone allografts: the biological consequences of immunological events. J Bone Joint Surg 73-A: 1119 – 1123Google Scholar
  16. 16.
    Friedlaender GE (1987) Current concepts review on bone grafts. The basic science rationale for clinical applications. J Bone Joint Surg 69-A: 780Google Scholar
  17. 17.
    Goldberg VM, Powell A, Shaffer JW, Zika J, Stevenson S, Davy D, Heiple K (1989) The role of histocompatibility in bone allografting. In: Aebi M, Regazzoni P (eds) Bone transplantation. Berlin: Springer, 126Google Scholar
  18. 18.
    Goldberg VM, Stevenson S (1987) Natural history of autografts and allografts. Clin Orthop 225: 7PubMedGoogle Scholar
  19. 19.
    Greco F, De Palma U, Spechia A, Santucci A (1989) Biological aspects of repair osteogenesis in cortico-spongy homologous grafts. Ital J Orthop Traumatol 23: 491Google Scholar
  20. 20.
    Harris WH, Crothers O, Oh I (1977) Total hip replacement and femoral head bone grafting for severe acetabular deficiency in adults. J Bone Joint Surg 59-A: 752PubMedGoogle Scholar
  21. 21.
    Hastings DE, Parker SM (1975) Protrusio acetabula in rheumatoid arthritis. Clin Orthop 108: 7684Google Scholar
  22. 22.
    Heiple KG, Chase SW, Herndon CH (1963) A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg 45-A: 1593 – 1612PubMedGoogle Scholar
  23. 23.
    Herndon CH, Chase SW (1954) The fate of massive autogenous and homogenous bone grafts including articular surfaces. Surg Gynec Obstet 98: 273 – 290PubMedGoogle Scholar
  24. 24.
    Lexer E (1908) Uber Gelenktransplantation. Med Klin 4: 817Google Scholar
  25. 25.
    MacEwen W (1881) Observations concerning transplantation of bones: Illustrated by a case of interhuman osseous transplantations, whereby over two-thirds of the shaft of a humerus was restored. Proc Roy Soc London 32: 232 – 247CrossRefGoogle Scholar
  26. 26.
    Mankin HJ, Friedlaender GE (1989) Bone and cartilage allografts: physiological and immunologi¬cal principles. In: Chandler HP, Penenberg BL (eds) Bone stock deficiency in total hip replacement. Thorofare, NJ: Slack, chapter 1Google Scholar
  27. 27.
    McCollum DE, Nunley JA, Harrelson JM (1980) Bone grafting in THR for acetabular protrusion. JBJS 72-A: 248 – 252Google Scholar
  28. 28.
    Oilier L (1867) Traite experimental et clinique de la regeneration des os et de la production artificielle du tissue osseux. Victor Masson et Fils: ParisGoogle Scholar
  29. 29.
    Ottolenghi CE (1972) Massive osteo and osteoarticular bone grafts. Technique and results of 62 cases. Clin Orthop 87: 156 – 164PubMedCrossRefGoogle Scholar
  30. 30.
    Scales JT, Wright KWJ (1983) Major bone and joint replacement using custom implants. In: Chao EYs, Irin IC (eds) Tumor prosthesis for bone and joint reconstruction, the design and application. Stuttgart: Thieme, pp 149 – 168Google Scholar
  31. 31.
    Schreurs BW, Huiskes R, Slooff TJJH (1990) Proceedings 7th Meeting European Society of Biomechanics, Aarhus, DK, A14Google Scholar
  32. 32.
    Schreurs W, Huiskes R, Slooff TJJH, Buma P (1992) A method to estimate the initial stability of cemented and non-cemented hip stems fixated with a bone grafting technique. In: Older J (ed) Bone implant grafting. Berlin: Springer, chapter 18, pp 131 – 134Google Scholar
  33. 33.
    Schreurs BW, Buma P, Huiskes R, Slagter JLM, Slooff TJJH (1993) Transactions ORS, 452, San Francisco, USAGoogle Scholar
  34. 34.
    Schreurs BW, Buma P, Huiskes R, Slagter JLM, Slooff TJJH (1994) A technique for using im¬pacted trabecular allografts in revision surgery with cemented stems. Acta Orthop Scand 65: 267 – 275PubMedCrossRefGoogle Scholar
  35. 35.
    Schreurs BW, Huiskes R, Slooff TJJH (1994) The initial stability of cemented and noncemented femoral stems fixated with a bone grafting technique. Clin Mater 16: 105 – 110CrossRefGoogle Scholar
  36. 36.
    Selvik G (1989) Roentgen stereophotogrammetry. Acta Orthop Scand 60 [Suppl 232]Google Scholar
  37. 37.
    Selvik G (1974) A roentgenstereophotogrammatic method for the study of the kinematics of the skeletal system. Thesis, University of Lund, Lund, SwedenGoogle Scholar
  38. 38.
    Slooff TJ, Van Horn J, Lemes A, Fluiskes R (1984) Bone grafting for total hip replacement for acetabular protrusion. Acta Orthop Scand 55: 593 – 596PubMedCrossRefGoogle Scholar
  39. Slooff TJJH (1992) Acetabular augmentation in cemented arthroplasty: pre-operative assess¬ment and surgical technique. In: Older J (ed) Bone implant grafting. Berlin: Springer, chapter 8, pp 51 – 55Google Scholar
  40. 40.
    Stevenson S, Xiao Qing Li, Martin B (1991) The fate of cancellous and cortical bone after transplantation of fresh and frozen tissue-antigen-matched and mismatched osteochondral allografts in dogs. J Bone Joint Surg 73-A: 1143 – 1157PubMedGoogle Scholar
  41. 41.
    Urist MR (1953) The physiological basis of bone graft surgery, with special reference to the theory of induction. Clin Orthop 1: 207PubMedGoogle Scholar
  42. 42.
    Urist MR (1965) Bone: formation by auto-induction. Science 150: 893 – 899PubMedCrossRefGoogle Scholar
  43. 43.
    Urist MR, De Lange RJ, Finerman GA (1983) Bone cell differentiation and growth factors. Science 220: 680PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1996

Authors and Affiliations

  • Tom J. J. H. Slooff
    • 1
  • P. Buma
    • 2
  • J. W. Schimmel
    • 1
  • J. Gardeniers
    • 1
  • R. Huiskes
    • 2
  1. 1.Institute of OrthopaedicsUniversity Hospital NijmegenNijmegenThe Netherlands
  2. 2.Institute of Orthopaedics, Laboratory of Experimental OrthopaedicsUniversity Hospital NijmegenNijmegenThe Netherlands

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