Subtalar Distraction Arthrodesis Using Frozen Allobone Graft by Interpositional Structural / 대한족부족관절학회지

PURPOSE: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. MATERIALS AND METHODS: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. RESULTS: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). CONCLUSION: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

Structural Allograft for Management of Severe Bone Defectin Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiographic results after revision total knee arthroplasty using a structural allograft for large bone defects. MATERIALS AND METHODS: 184 cases of revision total knee arthroplasty were performed from January 1992 to February 2003. Among them, 52 knees in 48 patients with the use of structural allograft for the management of large bone defects were retrospectively reviewed. Those 52 knees have been followed until recently. The average follow-up period was 5 years and 6 months. Fresh-frozen femoral head was used as the structural allograft in all knees. The clinical rating system of the American Knee Society was used for the clinical assessment. Union at the allograft-host bone junction, femoro-tibial angle and periprosthetic radiolucent lines using a radiographic evaluation of American Knee Society were analyzed radiographically. RESULTS: At the final follow-up, the mean preoperative knee and function score improved from 38.6 points to 82.6 and 30.3 to 76.4, respectively. Radiographically, union of the allograft to the host bone was observed in all knees. The average femoro-tibial angle was corrected from 1.8 degrees in valgus to 6.2 degrees. The radiographic evaluation revealed no evidence of loosening. CONCLUSION: Revision total knee arthroplasty using a femoral head allograft is an appropriate surgical method for treating large bone defects.

Structural Allograft for Femoral Deficiency in Revision Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: We investigated the results and the effectiveness of structural allografts, which were obtained from a donated cadaver for femoral deficiency in revision total hip arthroplasty. MATERIALS AND METHODS: We reviewed 27 patients who received a structural allograft for femoral deficiency in revision total hip arthroplasty with a minimum follow-up of 2 years. All allografts were fresh frozen bone obtained from donated cadavers. Whole proximal femur was used in 3 patients and strut or cortical onlay graft in the others. The results were evaluated by using Harris hip scores and by the presence of complications, clinically and stability of stem, osteolysis, radiolucent line, and by the radiographic union of the allograft. RESULTS: The average Harris hip score improved from 40.1 preoperatively to 86.9 postoperatively, and the stem showed bony stability in 18 patients, fibrous stability in 8 patients, and instability in 1 patient due to the recurrence of infection. Radiologically, osteolysis was observed in 4 patients (14.8%), radiolucent line over 2 mm in 1 patient, and union of allografts in 25 patients (92.6%) that showed stable stem. The average union time was 7.5 months. Nonunion of allografts were observed in 2 patients revised with a cancellous bone autograft. Complications were infection in 1 patient, dislocation in 2 patients, and heterotopic ossification in 1 patient. CONCLUSIONS: Structural allografts obtained from cadaveric donor were used for large femoral deficiency in revision total hip arthroplasty. Our results show that satisfactory union and can successfully restore the bone stock for further surgery.

Use of Structureal Allograft in Revision Total Knee Arthroplasty

PURPOSE: To analyze the clinical and radiological results after revision total knee arthroplasty(TKA) using structural allograft for severe bone defect, MATERIALS AND METHODS: Between l992 and 1997, we used structural allograft for revision TKA in 20 knees of 18 patients with severe bone defect, The average age at surgery was of 61.6 years. The follow-up period averaged 43 months(range, 1 3-80 months). All patients had severe bone defect of the femur and/or tibia. Ten distal femur and thirteen proximal tibia required allografting. Fresh frozen femoral heads were used in all patients. We used posterior stabilized stemmed PFC knee component in all cases except one case with constrained condylar type. Patients were evaluated with physical examination, radiographs and the Hospital for Special Surgery knee rating scale. RESULTS: Average range of motion before surgery was 87degrees and after surgery 107degrees. Average knee score was 65 before and 90.4 after surgery. Preoperative alignment averaged 1.8degrees valgus, ranging from 17degrees varus to 13degrees valgus, and postoperative alignment averaged 7,2 degrees velgus, ranging from 3degrees valgus to 10 val-gus, All patient improved pain and stability. Postoperatively average HSS score improved from 65(rang- ing from 46 to 92) to 90.4(ranging from 75 to 100). All of the allografts united with host bone. There was no radiolucent line, lysis, fracture and infection. CONCLUSION: Structural allograft can be a satisfactory method of managing large bone defects in the failed total knee arthroplasty.