Impaction bone grafting with morselized bone in total hip revision for acetabular deficiency / 中国组织工程研究

BACKGROUND:Bone graft for acetabular reconstruction includes morselized bone graft, structural bone graft and hybrid bone graft, and the morselized bone has been widely used because of the advantages of simple production and short healing time. OBJECTIVE:To explore the key technologies and clinical effect of impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency. METHODS:Sixteen cases of AAOS Ⅲ acetabular deficiency were treated with impaction bone grafting with morselized bone combined with metal devicesor constructive bone grafting. The hip Harris scores and radiographic data were compared before and after treatment. The effect of impaction bone grafting with morselized bone on acetabular deficiency was assessed. RESULTS AND CONCLUSION:Al the patients were fol owed-up at 3, 6, 12 months after surgery and every half a year successively. The pain of hip joints after operation was relieved significantly and the walking function was restored. The hip Harris score was improved from 48.00 points before surgery to 84.94 points after surgery (Pacetabular cup prosthesis did not displaced, and no displacement and breakage happened to the metal devices. Impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency can effectively reconstruct the acetabular bone structure, retain and restore the acetabular bone mass, and it has good technical advantages and good clinical effects.

Open autologous minimal morselized bone grafting with vancomycin repairs infected tibial defects / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.25.004

Posterior Lumbar Interbody Fusion Using a Unilateral Single Cage and a Local Morselized Bone Graft in the Degenerative Lumbar Spine

BACKGROUND: We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) with using a unilateral single cage and a local morselized bone graft. METHODS: Fifty three patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 31.1 months. The clinical outcomes were evaluated with using the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the last follow-up, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria at the last follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instablity and the disc height. RESULTS: For the clinical evaluation, the VAS pain index, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria showed excellent outcomes. For the the radiological evaluation, 52 cases showed complete bone union at the last follow-up. Regarding the complications, only 1 patient had cage breakage during follow-up. CONCLUSIONS: PLIF using a unilateral single cage filled with a local morselized bone graft has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.

Treatment of Thoracolumbar Vertebrate Fracture by Transpedicular Morselized Bone Grafting in Vertebrae for Spinal Fusion and Pedicle Screw Fixation / 华中科技大学学报（医学）（英德文版）

To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A (n=20) were reinforced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B (n=50) did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B (group A: 6.4 degree; group B: 5.4 degree)/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B (P=0.0001). Postoperatively, greater anterior height was achieved in group A than in group B (P<0.01). During follow-up study, anterior vertebral height was maintained only in Group A (P<0.001). Both group A and group B showed good Denis pain scores (P1 and P2) but group A outdid group B in terms of control of severe and constant pain (P4 and P5). By Frankel criteria, the changes in neurological functions in group A was better than those of group B (P<0.001). It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.

Acetabular Revision Using Cementless Acetabular Cup

PURPOSE: To evaluate implant survivorship and clinical outcomes after acetabular revision using cementless acetabular cups. MATERIALS AND METHODS: We evaluated 27 cementless acetabular revision cases performed between January 1998 and October 2005. All patients were followed up for more than 2 years, and the mean follow-up period was 54.1 months (range: 24~120 months). In all cases, morselized allografting was performed. Five cases needed structural allografting to achieve stability of the acetabular cup. The clinical results were analyzed using the Harris hip score, and radiological analysis was performed for evaluation of radiolucent lines, osteolysis, loosening, and changes in the hip center. RESULTS: At the time of latest follow-up, no cups showed failure requiring re-revision. The average Harris hip score improved from 67.1 points preoperatively to 91.4 points postoperatively. Radiologically, 7 cases (25.9%) showed radiolucent lines around the acetabular cup, but there was no loosening or osteolysis. CONCLUSION: Cementless acetabular revision showed satisfactory radiological and clinical results on short-term follow-up analysis. Even in cases with considerable amounts of acetabular bone loss, stable fixation could be obtained with structural bone grafting.

Acetabular Reconstruction with Impacted Morselized Allograft, Wire Mesh and Cemented Acetabular Cup in Severe Acetabular Bone Defect

PURPOSE: This study evaluated the clinical and radiographic results of an acetabular reconstruction with an impacted morselized allograft and wire mesh in revision total hip arthroplasty. MATERIALS AND METHODS: This study examined 21 cases of acetabular revisions involving 20 patients with a severe acetabular bone defect managed with an impacted morselized allograft, wire mesh and cemented acetabular cup between February 2000 and June 2003. The mean follow up period was 31.7 months. Clinically, the Harris hip score was evaluated. The radiographic parameters included bony incorporation between the host bone and allograft, the change in cup inclination, acetabular cup migration, radiolucency around the cup and loosening. RESULTS: The mean Harris hip score was improved from a preoperative 54.1 to 91.9 at the last follow up. Radiological incorporation between the host bone and allograft was achieved after an average 11.4 months after surgery. The mean change in cup inclination was 1.9 degrees, and the mean medial and superior migration was 3.93 mm and 4.41 mm respectively. The majority of these radiological changes occurred within 6 months after surgery. One case of Brooker grade I heterotopic ossification and one case of acetabular cup loosening was observed but there was no re-revision or complications, such as infection and dislocation. CONCLUSION: In a severe acetabular bone stock deficiency that cannot be reconstructed with a cementless acetabular cup, an acetabular reconstruction with an impacted morselized allograft, wire mesh and cemented acetabular cup showed good results in this short term follow up study.

Posterior Lumbar Interbody Fusion Using Titanium Cages and Morselized Local Bone Autograft / 대한척추외과학회지

STUDY DESIGN: A retrospective study to evaluate the results of posterior lumbar interbody fusion (PLIF) using titanium cages filled with morselized local bone. OBJECTIVE: To verify the clinical and radiological results of the PLIF procedure using rectangular titanium cages filled with morselized local bone. SUMMARY AND LITERATURE REVIEW: Stabilization of the spine can be achieved by interbody arthrodesis through the posterior approach. However many significant problems including bone graft collapse, resorption, nonunion, and iliac donor site morbidity caused by the classic PLIF procedure need to be solved. The use of local bone and a titanium cage might be a solution. MATERIALS AND METHOD: Fifty-nine patients(average age at surgery, 51.3 years), who underwent surgery for degenerated low back disease, were enrolled in this study. The average follow-up duration was 19.9 months. The radiological fusion status, intervertebral disc heights, visual analogue scales, clinical outcomes were evaluated. RESULTS: Forty-three (73%) patients were classified as complete-union, 16 (27%) patients as probable-union, and no patients were classified as non-union. The average intervertebral disc height increased by 3.7 mm at immediate postoperatively, and the average subsidence was 1.1 mm at the final follow-up. The average visual analogue scale decreased from 5.5 to 1.4 for back pain and from 6.6 to 0.8 for radicular pain. Nineteen (32%) and 28 (48%) patients were classified as excellent and good, respectively, according to clinical outcome assessment by Kim and Kim criteria. The complications encountered were a dural tear in 8 patients, partial root injury in 1, and upper adjacent segment instability during follow-up in 2. CONCLUSION: PLIF using titanium cages filled with morselized local bone has the advantages of maintaining an intervertebral disc height, immediate stability, and the avoidance of donor site morbidity. However, longer-term results are needed, because the follow-up period of this study was relatively short

Subtalar Arthrodesis using Cannulated Screws and Morselized Bone Graft / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological outcome of subtalar arthrodesis using cannulated screws and morselized bone graft. MATERIALS AND METHODS: Twenty one patients with follow-up of more than 1 year after subtalar arthrodesis were included in this study. Mean age was 40.8 years, and mean follow-up duration was 38 months. Underlying diseases were 19 cases of posttraumatic arthritis (18 calcaneal fractures and 1 talar fracture) and 2 cases of tarsal coalition. Clinically AOFAS ankle-hindfoot score, operation time, complication and satisfaction of patients were analyzed. Radiologically time to union, arthritis of surrounding joints, preoperative and postoperative talar declination angle were analyzed. RESULTS: AOFAS ankle-hindfoot score was improved from preoperative 33 points to postooperative 79 points. Eighteen patients (86%) were satisfied with the results. Mean operation time was 91 minutes. All cases were fixed with 1-2 cannulated screws and morselized bone graft. Mean time to radiologic union was 12.1 weeks. There was 1 case of delayed union. There was no significant perioperative changes in talar declination angles. CONCLUSION: Subtalar arthrodesis using cannulated screws and morselized bone graft seems to be relatively simple and effective treatment method for subtalar arthritis.

Experimental study of cervical interbody fusion with combined hollow threaded autograft fixator with morselized bone transplantation / 中国矫形外科杂志

[Objective]To study cervical hollow threaded autograft cortical bone fixator with morselized bone for cervical anterior interbody fusion.[Method] Eighteen sheep were underwent cervical anterior discectomy and fusion with a hollow threaded and fenestrated tibial cortical hone fixator filled with morselized bone(diameter of 300～500 um) for C5、6 or autogenous iliac crest bone cylinder or C3、4 respectively.Cervical spines were radiographed immediately after surgery and 1,2,3 months later,the specimens of C5～6 and C3～4 were taken for histology investigation and biomechanical test respectively.[Result] Interbody fusion was achieved 3 months after surgery in experimental gronp and all but one in control group,with statisticdly significant difference was found between two groups in biomechanical compression and torsion tests of ante or post-fatigue test(P

Titanium plate and morselized bone grafting for severe acetabular bone defect / 中国矫形外科杂志

[Objective]To explore the clinical effects of titanium plate and morselized hone grafting for the treatment of severe acetabular hone defect.[Method]A total of 27 patients with acetabular defects were treated with this procedure.According to AAOS,the acetabular defects were classified into various types:type Ⅰ in 6 cases,type Ⅱc in 4 and type Ⅲ in 17.The average preoperation Harris score were 37.The postoperative effect should be evaluated by clinical and X-ray manifestations.[Result]All patients were adopted this method to reconstruct the acetabular bone defects.The prosthetic dislocation was found in one case after operation,which was resulted from over-anteverted titanium plate impacted the greater trochanter.The part of trochanteric bone and impact factors were removed to healing.No complications were found in other patients.The average following up was 3 years and average Harris score was 87.The X-ray showed that none of the patients was presented the radiolucent lines in the acetabular mattress,bone transplantation,reconstructive titanium plate and interface of polyethylene liner.[Conclusion]The titanium plate and morselized bone grafting can repair the acetabular bone defects effectively and provide a solid initial fixation for prosthesis and restore the role of rotational center of hip.

Morselized bone grafting in osteolysis around the stable cenmentless acetabular cup / 中国矫形外科杂志

[Objective]To evaluate the clinical and radiological results of a curettage of granulation tissue,the exchange of polyethylene liner and morselized bone grafting for the treatment of osteolysis around a stable cementless acetabular cup.[Method]From Apr.1996 to Jul.2000,26 patients underwent revision of curettage of granulation tissue,the exchange of polyethylene liner and morselized allografting,which were followed up for an average of 5.5 years.The Harris Hip Score was used to evaluate the clinical result.The size of osteolysis of periacetabular cup was measured in AP and lateral view of X-rays.The allograft union was evaluated with the bone graft incorporation scale.[Result]Clinically,the average HHS increased from 82 to 88 points postoperatively.Radiologically,the size of osteolysis of peraacetabular cup changed from average 23.8 mm?24.9 mm to 11.5 mm?8.2 mm in the AP view,and from 11.1 mm?11.6 mm to 5.3 mm?4.5 mm in the lateral view.The bone graft incorporation scales were Grade Ⅰ and Ⅱ in 12 and 14 cases,respectively.[Conclusion]The Curettage of granulation tissues,morselized bone grafting and exchange of polyethylene liner and femoral head is an effective therapy in osteolysis around a stable cementless acetabular cup and could preserve the bone stock for the further revision THA.

Cementless Acetabular Revision Performed with Morselized Bone Grafts:A Ten-Year Minimum Follow-Up

Purpose: We evaluated the results of cementless acetabular revisions performed with morselized bone grafting and screw-fixed hemispherical cups with different surface treatments. Materials and Methods: Forty hips, which had been followed for more than 10 years, were included in this study. Reconstruction was performed with 10 hydroxyapatite (HA)-coated cups and 30 porocoated ones. The mean followup time was 12 years and 1 months (range, 10 years to 15 years). Re-revision or radiographic loosening was considered as an endpoint of follow-up. Results: The average Harris hip score improved from 52 points to 75 points. During the follow-up period, radiographic loosening was observed in 17 hips. The loosened implants were HA-coated cups in 8 hips and porocoated ones in 9 hips. In 14 of these, re-revision of the cups was performed. The re-revision rate was 20% for the porocoated cups and 80% for the HA-coated cups. There were 2 hips with liner wear, which had undergone liner and head changes. Bone grafts were united in all the hips. The average time to union was 5.2 months (range, 2 to 9 months), and the average time to incorporation was 12 months (range, 5 to 18 months). Conclusion: Our results imply that HA-coated cups have a significantly higher failure rate compared with the porocoated ones (P<0.05) after a minimum follow-up of 10 years. Morselized bone grafting with use of a porocoated cup is an effective modality, which can restore the bone loss of the acetabulum in revision total hip arthroplasty.

Experimental study on repairing bone defect with the compound of the allogeneic morselized bone / 中国康复理论与实践

@#ObjectiveTo observe the effect of the compound of the allogeneic morselized bone and the calcium phosphate cement on repairing bone defect.MethodsThe rabbit models of bilateral radius bone defect were created. 40 rabbits were randomly divided into group A, group B and group C. Animals of the group A were implanted with the compound of the allogeneic morselized bone and the calcium phosphate cement, group B implanted with allogeneic morselized bone, and group C as blank control implanted nothing. The X-ray examination, histopatholgical examination, vascularization and biomechanics of bone defect were evaluated at 4 and 8 weeks after operation.ResultsThe repair of bone defect, quantity and rate of the new formation bone and biomechanics measurement of the group A were superior than the group B; while, no repair of bone defect was found in the group C.ConclusionThe implantation of the allogeneic morselized bone can repair bone defect, but the effect of implanting the compound of the allogeneic morselized bone and the calcium phosphate cement is better than the former.

Expression of basic fibroblast growth factor in ectopic osteogenesis of autogenetic minimal morselized bone / 中华创伤杂志

Objective To study the expression of basic fibroblast growth factor (bFGF) in ectopic osteogenesis of autogenetic minimal morselized bone so as to discuss the bone formation of minimal morselized bone. Methods All 48 rabbits were divided into two groups randomly. Then autogenetic minimal morselized bone and bulk bone were implanted into the muscle bag models of gluteus maximus muscle respectively. Samples were harvested on day 1,3,5,7,11,14,21 and 28 postoperatively and tested by the methods of histology, immunohistochemistry (IHC) and in situ hybridization (ISH). Results (1) The morselized bone grew faster than the bulk bone and was replaced by neonatal bone on the 28th day. In the group of bulk bone, the ability of osteogenesis was weaker dominated by bone absorption. (2) In the morselized bone group, the expression peaks of bFGF and bFGFmRNA appeared at day 5-7 postoperatively, mainly appeared in the mesenchymal cells, fibroblast, chondrocyte and osteoblast by the method of IHC and ISH. While in the group of bulk bone, the expressions of bFGF and bFGFmRNA were similar to those in the morselized bone group. The difference between the two groups was significant ( P

Revision Total Hip Arthroplasty using Morselized Femoral Head Allograft and Cementless Cup in Acetabular Bone Deficiency / 대한정형외과학회잡지

PURPOSE: This study was aimed to evaluate the clinical and radiologic results of revision total hip arthroplasty using a cementless cup and a morselized femoral head allograft in acetabular bone deficiency. MATERIALS AND METHODS: From January 1992 to December 1999, the authors performed 37 revision total hip arthroplasties using morselized femoral head allografts and cementless cup. This study evaluated the clinical and radiologic results, at a mean follow-up of 50 months. We evaluated the Harris hip score clinically, and the displacement of acetabular cup by Yoder's criteria. Location and progression of radiolucent area within acetabular zone, which was defined by DeLee and Charnley was observed and recorded. RESULTS: Mean Harris hip score was improved from 50.6 preoperative to 89.2 at final follow-up. A radiolucent zone between host bone and graft bone was observed in 5 cases, and between graft bone and cup in 7 cases, but all of these were less than 2 mm. The change of cup angle more than 4 degrees were observed in 3 cases in Gross type 4, 4 mm superior migration of acetabular cup was observed in 1 case in Gross type 3 and 5 mm horizontal migration was observed in 1 case in Gross type 4. CONCLUSION: Although the early results in revision total hip arthroplasty have been encouraging to date except for Gross type 4, a more long term follow-up study with a larger size cases are needed.

Acetabular Revision Total Hip Arthroplasty Using Uncemented Cup and Morselized Impacted Allograft / 대한정형외과학회잡지

PURPOSE: This study was undertaken to evaluate the clinical and radiographic results of acetabular revision arthroplasty using an uncemented big cup and a morselized impacted allograft. MATERIALS AND METHODS: This study involved 81 hips of 77 patients experienced over a 2 year period (2-8 years 10 months). The bone defects of the acetabulum were classified by AAOS classification and by the Paprosky classification. We inserted an uncemented hemispherical cup by press-fitting technique as large size as possible. Only morselized impacted allograft was used for the bone defect. RESULTS: The average Harris hip score was 95.9. One case (Paprosky type IIIB) received revision with only morselized allograft and failed to achieve initial stability. Therefore re-revision was performed with tricortical autograft and morselized allograft which has been well maintained until now for 3.5 years. Vertical migration and horizontal migration of more than 3 mm were noted in five cases and two cases, respectively. Rotational migration of more than 8 degree was not noted. A radiolucent line between bone and cup was seen in 9 cases, and a radiolucent line between host bone and grafted bone in 2 cases, this line was less than 2 mm large. CONCLUSION: We believe this method is a good option in revision acetabular total hip arthroplasty.

Reconstruction of the Acetabular Bone Defect with Morselized Bone Grafts in Acetabular Cup Revision Screw fixed Hemispherical Cup vs. Bipolar Cup / 대한정형외과학회잡지

The purpose of this study is to evaluate the results of the reconstruction of acetabular bone defect with morselized bone graft in revision of failed acetabular cup, used screw fixed hemispherical cup or bipolar cup as a component. Forty five revisions of an acetabular component that had been performed in 42 patients between 1988 and 1993 at SNUH, and had followed more than two years were included in this study. The revised acetabulum was evaluated by Harris hip score, in terms of osseous union and resorption of the graft, the amount of the migration of the revised components. Cup angle change and radiolucency were also evaluated in screw fixed hemispherical cup. The mean Harris hip score was improved 54 to 87 in screw fixed hemispherical cup and 56 to 78 in bipolar cup. In screw fixed hemispherical cup, osseous union showed within 6 months is 91.3% (21 cases), the graft bone resorption less than 10% of the initial graft thickness is 73.9% (17 cases). In bipolar cup, osseous union within 6 months is 52.2% (12 cases), the graft bone resorption less than 10% of the initial graft thickness is 40.9% (9 cases). The failure of revised acetabular component was five in bipolar cup cases and one in screw fixed hemispherical cup cases. In conclusion, screw fixed hemispherical cup showed better clinical results, earlier graft osseous union, less graft bone resorption and lower failure rate than bipolar cup. There was no significant difference between pure allograft mixed with autograft in clinical and radiological results. So we recommend the technique used morselized allograft with screw fixed hemispherical cup, to reconstruct the acetabular bone defect in acetabular cup revision, though bipolar cup was used in staged operation in severe acetabular bone defect with was unable to fix the acetabular cup with screws.