Cemented acetabular component with femoral neck autograft for acetabular reconstruction in Crowe type III dislocated hips.

AIMS: Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck. METHODS: A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation. RESULTS: Radiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery. CONCLUSION: The technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips. Cite this article: Bone Joint J 2021;103-B(2):299-304.

Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head.

BACKGROUND: "Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO4)-calcium phosphate (CaPO4) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect. METHODS: A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study. RESULTS: In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions. CONCLUSIONS: Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH. TRIAL REGISTRATION: German clinical trials register ( DRKS00011269 , retrospectively registered).

Subtalar Distraction Arthrodesis with Fresh Frozen Femoral Neck Allograft: A Retrospective Case Series.

UNLABELLED: Subtalar joint distraction arthrodesis has been well reported with use of structural iliac crest or local autologous bone graft for malunited calcaneal fractures. Early reports for structural allograft did not yield good, consistent results, leading to a subsequent lack of recommendation in previous literature. Newer studies have had promising results utilizing femoral allograft as an alternative to autogenous bone graft. We performed a retrospective chart review on 10 patients (12 feet) undergoing subtalar joint distraction arthrodesis with femoral neck allograft for malunited calcaneal fractures. The primary aim of this study was to report on successful union rates and, in addition, outline any consistent complications. Twelve of the 12 procedures (100%) yielded successful fusion with a mean final follow-up of 7.7 months (range = 2.2-35.1 months). The mean increase in talocalcaneal height was 4 mm (range = 2-6 mm). The overall complication rate was 16.6%, including one superficial wound complication that healed uneventfully and one hardware removal. In conclusion, the current study reports a 100% successful fusion rate with interpositional structural femoral neck allograft in treatment for malunited calcaneal fractures. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

Neck fracture femoral heads for impaction bone grafting: evolution of stiffness and compactness during impaction of osteoarthrotic and neck-fracture femoral heads.

BACKGROUND: The need for safe bone allografts is increasing and preservation of femoral heads from patients being operated on with hip arthroplasty should be encouraged. However, should we preserve femoral heads from patients operated on for neck fracture as tissue mechanical quality may not be satisfactory? MATERIAL AND METHODS: We compared the evolution of stiffness and compactness of fresh-frozen morselized bone obtained from osteoarthrotic femoral heads and those from neck fractures. Both materials were also compared after freeze-drying and irradiation. We used 6 osteoarthrotic and 6 neck-fracture femoral heads to prepare 4 batches of morselized bone. 18 samples from each batch were impacted in a contained cylinder. Frozen bone grafts were tested after thawing at room temperature for 2 hours and freeze-dried grafts were tested after 30 minutes of rehydration. RESULTS: The stiffness of fresh-frozen neck fracture bone was lower than that of fresh-frozen osteoarthrotic bone at 150 impactions. The stiffness of freeze-dried irradiated bone was higher than that of the fresh-frozen bone and did not differ between osteoarthrotic and neck-fracture bone. INTERPRETATION: Solvent-treated freeze-dried bone from femoral heads procured during arthroplasty for sub-capital hip fractures represents a valuable source of material for allografts, addressing concerns regarding serological testing, medical history and bone quality.

Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine.

STUDY DESIGN: An analysis of consecutive adult patients treated surgically with anterior column structural allografts for sagittal plane abnormalities. OBJECTIVES: To evaluate the effectiveness of anterior structural allografts in maintaining long-term sagittal plane correction when combined with posterior spinal fusion and posterior segmental spinal instrumentation and to assess anterior allograft incorporation into adjacent vertebral bodies a minimum of 5 years after implantation. SUMMARY OF BACKGROUND DATA: There is no study in the literature in which incorporation and remodeling of anterior column structural allografts with minimum 5-year follow-up are assessed. Do they collapse or resorb or sustain stress fractures between a 2-year and 5-year follow-up? METHODS: Twenty-three consecutive adult patients (mean age, 45 years; range, 25-63 years) had a combination of anterior structural fresh-frozen allograft plus posterior autogenous grafting and posterior segmental spinal instrumentation performed from June 1988 through August 1992. All patients had sagittal plane abnormalities, and all surgeries were performed by the same surgeon. Twenty of the 23 patients returned for follow-up examinations for at least 5 years (average, 7 +/- 3 years; range, 5 +/- 4-10 +/- 3 years). Diagnoses included kyphoscoliosis (n = 8), spondylolisthesis (n = 3), degenerative disc disease (n = 3), and acute or chronic fracture (n = 6). The allografts spanned only disc spaces in 16 patients, and vertebral bodies and disc spaces in 4 patients. Forty disc spaces and four vertebral bodies were grafted, and 67 structural allografts were placed. Upright radiographs were analyzed before surgery, immediately after surgery, and at final follow-up examination to assess the degree of anterior allograft incorporation and maintenance of sagittal correction. A strict 4-point grading system was used. Two independent observers, not involved with surgical procedures, analyzed the radiographic results. RESULTS: Of the 67 structural allografts, 66 (98.5%) showed incorporation. Both observers concluded that none of the 67 structural allografts showed evidence of collapse. In all grafted levels and in any patient, there was no difference in sagittal plane measurements obtained immediately after surgery and those obtained at follow-up examinations 2 years and 5 or more years after surgery. CONCLUSIONS: Anterior fresh-frozen structural allograft works effectively in the long term to maintain correction of sagittal plane abnormalities if combined with posterior fusion and instrumentation. A minimum of 5 years after surgery, there is a high rate of structural allograft incorporation into the adjacent vertebral bodies.

Total hip replacement using femoral neck bone to graft the dysplastic acetabulum. Follow-up study of 18 patients with old congenital dislocation of the hip.

We performed total hip replacement on 25 congenitally dislocated hips using corticocancellous bone from the femoral neck as a bone graft to reconstruct the deficient acetabulum. Two patients (two hips) died less than five years after surgery and three hips developed deep infection. We reviewed the remaining 20 hips at an average interval of 8.4 years (5.2 to 12.9). Their functional scores (modified Merle d'Aubigné and Postel) averaged 5.7 for pain, 5.1 for walking ability, and 4.2 for range of motion. Radiographs showed union and remodelling of the grafted bone in every case. There were radiological signs of aseptic loosening in three sockets (15%) without collapse of the grafted bone. None of the femoral stems was loose. No revision operation has been performed. Our results confirm the usefulness in the long term of femoral autografts for severe acetabular deficiency.

[Active stabilization of the acetabular floor by auto-/homologous bone transplantation in inflammatory rheumatic protrusion hip]. / Aktive Pfannenbodenstabilisierung durch auto-/homologe Knochentransplantation bei entzündlich-rheumatischer Protrusionshüfte.

Inflammatory changes of the hip joint in rheumatoid arthritis often lead to secundary protrusio acetabuli. Total joint replacement may lead to problems, especially in mounting the acetabular component firmly to the pelvis. For about 7 years we have been using the so-called "active stabilisation of the acetabular floor" by implantation of autologeous bone prepared from the resected femoral neck. In changing the artificial joint homologeous bone from our bone bank was used. Up to Dec. 31, 1983 neither graft versus host reactions nor failure in healing were seen. 107 total joint replacements with bone transplantation in rheumatoid arthritis were performed. In all cases we could see optimal growing in of the transplanted bone, often confirmed by X-ray tomograms, with good support of the acetabular component. So far we have not seen any negative results. The active stabilisation of the acetabular floor seems to be a worthwhile addition to known surgical possibilities.

Salvage of acetabular insufficiency with bipolar prostheses.

Salvage of severely compromised, deficient, and insufficient acetabula associated with failed total hip arthroplasty, nonunited or malunited acetabular fractures, and metastatic tumor can be accomplished with the bipolar prosthesis. The procedure must be regarded as a salvage procedure, providing the patient with limited functional capabilities. All patients are prescribed permanent external support, even though some have refused to use it. This procedure is usually done by means of a transtrochanteric approach and frequently requires bone grafting. The acetabular component is fitted as tightly as possible, consistent with complete seating, stability, and rim or equatorial fit, and, in my opinion, holds and molds the bone grafts. The procedure is far more acceptable and gives a much more functional result than a Girdlestone resection. If necessary, a standard total hip arthroplasty acetabular component could be inserted after graft incorporation, fracture healing, or both.

Vertebral body replacement with femoral neck allograft and vascularized rib strut graft. A technique for treating post-traumatic kyphosis with neurologic deficit.

A technique using a vascularized rib pedicle graft and femoral neck allograft is presented as a new method of anterior spine fusion in the treatment of symptomatic post-traumatic kyphosis. The cases of six patients are reviewed who were treated surgically from seven months to 24 years following their initial injury. Substantial neurologic improvement was achieved in four patients with incomplete neurologic deficits when the procedure was combined with an anterior spine decompression. Two patients, one who was neurologically normal and one with complete paraplegia and L-1 pseudarthrosis were relieved of chronic back and radicular pain following this procedure. At the time of followup, complete anterior spine decompression was verified by lateral planography or computerized axial tomography. All patients were found to have solid anterior spine fusions with a 63% mean improvement in preoperative kyphosis. Early and rapid incorporation of bone grafts had been demonstrated, thus requiring shorter external immobilization periods for the patients.