Abstract
Introduction
Modular tantalum augments have been introduced to manage severe bone defects in hip and knee revision surgery. The porous surfaces of tantalum augments are intended to enhance osseointegration and a number of studies have documented their excellent biocompatibility. However, the characteristics of tantalum augment osseointegration on human ex vivo specimens from re-revision procedures have not been reported so far.
Methods
Out of a total number of 324 hip and knee revisions with a tantalum augment performed in our institution between 2007 and 2010 four patients had to be re-revised at a mean followup time of 15 months. The causes for re-revision were a periprosthetic acetabular fracture in one, a loosening of a tibial component in one and periprosthetic hip infections in two cases. To characterize osseointegration of the tantalum augments, they were removed during revision surgery and subjected to undecalcified processing. All specimens were analysed by contact radiography, histology (toluidine blue, von Kossa) and quantitative histomorphometry.
Results
In all specimens trabecular ingrowth was apparent along the former bone-augment-interface. The depth of bone ingrowth into the porous microarchitecture of the augments reached up to 2000 μm. Thin-section analysis revealed scattered and partially mineralized bone forming units within the interior of the augments.
Conclusions
To the best of our knowledge this is the first histomorphometric analysis on the osseointegration of tantalum augments in human ex vivo specimens. In the presented series porous tantalum showed excellent osteoconductive characteristics on the histological level. These early ex vivo histological findings are promising, but structural analysis of later re-revision cases is needed.
