Modern processing techniques in bone banking are thought to decrease the presence of allogenic material in bone. This project was performed to observe any changes in peripheral blood lymphocyte subsets in response to allografted bone used in revision hip replacement. 87 patients were entered into this prospective study and grouped according to whether impaction allograft was used or not. Samples were collected pre-operatively and at set time intervals up to one year post-operatively. Using flow cytometry, analysis of venous blood allowed counts of the following cells: Helper T-lymphocytes, cytotoxic T-lymphocytes, memory T-lymphocytes, naïve T-lymphocytes, Natural Killer cells and B-lymphocytes.Introduction
Methods
Periprosthetic femoral fractures around total knee arthroplasty present a challenge in octogenarians with advanced osteoporosis. We describe a salvage technique combining retrograde intramedullary nailing augmented with polymethylmethacrylate (PMMA) cement in five patients followed up for a median time of 12 months. The nail/cement construct bridges the femoral canal tightly and behaves like a stemmed cemented revision component. All patients had an uncomplicated recovery and returned to their pre-injury functional status within four months. This procedure does not disrupt the soft tissue envelope facilitating periosteal callus formation, is easy to perform and permits immediate full range of movement. When standard retrograde nailing or plating alone is inadequate in maintaining severely osteoporotic fracture reduction in octogenarians unfit for lengthy procedures, nailed cementoplasty is proposed as a salvage procedure.
This paper could not be resubmitted: The paper was initially presented at the BHS and they have already published it in the JBJS Supplement.
These results provide a biochemical insight into the bone formation and bone resorption processes during allograft incorporation.
These results provide a biochemical insight into the bone formation and bone resorption processes during allograft incorporation.
Factors influencing the results of revised cemented sockets with bone grafting have been studied in 249 cases. Freeze-dried allografts in 77 and fresh frozen in 172 cases have been used. The average follow-up was 8 years 11 months for the freeze-dried group and 2 years 11 months for the fresh frozen cases. There were 13 postoperative dislocations, 20 TNU, 4 thromboembolic complications, 4 delayed wound healing and 2 intraoperative fractures of the acetabulum. There have been 11 re-revisions: 8 for aseptic loosening, 2 for dislocation and 1 for infection. Radiographic evidence of loosening was seen in another 38 cases. The acetabular bone stock at the time of revision and initial stability of socket fixation had a significant influence on the outcome. Direction of socket migration before surgery appeared to predict risk of failure. The primary pathology, type of bone graft and grafting technique also had an effect.
We previously reported the result of 45 Charnley LFA’s with femoral head autograft for Developmental Dysplasia of the hip with a minimum follow-up of ten years. After an average follow-up of eleven years there was no revision. One socket migrated and four sockets were fully demarcated. To assess our long-term results we reviewed the clinical and radiological findings in the same group of patients that had been studied previously. To date 5 patients died from causes unrelated to the hip replacement and were excluded from the final radiological analysis. 40 Charnley LFA’s have been followed-up regularly. The average follow-up is now 17 years 1 month / range: 15–21 years/. Three sockets have been revised: two for aseptic loosening and one for infection. Radiographic assessment showed that three sockets migrated and four had full demarcation. Demarcation at the cement-bone interface of the socket was rare in zone one but was common in zone two. We concluded that sound fixation of the autograft and orientations of the acetabular component are essential. We recommend that solid bone graft should be combined with impaction bone grafting in dysplastic cases. We also observed that bone grafting at primary surgery gives better chances for component fixation at the time of revision.
We report the result of 49 revisions for aseptic cup loosening using freeze-dried allografts. We assessed the results according to the primary pathology, severity of bone loss, direction of socket migration before revision, method of bone grafting, socket position, graft incorporation and socket loosening. Patient’s mean age at revision was 56 years 8 months. At a mean follow up of 7 years and 5 months four cups have been revised for aseptic loosening. Five sockets have migrated but remained stable while six showed full demarcation but have not migrated. The other 34 remained stable and show radiographic evidence of graft incorporation.