Background. Revision hip arthroplasty for excessive bone loss because of osteolysis or infection is difficult theme. Bone grafting is essential technique for bone loss and need of allograft is increasing. Recently, many hospital
Impacted morsellised donor bone is succesfully used to treat bone loss in revision total hip arthroplasties. After implantation new bone is formed in the donor bone. It is generally thought, but not proven, that the processing and storage at −80°C of the donor bone kills all cells. There is however general concern about viral, bacterial, and/or oncogenetic contamination with donor bone. Based on these considerations it is essential to know whether the donor bone does contain viable bone cells. Fragmented biopsies from eleven femoral heads from our
Bone infections due to fractures or implants are a big medical problem. In experimental medicine, many experimental models have been created on different animal species to simulate the disease condition and to do experience treatments. The aim of this paper was to present an antibacterial efficacy of using a bone allograft developed according to the Marburg system of
Introduction: The National
Purpose: Prosthetic hip surgery (150,000 total hip arthroplasties in France including 10–12% revision procedures) have required the development of
Purpose: We report our experience with acetabular reconstruction using cyropreserved
A radiation sterilisation dose (RSD) of 25 kGy is commonly recommended for sterilisation of allograft bone. However, the mechanical and biological performance of allograft bone is gamma dose-dependent. Therefore, this study aimed to apply Method 1 – ISO 11137–2: 2006 to establish a low RSD for frozen bone allografts. Two groups of allograft bones were used: 110 femoral heads (FH) and 130 structural and morselized bones (SMB). The method included the following stages: bioburden determination using 10 FHs and 30 SMBs; verification dose selection using table six in the ISO standard and bioburden; the verification dose was used to irradiate 100 samples from each group; then irradiated bone segments were tested for sterility. The criterion for accepting the RSD as valid is that there must be no more than two non-sterile samples out of 100. The radiation sterilisation dose is then established based on table five, ISO 11137– 2: 2006. The bioburden of both types of frozen allograft was zero. The verification dose chosen was 1.3 kGy. Two hundred bone segments were irradiated at 1.3 kGy. The average delivery gamma dose was 1.23 kGy (with minimum dose of 1.05 kGy maximum dose of 1.41kGy), which is acceptable according to the ISO standard. Sterility tests achieved 100% sterility. Accordingly, 11 kGy was established as a valid RSD for those frozen bone allografts. A reduction in the RSD from 25 kGy to 11 kGy will significantly improve bone allograft mechanical and biological performance because our data show that this dose level improves the mechanical toughness and osteoclast activity of the allograft by more than 10 and 100 percent, respectively, compared with bone allografts irradiated at 25 kGy. A low RSD of 11 kGy was established for allograft bones manufactured at Queensland
The cryopreserved graft (femoral head bone bank) was used to reconstruct the acetabular defect. The graft was adapted to the size of the defect to fashion a congruent construct aimed at achieving primary stability. We did not use any supporting material in addition the primary osteosynthesis with one or two screws. A poly-ethylene cup was cemented in the graft. Most of the cement was applied onto the graft which was reamed to the size of the acetabulum. We retained a theoretical 6-year follow-up for review. All patients were seen for follow-up assessment using the Postel-Merle-d’Aubigné (PMA) clinical score and standard x-rays analysed according to the Oakeshott method. Kaplan-Meier survival curves were plotted taking change in status, revision for clinical failure as the endpoint.
Paediatric musculoskeletal (MSK) disorders often produce severe limb deformities, that may require surgical correction. This may be challenging, especially in case of multiplanar, multifocal and/or multilevel deformities. The increasing implementation of novel technologies, such as virtual surgical planning (VSP), computer aided surgical simulation (CASS) and 3D-printing is rapidly gaining traction for a range of surgical applications in paediatric orthopaedics, allowing for extreme personalization and accuracy of the correction, by also reducing operative times and complications. However, prompt availability and accessible costs of this technology remain a concern. Here, we report our experience using an in-hospital low-cost desk workstation for VSP and rapid prototyping in the field of paediatric orthopaedic surgery. From April 2018 to September 2022 20 children presenting with congenital or post-traumatic deformities of the limbs requiring corrective osteotomies were included in the study. A conversion procedure was applied to transform the CT scan into a 3D model. The surgery was planned using the 3D generated model. The simulation consisted of a virtual process of correction of the alignment, rotation, lengthening of the bones and choosing the level, shape and direction of the osteotomies. We also simulated and calculated the size and position of hardware and customized massive allografts that were shaped in clean room at the hospital
Introduction: Filling of bone defects is a significant challenge in Orthopaedic Surgery. Human fresh-frozen allograft is still the most effective bone graft substitution material («gold standard»), guaranteeing all essential biological and physiochemical demands (osteogenic, osteoinductive, and osteoconductive) when the necessary amount of autologous bone is not available. Using donor screening recommendations, more than 50 % of potential donors have to be excluded. With increasing incidence for revision hip surgery and especially acetabular reconstructions, a hospital associated
Introduction and Objective. In recent years, along with the extending longevity of patients and the increase in their functional demands, the number of annually performed RSA and the incidence of complications are also increasing. When a complication occurs, the patient often needs multiple surgeries to restore the function of the upper limb. Revision implants are directly responsible for the critical reduction of the bone stock, especially in the shoulder. The purpose of this paper is to report the use of allograft bone to restore the bone stock of the glenoid in the treatment of an aseptic glenoid component loosening after a reverse shoulder arthroplasty (RSA). Materials and Methods. An 86-years-old man came to our attention for aseptic glenoid component loosening after RSA. Plain radiographs showed a complete dislocation of the glenoid component with 2 broken screws in the neck of glenoid. CT scans confirmed the severe reduction of the glenoid bone stock and critical bone resorption and were used for the preoperative planning. To our opinion, given the critical bone defect, the only viable option was revision surgery with restoration of bone stock. We planned to use a bone graft harvested from distal
Introduction. Cancellous and cortical bone used as a delivery vehicle for antibiotics. Recent studies with cancellous bone as an antibiotic carrier in vitro and in vivo showed high initial peak concentrations of antibiotics in the surrounding medium. However, high concentrations of antibiotics can substantially reduce osteoblast replication and even cause cell death. Objectives. To determine whether impregnation with gentamycine impair the incorporation of bone allografts, as compared to allografts without antibiotic. Materials and method. Seventy two healthy rabbits (24 rabbits in each group) were used for this study. Bone defects (3-mm diameter, 10-mm depth) were created in the femur. Human femoral head prepared according to the Marburg
Aims: The purpose of this study is to answer the question, whether local femoral head
This study assessed factors responsible for exclusion of patients from bone donation at primary hip arthroplasty in order to improve bone banking. Fifty-five patients underwent screening in preoperative clinics assessing their suitability for femoral head donation. Records at the
Introduction The need for bone graft has increased in recent years partly due to the greater numbers of revision hip arthroplasties being performed secondary to the increasing life expectancy in the UK. Method Our study prospectively reviewed the practice of bone banking at Portsmouth Hospital NHS Trust to look into the various factors responsible for exclusion of patients from donation of bone. All 55 patients under-went screening in a preoperative assessment clinic using a standard proforma to assess their suitability for femoral head donation during the course of their primary hip arthroplasty and records at the
Femoral head allograft bone used in complex orthopaedic surgery may transmit infection from donor to recipient. In order to minimise the risk all donors are serologically screened for Hepatitis B and C, HIV, HTLV, and syphilis at the time of donation and again at 6 months post-donation. Culture swabs are taken from the acetabulum and femoral head for 48 hour anaerobic and aerobic culture, and a sample of bone is incubated for 5 days in enrichment broth culture. We have audited the culture results and screening tests performed in our
Introduction: With the growing number of primary knee arthroplasties, the number of revision operations is also increasing. The large number of unicondylar replacements carried out in the 1980’s, due to lack of modern total condylar implants, grant the revision techniques an outstanding significance in Hungary. One of the main issues of modern revision techniques is the management of bone defects, which can be solved by different methods documented in literature. Aim of study: The aim of our study was to investigate the success and feasibility of the various defect management techniques by evaluating the results of revision knee prosthetic surgeries carried out at our clinic. Patients and methods: Femoral and tibial bone defects had to be solved with revision surgeries in 35 cases, all performed due to aseptic loosening of uni- and total condylar prostheses implanted earlier. For filling of bone defects, metal augmentation of the prostheses was applied in 9 cases, allografts from
Aims. To report the outcome observed in 34 dogs with non metastatic distal radial osteosarcoma (OSA) treated by a combination of adjuvant chemotherapy and limb-sparing surgery. Limb-sparing procedures were based on the use of a frozen bone cortical allograft (group A; 18 cases) and of a pasteurised tumoral autograft (group B; 16 cases), respectively. Methods. In group A, limb-sparing procedure was performed using a fresh-frozen cortical allograft from a
Femoral revision after cemented total hip arthroplasty (THA) might include technical difficulties, following essential cement removal, which might lead to further loss of bone and consequently inadequate fixation of the subsequent revision stem. Bone loss may occur because of implant loosening or polyethylene wear, and should be addressed at time of revision surgery. Stem revision can be performed with modular cementless reconstruction stems involving the diaphysis for fixation, or alternatively with restoration of the bone stock of the proximal femur with the use of allografts. Impaction bone grafting (IBG) has been widely used in revision surgery for the acetabulum, and subsequently for the femur in Paprosky defects Type 1 or 2. In combination with a regular length cemented stem, impaction grafting allows for restoration of femoral bone stock through incorporation and remodeling of the proximal femur. Cavitary bone defects affecting the metaphysis and partly the diaphysis leading to a wide femoral canal are ideal indications for this technique. In case of combined segmental-cavitary defects a metal mesh is used to contain the defect which is then filled and impacted with bone grafts. Cancellous allograft bone chips of 2 to 4 mm size are used, and tapered into the canal with rods of increasing diameters. To impact the bone chips into the femoral canal a dummy of the dimensions of the definitive cemented stem is inserted and tapped into the femur to ensure that the chips are firmly impacted. Finally, a standard stem is implanted into the newly created medullary canal using bone cement. To date several studies from Europe have shown favorable results with this technique, with some excellent long-term results reported. Advantages of IBG include the restoration of the bone stock in the proximal femur, the use of standard length cemented stems and preserving the diaphysis for re-revision. As disadvantages of the technique: longer surgical time, increased blood loss and the necessity of a
Fresh-frozen allograft bone is frequently used in orthopaedic surgery. We investigated the incidence of allograft-related infection and analysed the outcomes of recipients of bacterial culture-positive allografts from our single-institute