Introduction: Filling of bone defects is a significant challenge in Orthopaedic Surgery. Human
To evaluate the clinical outcome of arthroscopic treatment of ACL with an Achilles tendon allograft in patient with acute rupture. 22 patients, between 2003 and 2006, with acute rupture of ACL, were treated with an Achilles tendon allograft. The mean age was 26 years. Patients were evaluated before and after surgery and at the latest follow-up with Noulis-Lahmann test and Pivot shift test. We also used IKDC score, Lysholm score and one leg stance test and functional reach test. Patients were also evaluated with Cybex II + and with plain radiographies. The mean follow-up time was 3.5 years. 90% of the patients had a negative pivot shift test and 95% of the patients had a score at Noulis-Lahmann test +1. The mean value of IKDC score was 88 (62–100) and the mean time of Lysholm score was 91 (75–100). Until the latest follow-up there were no clinical sighs of inflammation or graft rejection. Radiologic evaluation revealed no sign of tunnel enlargement. We believe that the use of a
Extensive bone deficiencies in proximal femur remains a significant challenge in hip surgery. In such a situation, one alternative is to use a proximal femoral allograft-prosthesis composite (APC) to restore the mechanical integrity and bone stock. The current study was performed to analyze the results of APC in the treatment of femoral bone deficiency. From January 1996 to June 2006, 12 patients who received 15 APC (3 of them received repeated APC), were followed for a mean of 4.2 years (range 2.0 to 9.8 years) by one surgeon. 5 were males and 7 were females and the mean age of the patients was 60.9 years (range 32 to 84 years). 6 patients were diagnosed with septic loosening, 5 were with aseptic loosening, 4 were with re-revision arthroplasty, and 1 was with limb salvage procedure due to malignancy and all were treated with
Introduction. Biological repair of acetabular bone defects after impaction bone grafting (IBG) in total hip arthroplasty could facilitate future re-revisions in case of failure of the reconstruction again using the same technique. Few studies have analysed the outcome of these acetabular re-revisions. Patients and Methods. We analysed 34 consecutive acetabular re-revisions that repeated IBG and a cemented cup in a cohort of 330 acetabular IBG revisions.
Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available. Cite this article:
Introduction. Impaction bone grafting (IBG) is a reliable technique for acetabular revision surgery with large segmental defects. However, bone graft resorption and cup migration are some of the limitations of this tecnique. We assess frequency and outcome of these complications in a large acetabular IBG series. Patients and Methods. We analysed 330 consecutive hips that received acetabular IBG and a cemented cup in revision surgery with large bone defects (Paprosky types 3A and 3B).
Background: Abductor failure after total hip arthroplasty is a rare but debilitating problem. The diagnosis is difficult, and when recognized, there are few successful treatment options. The purpose of this study is to review our experience with a new surgical technique using
Implantation of allograft bone continues to be an integral part of revision hip surgery. One major concern with its use is the risk of transmission of infective agents. There are a number of methods of processing bone in order to reduce that risk. One part of that processing can be carried out immediately prior to implantation using pulsed irrigation. We report the incidence of deep bacterial infection in a series of 138 patients undergoing 144 revision hip arthroplasty procedures who had undergone allograft bone implantation. The allograft bone used was
Synthetic graft expanders have recently been developed for use in impaction grafting revision hip arthroplasty, but their true role has yet to be determined. We performed a series of experiments to investigate the properties of one such porous hydroxyapatite material (IG-Pore, ApaTech Ltd). IG-Pore was mixed with
Block allografts traditionally have been used for massive bone deficiencies, but their complication rates are high, and the destructive effects of allograft rejection can limit their long-term success. Large segments of allograft also heal slowly, are never replaced by new bone, and weaken as the ossification and vascularisation front proceeds. In contrast, morselised allograft has proven structurally reliable for both small and large defects while supporting new bone formation. Morsels that are 1 cm in diameter maintain their integrity long enough to act as a substrate for new bone formation. Morsels less than 0.5 to 1 cm in diameter tend to be resorbed while those larger than 1 cm incorporate slowly, if ever, and tend to collapse. Rejection can be a major problem with allograft because marrow is immunogenic. However, marrow elements can be thoroughly removed from morselised allograft to prevent the inflammatory response and loss of graft and to capitalise on the osteoconductive potential of the demineralised bone and autologous marrow. The allograft acts as scaffolding for new bone growth, and although it is not osteoinductive, demineralised bone (mildly osteoinductive) and bone marrow aspirate (highly osteoinductive) can be added to the allograft to enhance bone formation. The surrounding bone structure supplies most of the osteoinductive activity because metaphyseal bone has a rich blood supply and maintains the capacity to heal even after repeated failed arthroplasty. Grafting preparation and placement:
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
The October 2012 Knee Roundup360 looks at: autologous chondrocytes and chondromalacia patellae; drilling the femoral tunnel at ACL reconstruction; whether we repair the radially torn lateral meniscus; factors associated with patellofemoral pain; mechanoreceptors and the allografted ACL; whether high tibial osteotomy can delay the need for knee replacement; return to sport after ACL reconstruction; tissue-engineered cartilage; and the benefits of yoga.