In 2012 we reviewed a consecutive series of 92
uncemented THRs performed between 1986 and 1991 at our institution
using the CLS Spotorno stem, in order to assess clinical outcome
and radiographic data at a minimum of 21 years. The series comprised
92 patients with a mean age at surgery of 59.6 years (39 to 77)
(M:F 43;49). At the time of this review, seven (7.6%) patients had died and
two (2.2%) were lost to follow-up. The 23-year Kaplan–Meier survival
rates were 91.5% (95% confidence intervals (CI) 85.4% to 97.6%;
55 hips at risk) and 80.3% (95% CI, 71.8% to 88.7%; 48 hips at risk)
respectively, with revision of the femoral stem or of any component
as endpoints. At the time of this review, 76 patients without stem
revision were assessed clinically and radiologically (mean follow-up
24.0 years (21.5 to 26.5)). For the 76 unrevised hips the mean Harris
hip score was 87.1 (65 to 97). Femoral osteolysis was detected in
five hips (6.6%) only in Gruen zone 7. Undersized stems were at
higher risk of revision owing to aseptic loosening (p = 0.0003).
Patients implanted with the stem in a varus position were at higher risk
of femoral cortical hypertrophy and thigh pain (p = 0.0006 and p
= 0.0007, respectively). In our study, survival, clinical outcome and radiographic data
remained excellent in the third decade after implantation. Nonetheless,
undersized stems were at higher risk of revision owing to aseptic
loosening. Cite this article:
Numerous growth factors, together with bone morphogenetic proteins (BMP), are involved in the biological mechanism of bone induction. BMP 7 combined with collagen type 1 has shown to be effective in triggering the osteoinductive mechanism in the presence of bone defects as an alternative to bone graft. The aim of the present study is to present the experience gained at the Orthopaedic Clinic of Catania with BMP in lower limb non-union or pseudoarthrosis with bone defect after skeletal stabilisation. From December 2003 to May 2004 at the Orthopaedic Clinic Of Catania four patients were treated using OP 1. The study group comprised three women and one man with a mean age at the time of operation of 27 years (range 23– 32 years). One subject presented with non-union, two patients with normotrophic pseudoarthrosis and one with atrophic pseudoarthrosis. In all cases the bone defect was localised at the tibia. All patients were treated surgically with skeletal stabilisation (one with a monolateral external fixator, one with a T2 intramedullary nail and two with a Gross-Kempf nail) always after decortication of Judet. Three patients healed with a mean follow-up of 5 months. One subject is still under treatment. None of the patients have any pain and demonstrate complete weight bearing and functional capacity. X-rays showed good consolidation of bone defect. Clinical and radiographic results obtained at this point are more than fair. Healing time was short without any side effects. It is important to verify whether, in the treatment of lower limb non-union and or pseudoarthrosis, the osteoinductive capacity of the OP 1 could provide the same valid results without good reduction and skeletal stabilisation. The use of OP 1 is extremely interesting for many reasons. However, it would be extremely important to test whether the biological effect is not exclusively related to an optimal mechanical stability.
