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Published in: International Orthopaedics 5/2008

01-10-2008 | Original Paper

Initial stability of circumferential meshes with impacted bone allografts for massive femoral defects

Authors: Agustín José Guala, Martin Buttaro, Francisco Piccaluga

Published in: International Orthopaedics | Issue 5/2008

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Abstract

When the proximal femur is absent due to a failed femoral stem in total hip arthroplasty, impacted bone grafts contained within circumferential meshes could be an alternative reconstructive method. The purpose of this study was to analyse the initial resistance to axial and rotational forces in a fresh frozen bovine model with complete loss of the proximal femur reconstructed with a circumferential metal mesh, impacted bone allografts and a long cemented stem. Four bovine femurs with a complete proximal bone defect were reconstructed with a circumferential mesh, impacted bone grafts and a cemented stem. The results were compared with four intact femurs using the same implant. Under axial load, subsidence was observed at an average of 617 kg in the experimental group, and a cortical fracture occured at 1335 kg in the control group. Under rotational load, experimental femurs failed at an average of 79 kg and the control femurs fractured at 260 kg. This model provided 50% of the resistance to axial load and 30% of the resistance to rotational load compared to an intact femur, which is enough to resist physiological load. This stability encourages the use of circumferential meshes, impacted bone allografts and cemented stems in revision hip surgery with massive bone loss.
Literature
1.
go back to reference Bolder SB, Schreurs BW, Verdonschot N, Ling RS, Slooff TJ (2004) The initial stability of an exeter femoral stem after impaction bone grafting in combination with segmental defect reconstruction. J Arthroplasty 19:598–604PubMedCrossRef Bolder SB, Schreurs BW, Verdonschot N, Ling RS, Slooff TJ (2004) The initial stability of an exeter femoral stem after impaction bone grafting in combination with segmental defect reconstruction. J Arthroplasty 19:598–604PubMedCrossRef
2.
go back to reference Bolder SB, Schreurs BW, Verdonschot N, Veth RP, Buma P (2004) Wire mesh allows more revascularization than a strut in impaction bone grafting: an animal study in goats. Clin Orthop 423:280–286PubMedCrossRef Bolder SB, Schreurs BW, Verdonschot N, Veth RP, Buma P (2004) Wire mesh allows more revascularization than a strut in impaction bone grafting: an animal study in goats. Clin Orthop 423:280–286PubMedCrossRef
3.
go back to reference Boldt JG, Dilawari P, Agarwal S, Drabu K (2001) Revision total hip arthroplasty using impaction bone grafting with cemented nonpolished stems and Charnley cups. J Arthroplasty 16:943–952PubMedCrossRef Boldt JG, Dilawari P, Agarwal S, Drabu K (2001) Revision total hip arthroplasty using impaction bone grafting with cemented nonpolished stems and Charnley cups. J Arthroplasty 16:943–952PubMedCrossRef
4.
go back to reference Buttaro M, Pusso R, Piccaluga F (2005) Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. J Bone Joint Surg Br 87-B:314–319CrossRef Buttaro M, Pusso R, Piccaluga F (2005) Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. J Bone Joint Surg Br 87-B:314–319CrossRef
5.
go back to reference Callaghan JJ, Heiner AD, Brown TD (2000) The basic science of impaction allografting in revision hip surgery. Instr Course Lect 49:103–110PubMed Callaghan JJ, Heiner AD, Brown TD (2000) The basic science of impaction allografting in revision hip surgery. Instr Course Lect 49:103–110PubMed
6.
go back to reference Eldridge JD, Smith EJ, Hubble MJ, Whitehouse SL, Learmonth ID (1997) Massive early subsidence following femoral impaction grafting. J Arthroplasty 12:535–540PubMedCrossRef Eldridge JD, Smith EJ, Hubble MJ, Whitehouse SL, Learmonth ID (1997) Massive early subsidence following femoral impaction grafting. J Arthroplasty 12:535–540PubMedCrossRef
7.
go back to reference English H, Timperley AJ, Dunlop D, Gie G (2002) Impaction grafting of the femur in two-stage revision for infected total hip replacement. J Bone Joint Surg Br 84-B:700–705CrossRef English H, Timperley AJ, Dunlop D, Gie G (2002) Impaction grafting of the femur in two-stage revision for infected total hip replacement. J Bone Joint Surg Br 84-B:700–705CrossRef
8.
go back to reference Gie GA, Linder L, Ling RSM, Simon JP, Slooff TJ, Timperley AJ (1993) Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br 75-B:14–21 Gie GA, Linder L, Ling RSM, Simon JP, Slooff TJ, Timperley AJ (1993) Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br 75-B:14–21
9.
go back to reference Giesen EB, Lamerigts NM, Verdonschot N, Buma P, Schreurs BW, Huiskes R (1999) Mechanical characteristics of impacted morsellised bone grafts used in revision of total hip arthroplasty. J Bone Joint Surg Br 81:1052–1057PubMedCrossRef Giesen EB, Lamerigts NM, Verdonschot N, Buma P, Schreurs BW, Huiskes R (1999) Mechanical characteristics of impacted morsellised bone grafts used in revision of total hip arthroplasty. J Bone Joint Surg Br 81:1052–1057PubMedCrossRef
11.
go back to reference Haddad FS, Spangehl MJ, Masri BA, Garbuz DS, Duncan CP (2000) Circumferential allograft replacement of the proximal femur. A critical analysis. Clin Orthop Relat Res 371:98–107PubMedCrossRef Haddad FS, Spangehl MJ, Masri BA, Garbuz DS, Duncan CP (2000) Circumferential allograft replacement of the proximal femur. A critical analysis. Clin Orthop Relat Res 371:98–107PubMedCrossRef
12.
go back to reference Harris WH, Jones WN (1975) The use of wire mesh in total hip replacement surgery. Clin Orthop 106:127–221 Harris WH, Jones WN (1975) The use of wire mesh in total hip replacement surgery. Clin Orthop 106:127–221
13.
go back to reference Hubble MJW, Kuiper JH, Learmonth ID (1996) The initial stability of femoral prostheses in human, bovine and sheep impacted bone graft. Trans EORS 6:43 Hubble MJW, Kuiper JH, Learmonth ID (1996) The initial stability of femoral prostheses in human, bovine and sheep impacted bone graft. Trans EORS 6:43
14.
go back to reference Klein G, Parvizi J, Rapuri V, Wolf C, Hozack W, Sharkey P, Purtill J (2005) Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am 87:1777–1781PubMedCrossRef Klein G, Parvizi J, Rapuri V, Wolf C, Hozack W, Sharkey P, Purtill J (2005) Proximal femoral replacement for the treatment of periprosthetic fractures. J Bone Joint Surg Am 87:1777–1781PubMedCrossRef
15.
go back to reference Lindsey RW, Gugala Z, Milne E, Sun M, Gannon FH, Latta LL (2006) The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect. J Orthop Res 24:1438–1453PubMedCrossRef Lindsey RW, Gugala Z, Milne E, Sun M, Gannon FH, Latta LL (2006) The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect. J Orthop Res 24:1438–1453PubMedCrossRef
16.
go back to reference Malkani AL, Voor MJ, Fee KA, Bates CS (1996) Femoral component revision using impacted morsellised cancellous graft. A biomechanical study of implant stability. J Bone Joint Surg Br 78:973–978PubMedCrossRef Malkani AL, Voor MJ, Fee KA, Bates CS (1996) Femoral component revision using impacted morsellised cancellous graft. A biomechanical study of implant stability. J Bone Joint Surg Br 78:973–978PubMedCrossRef
17.
go back to reference Pak JH, Paprosky WG, Jablonsky WS, Lawrence JM (1993) Femoral strut allografts in cementless revision total hip arthroplasty. Clin Orthop Relat Res 295:172PubMed Pak JH, Paprosky WG, Jablonsky WS, Lawrence JM (1993) Femoral strut allografts in cementless revision total hip arthroplasty. Clin Orthop Relat Res 295:172PubMed
18.
go back to reference Pekkarinen J, Alho A, Lepisto J, Ylikoski M, Ylinen P, Paavilainen T (2000) Impaction bone grafting in revision hip surgery. A high incidence of complications. J Bone Joint Surg Br 82:103–107PubMedCrossRef Pekkarinen J, Alho A, Lepisto J, Ylikoski M, Ylinen P, Paavilainen T (2000) Impaction bone grafting in revision hip surgery. A high incidence of complications. J Bone Joint Surg Br 82:103–107PubMedCrossRef
19.
go back to reference Peters CL, Bachus KN, Davitt JS (2003) Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates. Orthopedics 26:7 Peters CL, Bachus KN, Davitt JS (2003) Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates. Orthopedics 26:7
20.
go back to reference Piccaluga F, González Della Valle A, Encinas JC, Pusso R (2002) Femoral stem revision with impaction grafting and a Charnley stem. A two- to twelve-year follow-up study. J Bone Joint Surg Br 84-B:544–549CrossRef Piccaluga F, González Della Valle A, Encinas JC, Pusso R (2002) Femoral stem revision with impaction grafting and a Charnley stem. A two- to twelve-year follow-up study. J Bone Joint Surg Br 84-B:544–549CrossRef
21.
go back to reference Schreurs BW, Buma P, Huiskes R, Slagter JL, Slooff TJ (1994) Morsellized allografts for fixation of the hip prosthesis femoral component. A mechanical and histological study in the goat. Acta Orthop Scand 65:267–275PubMedCrossRef Schreurs BW, Buma P, Huiskes R, Slagter JL, Slooff TJ (1994) Morsellized allografts for fixation of the hip prosthesis femoral component. A mechanical and histological study in the goat. Acta Orthop Scand 65:267–275PubMedCrossRef
22.
go back to reference Schreurs BW, Arts JJ, Verdonschot N, Buma P, Slooff TJ, Gardeniers JW (2006) Femoral component revision with use of impaction bone-grafting and a cemented polished stem. Surgical technique. J Bone Joint Surg Am 88[Suppl 1 Pt 2]:259–274PubMedCrossRef Schreurs BW, Arts JJ, Verdonschot N, Buma P, Slooff TJ, Gardeniers JW (2006) Femoral component revision with use of impaction bone-grafting and a cemented polished stem. Surgical technique. J Bone Joint Surg Am 88[Suppl 1 Pt 2]:259–274PubMedCrossRef
23.
go back to reference Slooff TJ, Schimmel JW, Buma P (1993) Cemented fixation with bone grafts. Orthop Clin North Am 24:667–677PubMed Slooff TJ, Schimmel JW, Buma P (1993) Cemented fixation with bone grafts. Orthop Clin North Am 24:667–677PubMed
24.
go back to reference Yim SJ, Kim MY, Suh YS (2006) Impaction allograft with cement for the revision of the femoral component. A minimum 39-month follow-up study with the use of the Exeter stem in Asian hips. Int Orthop (Sept 9 published online) Yim SJ, Kim MY, Suh YS (2006) Impaction allograft with cement for the revision of the femoral component. A minimum 39-month follow-up study with the use of the Exeter stem in Asian hips. Int Orthop (Sept 9 published online)
Metadata
Title
Initial stability of circumferential meshes with impacted bone allografts for massive femoral defects
Authors
Agustín José Guala
Martin Buttaro
Francisco Piccaluga
Publication date
01-10-2008
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 5/2008
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-007-0362-5

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