Osteochondral defects of the talus treated with autologous bone grafting

We reviewed, retrospectively, 13 patients who had undergone open anterograde autologous bone grafting of the talus for symptomatic osteochondral defects of the dome of the talus. The mean age of the seven men and six women was 38.4 years. The defects included the full thickness of articular cartilage, extended through the subchondral plate and were associated with subchondral cysts. Six patients (46%) were clinical failures requiring further surgery. Of the remaining seven, functional outcome results were obtained at a mean of 51.9 months after surgery. The mean outcome scores for the Musculoskeletal Outcomes Data Evaluation and Management System foot and ankle questionnaire and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale were 87.0 and 84.3, respectively. There was an overall 46.2% patient satisfaction rate. We believe that the technique of autologous bone grafting presented should be used with extreme caution, when considered as the primary treatment for the adult patient with a symptomatic advanced osteochondral defect of the talus.     

Bridging the gap: Bone marrow aspiration concentrate reduces autologous bone grafting in osseous defects

Although autologous bone grafting represents an effective tool to induce osteogenic regeneration in local bone defects or pseudarthroses, it is associated with significant donor site morbidity and limited by the amount available for grafting. We investigate the potency of bone marrow aspiration concentrate (BMAC) to augment bone grafting and support bone healing. The functional and radiographic outcome of 39 patients with volumetric bone deficiencies treated with BMAC are presented and evaluated in a prospective clinical trial. A collagen sponge (Col) served as scaffold in 12 patients and a bovine hydroxyapatite (HA) was applied in the other 27 individuals. The minimal follow‐up was 6 months. Clinical and radiographic findings were completed by in vitro data. All patients showed new bone formation in radiographs during follow‐up. However, two patients underwent revision surgery due to a lack in bone healing. In contrast to the Col group, the postoperative bone formation appeared earlier in the HA group (HA group: 6.8 weeks vs. Col group 13.6 weeks). Complete bone healing was achieved in the HA group after 17.3 weeks compared to 22.4 weeks in the Col group. The average concentration factor of BMAC was 5.2 (SD 1.3). Flow cytometry confirmed the mesenchymal nature of the cells. Cells from BMAC created earlier and larger colonies of forming units fibroblasts (CFU‐F) compared to cells from bone marrow aspirate. BMAC combined with HA can reduce the time needed for healing of bone defects when compared to BMAC in combination with collagen sponge. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:173–180, 2011     

Calvarial bone grafting of facial defects

Bony defects of the face continue to challenge the reconstructive surgeon. Traditional sources of autologous bone from the rib or pelvis have been associated with the limitations of pain at the donor site, the need for a second operative field, variable "take" of the graft with poor eventual survival and, ultimately, less than optimal reconstruction. Calvarial bone grafting provides a readily accessible source of bone from an inconspicuous donor site, usually within the same operative field. The morbidity is minimal. The calvarial bone graft is especially useful in repair of the frontal sinus, orbital floor, nasal and malar regions, as well as in certain instances of cleft palate with alveolar involvement.     

Open cancellous bone grafting of infected bone defects

A historical review of the role of cancellous bone grafting in the management of bone infections is presented. The technique of open cancellous bone grafting is explained in detail, along with the early experience of the author. The indications, advantages, disadvantages, and limitations of this technique are discussed.     

天然型无机骨修复骨巨细胞瘤刮除术后骨缺损

目的　观察骨巨细胞瘤刮除术后采用天然型无机骨 (NNB)充填的临床结果。方法　 7例骨巨细胞瘤手术刮除内瘤腔 ,95 %乙醇灭活 ,充填块状NNB。结果　 7例患者术后 3～ 7个月均可下地行走 ,术后 4～ 8个月复查可见X线片中骨缺损充填处的方块状NNB间隙影消失 ,新生骨与NNB及周围骨壳融合 ,显示病灶愈合。术后随访 14～ 5 0个月 ,无肿瘤复发。结论　NNB作为一种新型的人体骨组织替代材料 ,是修复骨巨细胞瘤刮除术后骨缺损理想的充填材料     

颗粒骨打压植骨结合多孔非骨水泥臼杯在AAOSⅢ型髋臼大面积骨缺损翻修中的应用

背景：颗粒骨打压植骨是修复髋臼骨缺损的重要方法,对大面积髋臼骨缺损采用打压植骨结合非骨水泥臼杯重建仍然存在争议。目的：探讨同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损的方法及近期疗效。方法：随访2005年6月至2010年4月收治的28例（28髋）AA0SⅢ型髋臼大面积骨缺损患者。男18例,女10例,年龄34-74岁,平均53．8岁。髋关节置换术后感染醐翻修9例,骨溶解及髋臼假体松动翻修19例。本组AAOSⅢ型髋臼骨缺损面积大,术中见髋臼骨缺损超过髋臼关节面的50％。全部采用同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术。术后定期随访,观察臼杯有无松动、植入骨与宿主骨整合情况,髋关节功能评分采用Harris评分。结果：28例均获得随访,术后随访时间为13-70个月,平均43个月。Harris评分由术前32-48分,平均41分,提高至末次随访时86-95分,平均90分。28例髋臼假体均固定牢固无松动征象,植入骨逐渐与宿主骨整合,无感染及坐骨神经损伤。结论：在获得臼杯初始稳定固定的情况下,大面积颗粒骨打压植骨（臼杯与宿主骨接触面积〈50％）结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损近期疗效较好,远期疗效尚待进一步随访。     

Bone grafting of tibial defects in primary and revision total knee arthroplasty

Bone grafting of tibial defects in primary and revision total knee arthroplasty is performed by at least two different methods, preferably with local autogeneic bone. Incorporation of the graft occurs between four and eight months. No restriction in weight-bearing is recommended, except with repair of large defects. Bone grafting is a viable alternative to using custom tibial prostheses or excess cement, even for very large defects.     

单边外固定骨牵张延长器骨搬移治疗下肢骨缺损的疗效

下肢开放性骨折往往会造成感染及骨外露,进而导致骨缺损.骨缺损在临床上是治疗的难题,随着医学技术的不断发展,应用吻合血管的自体骨移植、异体骨移植等方法均可修复骨缺损,但方法比较复杂,且治疗时间较长.     

Bone grafting of humeral head cystic defects during rotator cuff repair

Cystic bony defects of the humeral head greater tuberosity are often encountered during rotator cuff repair. These defects may be idiopathic, related to a patient's rotator cuff disease, or secondary to suture anchor placement from previous repairs. Some cysts are visible on preoperative magnetic resonance imaging, but most are discovered on footprint exploration or implant removal during revision surgery. These osseous defects reduce biological healing capacity and may decrease repair fixation strength. Bone grafting techniques are needed to address these defects. In this article, we present an arthroscopic allograft compaction technique with concomitant suture anchor rotator cuff repair.     

Fate of bone grafting for acetabular defects in total hip replacement

Background:

The use of allografts and autografts in the management of acetabular defects have been reported with varying results. Trabecular metal is an expensive option in the management of these defects. This study aims to assess the fate and efficacy of bone grafting for acetabular bone defects in total hip arthroplasty.

Materials and Methods:

A total of 30 hips in 28 patients with acetabular deficiencies were treated with bone grafting and total hip replacement (THR). Seventeen hips had American Academy of Orthopedic Surgeons (AAOS) type 2 (Paprosky type 2c) deficiency and 13 had AAOS type 3 (Paprosky type 3a) defects of the acetabulum. Allografts were used in 15 patients and autografts were used in the remaining 13. Cemented total hip arthroplasty was done in 18 hips and uncemented THR in 12. Seven patients underwent the procedure for, acetabular erosion and symptoms following hemiarthroplasty (4 out of 7), or, acetabular revision for failure (3 out of 7) following total hip arthroplasty. Acetabular deficiencies in other patients were due to posttraumatic causes, advanced primary hip arthritis and second stage treatment of postinfective arthritis. A mesh was used in 6 hips and screws were used in 13 hips for graft fixation.

Results:

Patients were followed up clinicoradiologically for a period of 10 months to 4 years (mean 23.4 months). One patient required staged revision due to infection. Two patients had early asymptomatic cup migration. One patient had graft lysis and change in cup inclination with persistent pain. He was not keen on further intervention at last followup. Other patients were pain free at the time of followup with radiographs showing maintenance of graft and implant position.

Conclusion:

Bone grafting is a suitable option in the management of acetabular defects in total hip arthroplasty, especially in resource challenged countries.     

Morselized bone grafting of defects in revision total knee arthroplasty.

In a prospective, multicenter study evaluating one revision knee system, 33 of 409 patients underwent morselized bone grafting for tibial and femoral defects. Fifty-four percent of defects were bicondylar and the defect volumes averaged 36 cc3. There was no difference in preoperative or postoperative knee scores between patients undergoing morselized grafting and the entire group. Radiographic evaluation showed remodeling of the grafted areas consistent with viable incorporation of the graft. The incidence of radiolucent lines, at 2 years followup, was not different between the patients who received grafting and the patients who did not receive grafting. There have been no clinical failures or reoperations in the patients who received morselized bone grafting. Morselized bone grafting seems to offer a viable alternative in the reconstruction of osseous defects in patients undergoing revision total knee arthroplasty.     

Impaction bone grafting with hydroxyapatite: increased femoral component stability in experiments using Sawbones

Background Substantial bone loss and bone defects increase the amount of allografting required in hip revision surgery. Thus, the use of a synthetic material to limit the amount of allograft tissue required for impaction grafting is desirable. We evaluated the potential of hydroxyapatite (HA) mixtures to provide initial mechanical stability to a polished tapered femoral stem.

Material and methods We determined the initial stability of a polished tapered femoral stem after reconstructing a cavitary femoral bone defect by impaction bone grafting with cement in Sawbones composite femurs. Three types of graft material were tested for their ability to improve initial rotational stability. The graft materials investigated were pure allograft, a mixture of 50% allograft and 50% hydroxyapatite (HA), and pure HA.

Results We found a statistically significant difference between the three groups as regards torsional micromotion and failure load.

Interpretation Our findings suggest that reconstruction of femoral bone defects with pure HA or a mixture of allograft and HA provides adequate initial stability for femoral revision arthroplasty using impaction grafting.     

Bone regeneration 6 years after impaction bone grafting: a PET analysis

BACKGROUND: Impacted morselized bone allograft in revision total hip arthroplasty for prosthetic loosening has gained widespread clinical use during the last decades. The clinical results are good but little is known about the bone regeneration in the graft. PATIENTS AND METHODS: 5 patients were revised with impaction of morselized frozen allograft and a cemented total hip arthroplasty (THA) due to loosening and osteolysis of a primary THA. We used positron emission tomography ([18F]-fluoride PET) to produce quantitative images of new bone formation in the allograft surrounding the femur stem 6 years after surgery. RESULTS: The 5 patients had previously been analyzed by [18F]-fluoride PET during the first year after surgery (S?rensen et al. 2003). During the first year, bone formation proceeded through the graft layer and reached the cement layer surrounding the femoral stems. The clinical and radiographic results were excellent at 6 years. PET analyses at 6 years showed that the bone metabolism was significantly reduced in most areas of the proximal femur, compared to the elevated activity during the first year after surgery, and also normalized compared to the contralateral healthy femur. Graft bone metabolism distal to the stem tip remained slightly increased. Small patchy areas of increased uptake remained along the proximal femoral stem, probably reflecting small volumes of fibrous healing. INTERPRETATION: The metabolism of the allografted bone had normalized compared to native bone, indicating full regeneration throughout the graft--and a good long-term prognosis for implant fixation.     

Comparison of internal bone transport and vascularized fibular grafting for femoral bone defects

OBJECTIVE: To compare results between vascularized fibular grafting and internal bone transport for large bone defects of the femur. DESIGN: Retrospective review of patients. SETTING: University teaching hospitals. PATIENTS: This study included 37 patients with femoral bone loss: 20 patients were treated with internal bone transport and seventeen patients were treated with vascularized fibular grafting. MAIN OUTCOME MEASUREMENTS: The outcomes investigated were external fixation time, external fixation index, bone results (union, infection, deformity, leg length discrepancy), and functional results. RESULTS: The mean amount of filled defect was 8.4 cm with internal bone transport and 8.9 cm with vascularized fibular grafting. The external fixation index was 1.4 months/cm with internal bone transport and 1 month/cm with vascularized fibular grafting. The bone results and functional results of the internal bone transport were excellent in 65% and 0%, good in 5% and 45%, fair in 5% and 40%, poor in 25% and 15%, respectively, whereas those of the vascularized fibular grafting were excellent in 35% and 0%, good in 25% and 47%, fair in 5% and 35%, and poor in 35% and 18%. CONCLUSION: With vascularized fibular grafting, careful monitoring of circulation and early intervention surgery is necessary to avoid vascular failure. With internal bone transport, repeated radical debridement until control of infection is achieved, bone grafting at the docking site for early union, and avoiding stress fracture are recommended to improve bone results.     

Ilizarov technique: Bone transport versus bone shortening-lengthening for tibial bone and soft-tissue defects

Objective

To compare the outcomes of bone transport and bone shortening-lengthening by Ilizarov technique for treatment of tibial bone and soft-tissue defects.

Autologous bone grafting for medial tibial defects in total knee arthroplasty

Seventeen posterior stabilized Insall-Burstein knee arthroplasties were implanted in severely deformed varus knees with large medial tibial bony defects. The defect was filled with an autologous bone graft obtained from the same knee and fixed with one or two screws. The patients were reviewed during an average follow-up period of 4 years (range, 2-8 years). The graft was completely united in 14 cases (82%), with bony trabeculae crossing the interface. Fibrous union occurred in three cases (18%). There was no evidence of graft necrosis or collapse. The results were classified as excellent in 10 knees (59%), good in 6 (35%), and poor in 1 (6%), which was revised for femoral loosening. The importance of meticulous technique and correct component positioning is emphasized.