Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes |
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| Institution: | 1. Dept of Spine Surgery, Columbia Asia Hospital, Saltlake, Kolkata, India;2. KIMS Hospital, Burdwan, India;3. ESKAG Sanjeevani N.Home, Kolkata, India;4. Dept of Anaesthesiology RKMSP and VIMS, Kolkata, India;5. Dept of Community Medicine, AIIMS, Nagpur, India;1. Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada;2. McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada;3. Cumming School of Medicine, University of Calgary, Calgary, Canada;4. Orthopaedic Trauma Surgeon, Department of Surgery and Community Health Sciences, Foothills Medical Centre, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada;1. Western Upper Limb Facility, Sturgeon Hospital, St. Albert, Alberta, Canada;2. Division of Orthopaedic Surgery, Department of Surgery, Edmonton, Alberta, Canada;3. Roth-McFarlane Hand & Upper Limb Centre, St. Joseph’s Health Care, London, Ontario, Canada;4. Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada;1. Department of Trauma & Orthopaedics, King’s College Hospital, London, UK;2. Diabetic Foot Clinic, King’s College Hospital, London, UK;3. University of Southern Denmark, Denmark |
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| Abstract: | BackgroundThe aim of this study was to present our clinical outcomes and surgical technique in strut allografts preparation using staggered holes to enhance osteointegration and demineralised bone matrix (DBM) as an adjunct to cortical strut allografts in salvage revision arthroplasty patients.MethodsRetrospective consecutive series of patients who required strut allograft femoral reconstructions with minimum 2 years follow up between 2012 and 2018. Frozen washed irradiated, cortical struts were used and prepared adding 2 mm staggered drill holes along the length of the strut and applying DBM paste on the graft-host interface. Outcome measures included radiographic strut union, graft resorption, infection and complications.Results15 patients included; 3 males and 12 females with median age 72 years (range 60–93). All had significant bony defects (Paprosky III/IV in 12 cases including 3 cases of periprosthetic hip fractures and further 3 cases of periprosthetic knee fractures around revision hinged implants). At final follow up, median 3.8 years (range 2.7–7.2), 14/15 (93.3%) struts had united at a median 6 months (range 5–8), complete incorporation with cortical round-off was seen at median 12 months (range 8–48) in 12/15 (80%) struts, 2/15 (13.3%) show radiographic evidence of proximal minimal graft resorptions although the remainder of the strut had integrated and were asymptomatic. There were no cases of infection.ConclusionsUse of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months. |
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| Keywords: | Cortical strut allografts Revision hip arthroplasty Periprosthetic fractures Surgical technique Case series |
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