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. 2009 Apr;80(2):150-4.
doi: 10.3109/17453670902884767.

Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute

Ashley W Blom  1 , Vikki Wylde, Christine Livesey, Michael R Whitehouse, Steve Eastaugh-Waring, Gordon C Bannister, Ian D Learmonth
Affiliations

Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute

Ashley W Blom et al. Acta Orthop. 2009 Apr.

Abstract

Background and purpose: One of the greatest problems of revision hip arthroplasty is dealing with lost bone stock. Good results have been obtained with impaction grafting of allograft bone. However, there have been problems of infection, reproducibility, antigenicity, stability, availability of bone, and cost. Thus, alternatives to allograft have been sought. BoneSave is a biphasic porous ceramic specifically designed for use in impaction grafting. BoneSave is 80% tricalcium phosphate and 20% hydroxyapatite. Previous in vitro and in vivo studies have yielded good results using mixtures of allograft and BoneSave, when compared with allograft alone. This study is the first reported human clinical trial of BoneSave in impaction grafting.

Methods: We performed a single-institution, multi-surgeon, prospective cohort study. 43 consecutive patients underwent revision hip arthroplasty using BoneSave and allograft to restore missing bone in the acetabulum. 9 patients had cemented acetabular components implanted and 34 uncemented. 10 patients had cemented femoral components implanted and 1 had an uncemented femoral component. 32 patients did not have their femoral component revised.

Results: No patients were lost to follow-up. At a mean follow-up of 24 (11-48) months, there were no re-revisions and there was no implant migration. 1 acetabular component had confluent lucent lines at the implant-graft interface. Complications were rare (1 fracture, 2 dislocations). Patient satisfaction with the procedure was high.

Interpretation: Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.

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Figures

Figure 1A.
Figure 1A.
1 year postoperatively. Demonstrates 2-mm-thick confluent radiolucent line around the acetabular component.
Figure 1B.
Figure 1B.
3 years postoperatively, showing stable radiolucency with excellent clinical results.
Figure 2A.
Figure 2A.
Preoperatively. Loose acetabular component and migration, leading to dislocation.
Figure 2B.
Figure 2B.
Postoperatively. Well-fixed acetabular component with visible BoneSave granules impacted.
Figure 2C.
Figure 2C.
3 years postoperatively. The acetabular component remains well fixed with integration of BoneSave graft.
See this image and copyright information in PMC

References

    1. Arts JJ, Schreurs BW, Buma P, Verdonschot N. Cemented cup stability during lever-out testing after acetabular bone impaction grafting with bone graft substitutes mixes containing morselized cancellous bone and tricalcium phosphate-hydroxyapatite granules. Proc Inst Mech Eng [H]. 2005a;219(4):257–63. - PubMed
    1. Arts JJ, Gardeniers JW, Welten ML, Verdonschot N, Schreurs BW, Buma P. No negative effects of bone impaction grafting with bone and ceramic mixtures. Clin Orthop. 2005b;(438):239–47. - PubMed
    1. Begley C, Doherty M, Mollan R, Wilson D. Comparative study of the osteoinductive properties of bioceramic, coral and processed bone grafts. Biomaterials. 1995;16:1181–5. - PubMed
    1. Blom AW, Grimm B, Miles AW, Cunningham J, Learmonth ID. Subsidence in impaction grafting. The effect of adding a ceramic bone graft substitute. Engineering in Medicine. Proc Inst Mech Eng [H] 2002;216:265–70. - PubMed
    1. Blom AW, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total hip arthroplasty. The Avon experience. J Bone Joint Surg (Br) 2003;85:956–9. - PubMed

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