title: No negative effects of bone impaction grafting with bone and ceramic mixtures.
abstract: Reconstructing large loaded bone defects with ceramic bone graft extenders is tempting considering the expected future donor bone shortage. However, whether there are negative effects is unknown. Standardized large defects in the acetabulum of goats were created and subsequently reconstructed with metal mesh and impacted morselized cancellous bone grafts or a 50/50% volume mixture of tricalcium phosphate-hydroxyapatite granules and morselized cancellous bone grafts using the bone impaction grafting technique. Subsequently, a cemented total hip prosthesis was inserted. Clinically, no differences were observed between groups. Most of the morselized cancellous bone graft had been resorbed and incorporated into new bone after 15 weeks. The large tricalcium phosphate-hydroxyapatite granules were integrated, the smaller crushed tricalcium phosphate-hydroxyapatite granules were surrounded by osteoclasts or engulfed by macrophages and giant cells. The cement penetration into the reconstructive layer and the quality of the bone based on a semiquantitative score were similar in both groups. We found no suggestion of tricalcium-hydroxyapatite granule-induced third-body wear in this short-term followup study. No negative effects were observed in this study, and therefore, it seems reasonable to use tricalcium-hydroxyapatite granules in a 50/50% volume mix with morselized cancellous bone graft as a bone graft extender in acetabular revision surgery with the bone impaction grafting technique.
authors.affiliation: From the Orthopaedic Research Laboratory, Department of Orthopedics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: J J Chris
authors.initials: JJ
authors.lastname: Arts
authors.forename: Jean W M
authors.initials: JW
authors.lastname: Gardeniers
authors.forename: Marianne L M
authors.initials: ML
authors.lastname: Welten
authors.forename: Nico
authors.initials: N
authors.lastname: Verdonschot
authors.forename: B Willem
authors.initials: BW
authors.lastname: Schreurs
authors.forename: Pieter
authors.initials: P
authors.lastname: Buma
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000818:Animals; D019644:Arthroplasty, Replacement, Hip; D018786:Bone Substitutes / Q000009:adverse effects*; D016025:Bone Transplantation; D002130:Calcium Phosphates / Q000009:adverse effects / Q000032:analysis; D002516:Ceramics / Q000009:adverse effects*; D004195:Disease Models, Animal; D005260:Female; D006041:Goats; D008422:Materials Testing; D016348:Osseointegration / Q000187:drug effects*; D010316:Particle Size; D011475:Prosthesis Failure; D016474:Weight-Bearing
chemical_list: D018786:Bone Substitutes; D002130:Calcium Phosphates; C018392:tricalcium phosphate