title: Histologic analysis of allograft mixed with hydroxyapatite-tricalcium phosphate used in revision femoral impaction bone grafting.
abstract: Failed total hip arthroplasty (THA) often is accompanied by loss of bone stock. In cases in which revision THA becomes necessary, adequate stabilization of the implant can be difficult because of the bone loss. Bone can be reconstructed by using tightly packed morselized cancellous bone graft in combination with a cemented stem. However, worldwide availability of human bone is limited, and risks such as infection and antigenicity are associated with the use of allogeneic bone. These risks have led to the development of synthetic bone graft extenders. The objective of impaction bone grafting is to achieve stability of an implant and subsequently allow the restoration of living bone stock. To reduce the amount of allograft consumed, a mixture of morselized allograft and hydroxyapatite-tricalcium phosphate was used for impaction grafting in a series of 15 patients. In 2 patients who required re-revision arthroplasty, the areas of impacted graft were analyzed histologically. The results showed a complex mixture of residual hydroxyapatite-tricalcium phosphate, necrotic bone (graft), viable bone, and fibrous tissue. Although several pre-clinical studies have described the expansion of allograft with synthetic materials, this article represents the first description of histologic findings in human femoral impaction grafting with a combination of allograft and hydroxyapatite-tricalcium phosphate.
authors.affiliation: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujishiro
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Niikura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takikawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Saegusa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Bauer
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D018786:Bone Substitutes / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000295:instrumentation* / Q000379:methods; D002130:Calcium Phosphates / Q000627:therapeutic use*; D017886:Durapatite / Q000627:therapeutic use*; D005260:Female; D005264:Femoral Fractures / Q000473:pathology* / Q000601:surgery*; D005269:Femur; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes; D002130:Calcium Phosphates; D017886:Durapatite; C018392:tricalcium phosphate