A novel technique for impaction bone grafting in acetabular reconstruction of revision total hip arthroplasty using an ex vivo compaction device.
BACKGROUND
Impaction bone grafting allows restoration of the acetabular bone stock in revision hip arthroplasty. The success of this technique depends largely on achieving adequate initial stability of the component. To obtain well-compacted, well-graded allograft aggregates, we developed an ex vivo compaction device to apply it in revision total hip arthroplasty on the acetabular side, and characterized mechanical properties and putative osteoconductivity of allograft aggregates.


METHODS
Morselized allograft bone chips were compacted ex vivo using the creep technique and subsequent impaction technique to form the bone aggregates. Impaction allograft reconstruction of the acetabulum using an ex vivo compaction device was performed on eight hips. The mechanical properties and three-dimensional micro-CT-based structural characteristics of the bone aggregates were investigated.


RESULTS
In clinical practice, this technique offered good reproducibility in reconstructing the cavity and the segmental defects of the acetabulum, with no migration and no loosening of the component. In vitro analysis showed that the aggregates generated from 25 g fresh-frozen bone chips gained compression stiffness of 13.5-15.4 MPa under uniaxial consolidation strain. The recoil of the aggregates after compaction was 2.6-3.9%. The compression stiffness and the recoil did not differ significantly from those measured using a variety of proportions of large- and small-sized bone chips. Micro-CT-based structural analysis revealed average pore sizes of 268-299 μm and average throat diameter of pores in the bone aggregates of more than 100 μm. These sizes are desirable for osteoconduction, although large interconnected pores of more than 500 μm were detectable in association with the proportion of large-sized bone chips. Cement penetration into the aggregates was related to the proportion of large-sized bone chips.


CONCLUSIONS
This study introduces the value of an ex vivo compaction device in bone graft compaction in clinical applications. In vitro analysis provided evidence that compaction of sequential layers of well-compacted, well-graded bone aggregates, i.e., the aggregates comprising smaller sized chips at the host bone side and larger sized chips at the component side, may have the advantages of initial stability of the acetabular component and biological response of the grafted aggregates.
Department of Orthopaedics, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo, Kyoto, 606-8507, Japan. hakiyama@kuhp.kyoto-u.ac.jp
Haruhiko
H
Akiyama
Takkan
T
Morishima
Mitsuru
M
Takemoto
Koji
K
Yamamoto
Hiromi
H
Otsuka
Toshiki
T
Iwase
Tamon
T
Kabata
Tsunemitsu
T
Soeda
Keiichi
K
Kawanabe
Keiji
K
Sato
Takashi
T
Nakamura
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D011475:Prosthesis Failure; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012086:Reoperation; D014184:Transplantation, Homologous; D016896:Treatment Outcome