Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects :  a retrospective analysis

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Abstract

Aims

Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects.

Methods

We performed a retrospective review at a single institution of patients undergoing revision THA by a single surgeon. We identified 49 consecutive patients with large acetabular defects where the biphasic BGS was applied, with no other products added to the BGS. After placement of metallic acetabular implants, the BGS was injected into the remaining bone defects surrounding the new implants. Patients were followed and monitored for functional outcome scores, implant fixation, radiological graft site remodelling, and revision failures.

Results

Mean follow-up was 39.5 months (36 to 71), with a significant improvement in post-revision function compared to preoperative function. Graft site remodelling was rated radiologically as moderate in 31 hips (63%) and strong in 12 hips (24%). There were no cases of complete graft site dissolution. No acetabular loosening was identified. None of the patients developed clinically significant heterotopic ossification. There were twelve reoperations: six patients developed post-revision infections, three experienced dislocations, two sustained periprosthetic femur fractures, and one subject had femoral component aseptic loosening.

Conclusion

Our series reports bone defect restoration with the sole use of a biphasic injectable BGS in the periacetabular region. We did not observe significant graft dissolution. We emphasize that successful graft site remodelling requires meticulous recipient site preparation.

Cite this article: Bone Jt Open 2022;3(12):991–997.

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Most cited references 33

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Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.

Steven Kurtz, Kevin Ong, Edmund Lau … (2007)

Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030. The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030. By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030. These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need.

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Bone grafts and biomaterials substitutes for bone defect repair: A review

Wenhao Wang, Kelvin W.K. Yeung (2017)

Bone grafts have been predominated used to treat bone defects, delayed union or non-union, and spinal fusion in orthopaedic clinically for a period of time, despite the emergency of synthetic bone graft substitutes. Nevertheless, the integration of allogeneic grafts and synthetic substitutes with host bone was found jeopardized in long-term follow-up studies. Hence, the enhancement of osteointegration of these grafts and substitutes with host bone is considerably important. To address this problem, addition of various growth factors, such as bone morphogenetic proteins (BMPs), parathyroid hormone (PTH) and platelet rich plasma (PRP), into structural allografts and synthetic substitutes have been considered. Although clinical applications of these factors have exhibited good bone formation, their further application was limited due to high cost and potential adverse side effects. Alternatively, bioinorganic ions such as magnesium, strontium and zinc are considered as alternative of osteogenic biological factors. Hence, this paper aims to review the currently available bone grafts and bone substitutes as well as the biological and bio-inorganic factors for the treatments of bone defect.

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Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.

W Harris (1969)

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Author and article information

Contributors

Edward J. McPherson: Role: Professor

Alexandra I. Stavrakis: Role: Assistant Professor

Madhav Chowdhry: Role: Grad Student

Nora L. Curtin: Role: Researcher

Matthew V. Dipane:

ORCID: https://orcid.org/0000-0001-5978-8662

Role: Research Assistant

Brooke M. Crawford: Role: Associate Professor

Journal

Journal ID (nlm-ta): Bone Jt Open

Journal ID (iso-abbrev): Bone Jt Open

Journal ID (publisher-id): BJO

Title: Bone & Joint Open

Publisher: The British Editorial Society of Bone & Joint Surgery (London )

ISSN (Electronic): 2633-1462

Publication date (Electronic): 22 December 2022

Publication date Collection: December 2022

Volume: 3

Issue: 12

Pages: 991-997

Affiliations

[1 ] org-divisionDepartment of Orthopaedic Surgery , org-divisionDavid Geffen School of Medicine at UCLA , Santa Monica, California, USA

[2 ] org-divisionNuffield Department of Primary Care Health Sciences & Department of Continuing Education , org-divisionKellogg College, University of Oxford , Oxford, UK

[3 ] org-divisionDepartment of Orthopedic Surgery , org-divisionThe University of Miami Miller School of Medicine , Miami, Florida, USA

Author notes

Correspondence should be sent to Matthew V. Dipane. E-mail: mdipane@ 123456mednet.ucla.edu

Author information

Matthew V. Dipane https://orcid.org/0000-0001-5978-8662

Article

Publisher ID: BJO-3-991

DOI: 10.1302/2633-1462.312.BJO-2022-0094.R1

PMC ID: 9783269

PubMed ID: 36545948

SO-VID: 6b46a254-7cef-4ff1-a45c-626c6e3451ea

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

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Custom metadata

odf2nlm-version 2.0

price $2.00

principal-institution David Geffen School of Medicine at UCLA, Los Angeles, California, USA

article-type Hip

coi-statement E. J. McPherson reports payments for lectures, presentations, speakers bureaus, manuscript writing or educational events from BoneSupport AB, unrelated to this study.

Keywords: bone graft substitute,bgs,biphasic,cerament,revision,total hip arthroplasty,tha,acetabulum,bone defect,bone loss,acetabular bone defects,revision total hip arthroplasty,bone grafts,calcium sulphate,hydroxyapatite,acetabular defects,revision surgery,biomaterial,autograft

Data availability:

Keywords: bone graft substitute, bgs, biphasic, cerament, revision, total hip arthroplasty, tha, acetabulum, bone defect, bone loss, acetabular bone defects, revision total hip arthroplasty, bone grafts, calcium sulphate, hydroxyapatite, acetabular defects, revision surgery, biomaterial, autograft

Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects : a retrospective analysis

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Core Readings in Statistical Mediation Analysis

Most cited references 33

Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.

Bone grafts and biomaterials substitutes for bone defect repair: A review

Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.

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