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The Journal of Bone and Joint Surgery, Vol 75, Issue 6 845-862, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Revision, without cement, of aseptically loose, cemented total hip prostheses. Quantitative comparison of the effects of four types of medullary treatment on bone ingrowth in a canine model
TM Turner, RM Urban, DR Sumner and JO Galante
Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
A model that replicated the radiographic and histological features of
aseptic loosening of the femoral component of a total hip replacement that
had been done with cement was created in thirty-seven dogs. A deep wound
infection developed in one dog, and that dog was excluded from the study.
Revision was performed without cement in twenty-nine dogs, which were then
followed for six months. The remaining seven dogs were used for
histological study only. The components that were used for revision were
made from Ti-6-Al-4-V, and a titanium fiber-metal porous surface had been
applied to the anterior, posterior, and medial surfaces of the proximal
part of the stem. The femora were revised either with no graft material
applied to the osseous defect; with hydroxyapatite/beta-tricalcium
phosphate placed in the defect; with application of an autologous
cancellous bone graft as part of a one-stage revision; or with application
of an autologous cancellous bone graft as the first part of a two-stage
revision, with implantation of the component four months later. The use of
an autologous bone graft led to greater and more consistent ingrowth of
bone. The greatest amount of bone ingrowth was found in the group in which
the procedure had been done in two stages (18 +/- 4.1 per cent), followed
by the group in which the prosthesis and the graft had been inserted in a
single stage (15 +/- 5.0 per cent), the group that had been treated with
hydroxyapatite/beta-tricalcium phosphate (10 +/- 9.1 per cent), and the
control group, in which no graft had been used (7 +/- 7.0 per cent).
Notably, all of the components in the animals in which an autologous graft
had been used were well fixed by bone ingrowth, while the component in two
of the animals in the group in which no graft had been used in one animal
in the hydroxyapatite/beta-tricalcium phosphate group had only
fibrous-tissue ingrowth. In contrast to the findings with respect to bone
ingrowth, there was more medullary bone adjacent to the lateral aspect of
the implant in the groups in which hydroxyapatite/beta-tricalcium phosphate
or no graft had been inserted than in the groups that had had an autologous
graft.(ABSTRACT TRUNCATED AT 400 WORDS)
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