This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exams for this article:
 Adult Knee Reconstruction Test 1: Revision Total Knee Arthroplasty
Adult Hip Reconstruction Test 2: Revision Total Hip Arthroplasty
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dunlop, D. G.
Right arrow Articles by Howie, C. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dunlop, D. G.
Right arrow Articles by Howie, C. R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 85:639-646 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Techniques to Improve the Shear Strength of Impacted Bone Graft

The Effect of Particle Size and Washing of the Graft

Douglas G. Dunlop, MD, FRCS, FRCSEd (Tr and Orth), Nigel T. Brewster, FRCSEd (Orth), S. P.Gopal Madabhushi, PhD, Asif S. Usmani, PhD, P. Pankaj, PhD and Colin R. Howie, FRCSEd

Investigation performed at the Edinburgh Orthopaedic Research Department, Princess Margaret Rose Orthopaedic Hospital, Edinburgh, Scotland

Douglas G. Dunlop, MD, FRCS, FRCSEd (Tr and Orth)
Trauma and Orthopaedics, Southampton University Hospitals NHS Trust, Mailpoint 45, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, England. E-mail address: douglas.dunlop{at}virgin.net

Nigel T. Brewster, FRCSEd (Orth)
Freeman Hospital, High Heaton, Newcastle Upon Tyne NE 77 DN, England. E-mail address: nigelbrewster@hotmail.com

S.P. Gopal Madabhushi, PhD
Schofield Centrifuge Centre, Trumpington Street, Cambridge CB2 1PZ, England. E-mail address: mspg1@eng.cam.ac.uk

Asif S. Usmani, PhD
P. Pankaj, PhD
School of Civil and Environmental Engineering, University of Edinburgh Crew Building, The King's Buildings, Edinburgh EH9 3JN, Scotland. E-mail address for A. Usmani: asif.usmani@ed.ac.uk. E-mail address for P. Pankaj: pankaj@ed.ac.uk

Colin R. Howie, FRCSEd
New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh EH16 4SU, Scotland. E-mail address: howsta@globalnet.co.uk

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: When fresh morselized graft is compacted, as in impaction bone-grafting for revision hip surgery, fat and marrow fluid is either exuded or trapped in the voids between particles. We hypothesized that the presence of incompressible fluid damps and resists compressive forces during impaction and prevents the graft particles from moving into a closer formation, thus reducing the graft strength. In addition, viscous fluid such as fat may act as an interparticle lubricant, thus reducing the interlocking of the particles.

Methods: We performed mechanical shear testing in the laboratory with use of fresh-frozen human femoral-head allografts that had been passed through different orthopaedic bone mills to produce graft of differing particle-size distributions (grading).

Results: After compaction of fresh graft, fat and marrow fluid continued to escape on application of normal loads. Washed graft, however, had little lubricating fluid and better contact between the particles, increasing the shear resistance. On mechanical testing, washed graft was significantly (p < 0.001) more resistant to shearing forces than fresh graft was. This feature was consistent for different bone mills that produced graft of different particle-size distributions and shear strengths.

Conclusions: Removal of fat and marrow fluid from milled human allograft by washing the graft allows the production of stronger compacted graft that is more resistant to shear, which is the usual mode of failure. Further research into the optimum grading of particle sizes from bone mills is required.

Clinical Relevance: Understanding the mechanical properties of milled human allograft is important when impaction grafting is used for mechanical support. A simple means of improving the mechanical strength of graft produced by currently available bone mills, including an intraoperative washing technique, is described.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
D. A. Oakes and M. E. Cabanela
Impaction bone grafting for revision hip arthroplasty: biology and clinical applications.
J. Am. Acad. Ortho. Surg., October 1, 2006; 14(10): 620 - 628.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
B. W. Schreurs, J.J. C. Arts, N. Verdonschot, P. Buma, T. J.J.H. Slooff, and J. W.M. Gardeniers
Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem. Surgical Technique
J. Bone Joint Surg. Am., September 1, 2006; 88(1_suppl_2): 259 - 274.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
B. W. Schreurs, J.J. C. Arts, P. Buma, and N. Verdonschot

J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1162 - 1163.
[Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
F. N. K. Kwong, T. Ibrahim, and R. A. Power
Incidence of infection with the use of non-irradiated morcellised allograft bone washed at the time of revision arthroplasty of the hip
J Bone Joint Surg Br, November 1, 2005; 87-B(11): 1524 - 1526.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
A. D. Toms, R. L. Barker, R. S. Jones, and J. H. Kuiper
Impaction Bone-Grafting in Revision Joint Replacement Surgery
J. Bone Joint Surg. Am., September 1, 2004; 86(9): 2050 - 2060.
[Abstract] [Full Text] [PDF]