Malhotra Rajesh, Gautam Deepak, Mukherjee Kaushik, Mukherjee Sudipto, Swamy Arun Manjunatha, Rai Alok, Goyal Ajay, Chawla Anoop
Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Medicover Hospital, Navi Mumbai, Maharashtra, India.
Arthroplast Today. 2023 Jun 14;22:101150. doi: 10.1016/j.artd.2023.101150. eCollection 2023 Aug.
Impaction of morselized allograft is an appealing procedure for addressing the bone defects. However, concerns remain about its suitability for massive defects. We used a novel "sandwich" technique by impacting the morselized allograft in layers with an intervening layer of injectable bone graft substitute for restoring bone defects during acetabular reconstruction in total hip arthroplasties.
From August 2015 to June 2017, 17 revisions, 4 rerevisions, and 3 complex primary total hip arthroplasties were operated by this novel technique. Postoperatively, serial X-rays were evaluated at regular intervals. Clinical and functional outcomes were assessed by the Harris hip score. To examine if introducing an injectable bone substitute into allograft stock increased its load-bearing capability, simulated mechanical testing using Synbone samples was conducted in the laboratory.
The mean Harris hip score significantly improved from 54.6 preoperatively to 86.8 at the latest follow-up. Graft incorporation was seen in all the cases. There was no evidence of component migration or loosening as compared to the X-rays at 3 weeks and 3 months in all the cases. With revision of component as end point, the survivorship was 100% at 82 months. The mechanical testing reported a higher capability of allograft samples when compared to those without bone substitutes.
Our data confirms that the use of the "sandwich" technique is a reliable option for major acetabular reconstruction. Early weight bearing is a significant value addition, and short-term results confirm good clinical and functional outcome. Longer follow-up is necessary to assess the status of the construct in the long term.
颗粒状同种异体骨打压植骨是一种治疗骨缺损的有效方法。然而，对于其在大块骨缺损中的适用性仍存在疑虑。我们采用了一种新颖的“三明治”技术，即在全髋关节置换髋臼重建过程中，通过分层打压颗粒状同种异体骨，并在其间置入一层可注射骨移植替代物来修复骨缺损。
2015年8月至2017年6月，采用这种新技术进行了17例翻修手术、4例再次翻修手术和3例复杂初次全髋关节置换手术。术后定期进行系列X线检查。采用Harris髋关节评分评估临床和功能结果。为了检验在同种异体骨中引入可注射骨替代物是否能提高其承重能力，在实验室使用Synbone样本进行了模拟力学测试。
Harris髋关节评分的平均值从术前的54.6显著提高到最近一次随访时的86.8。所有病例均可见移植骨融合。与所有病例术后3周和3个月时的X线片相比，没有发现假体移位或松动的迹象。以假体翻修为终点，82个月时的生存率为100%。力学测试报告显示，与未使用骨替代物的样本相比，同种异体骨样本的承重能力更高。
我们的数据证实，“三明治”技术是髋臼大段重建的可靠选择。早期负重具有重要价值，短期结果证实了良好的临床和功能结果。需要更长时间的随访来长期评估植入物的状况。
