Vascularised bone graft is an effective technique for extracortical bone bridging to combat cemented megaprosthesis loosening at the bone-implant junction
| Autor: | Raymond Yau, Ying-Lee Lam, Michelle Hilda Luk, Kenneth Wai Yip Ho, Andy Hon-Fai Yee |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation Bridging (networking) Aseptic loosening Dentistry Bone Neoplasms Implant fixation 03 medical and health sciences 0302 clinical medicine lcsh:Orthopedic surgery Bone tumours Medicine Humans 030212 general & internal medicine Arthroplasty Replacement Knee 030222 orthopedics Bone Transplantation business.industry Bone implant Prostheses and Implants Middle Aged Prosthesis Failure Radiography lcsh:RD701-811 Treatment Outcome Surgery Female business |
| Zdroj: | Journal of Orthopaedic Surgery, Vol 28 (2020) |
| ISSN: | 2309-4990 |
| Popis: | Introduction: The bone–implant junction is a potential site for aseptic loosening. Extracortical bone bridging at the bone–implant junction is advocated to improve implant fixation by forming a biological seal. We propose a novel technique with vascularised bone graft (VBG) to form an extracortical bone bridge at the bone–implant junction to enhance implant stability. We compared the clinical and radiological outcomes for tumour megaprostheses performed (1) with and without bone graft and (2) with non-vascularised versus VBG technique. Methods: Forty-six tumour megaprosthesis procedures from 1 June 2007 to 31 October 2017 were identified from hospital records. Twenty-eight operations incorporated bone graft at the bone–implant junction, and 18 did not. Of these 28 bone graft procedures, 13 involved VBG, and 15 did not (non-VBG). The VBG technique involves resecting a short segment of healthy bone beyond the oncological margin with its preserved blood supply, splitting it, then securing it over the junction. Clinical outcomes assessed included loosening, fracture and recurrence. Extracortical bone growth at the bone–implant junction was quantified radiologically at intervals 0–24 months post-operatively. The mean follow-up was 4.27 years. Results: There were five incidences (27.8%) of loosening in the non-bone graft group compared to zero in the bone graft group ( p = 0.03). There was a higher radiological score of extracortical bone growth in the bone graft group compared to no bone graft at 3–24 months post-operatively ( p < 0.05). Within the bone graft group, the VBG group fared superior at 6 and 12 months post-operatively compared to non-VBG ( p < 0.05), as well as a lower rate of radiological junctional resorption ( p = 0.04). Conclusions: We recommend bone grafting for its merits of less implant loosening. We propose the VBG technique to combat early aseptic loosening in megaprosthesis replacement as there was a higher radiological score compared to non-VBG. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|