Fixation of hydroxyapatite-coated revision implants is improved by the surgical technique of cracking the sclerotic bone rim.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
Brian ElmengaardKjeld Søballe

Abstract

Revision joint replacement has poorer outcomes that have been associated with poorer mechanical fixation. We investigate a new bone-sparing surgical technique that locally cracks the sclerotic bone rim formed during aseptic loosening. We inserted 16 hydroxyapatite-coated implants bilaterally in the distal femur of eight dogs, using a controlled weight-bearing experimental model that replicates important features of a typical revision setting. At 8 weeks, a control revision procedure and a crack revision procedure were performed on contralateral implants. The crack procedure used a splined tool to perform a systematic local perforation of the sclerotic bone rim of the revision cavity. After 4 weeks, the hydroxyapatite-coated implants were evaluated for mechanical fixation by a push-out test and for tissue distribution by histomorphometry. The cracking revision procedure resulted in significantly improved mechanical fixation, significantly more bone ongrowth and bone volume in the gap, and reduced fibrous tissue compared to the control revision procedure. The study demonstrates that the sclerotic bone rim prevents bone ingrowth and promotes fixation by fibrous tissue. The effect of the cracking technique may be due to improved ac...Continue Reading

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Citations

Nov 25, 2014·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Bryan S MarguliesTimothy S Damron

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