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Femoral bone regeneration subsequent to impaction grafting during hip revision: histologic analysis of a human biopsy specimen
Department of Orthopaedic Biomedical Engineering Research, and Department of Orthopaedic Surgery Medical College of Ohio, Toledo, Ohio, USA.
Department of Orthopaedic Surgery, Karolinska Hospital, Stockholm, Sweden.
Department of Orthopaedic Surgery, Karolinska Hospital, Stockholm, Sweden.
Mayo Medical School, Rochester, Minnesota, USA.
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1999 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 14, no 7, 849-953 p.Article in journal (Refereed) Published
Abstract [en]

Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. Biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.

Place, publisher, year, edition, pages
Philadelphia, USA: Elsevier, 1999. Vol. 14, no 7, 849-953 p.
Keyword [en]
Bone cement, bone remodeling, bone transplantation, femur/pathology, hip prosthesis
National Category
Medical and Health Sciences Orthopedics
Identifiers
URN: urn:nbn:se:oru:diva-55750DOI: 10.1016/S0883-5403(99)90036-0ISI: 000083123700013PubMedID: 10537261Scopus ID: 2-s2.0-0032871455OAI: oai:DiVA.org:oru-55750DiVA: diva2:1074518
Available from: 2017-02-15 Created: 2017-02-15 Last updated: 2017-10-18Bibliographically approved

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