(1/715) Mechanical considerations in impaction bone grafting.
In impaction grafting of contained bone defects after revision joint arthroplasty the graft behaves as a friable aggregate and its resistance to complex forces depends on grading, normal load and compaction. Bone mills in current use produce a distribution of particle sizes more uniform than is desirable for maximising resistance to shear stresses. We have performed experiments in vitro using morsellised allograft bone from the femoral head which have shown that its mechanical properties improve with increasing normal load and with increasing shear strains (strain hardening). The mechanical strength also increases with increasing compaction energy, and with the addition of bioglass particles to make good the deficiency in small and very small fragments. Donor femoral heads may be milled while frozen without affecting the profile of the particle size. Osteoporotic femoral heads provide a similar grading of sizes, although fewer particles are obtained from each specimen. Our findings have implications for current practice and for the future development of materials and techniques. (+info)
(2/715) The pathogenesis of Perthes' disease.
It has been shown that in the puppy, two infarcts separated by an interval of four weeks produce a disorder of long duration which results in flattening and broadening of the femoral head and which reproduces the radiological changes seen in Perthes' disease in man. The histological appearances produced by two infarcts are characteristic. In this study the histological appearance of fifty-seven femoral head biopsy specimens in Perthes' disease in man have been studied. In 51 per cent of hips histopathological changes characteristic of double infarction were present, and there were grounds for postulating that double infarction might eventually occur in all cases. The findings support the concept that the deformation of the femoral head and the chronicity of Perthes' disease in man may be due at least as much or even more to repeated episodes of infarction and the ensuing abnormalities of growth as to mechanical factors related to weight-bearing. (+info)
(3/715) The influence of weight-bearing on the measurement of polyethylene wear in THA.
We have studied the influence of weight-bearing on the measurement of wear of the polyethylene acetabular component in total hip arthroplasty using two techniques. The measured vertical wear was significantly greater when radiographs were taken weight-bearing rather than with the patient supine (p = 0.001, method 1; p = 0.007, method 2). Calculations of rates of linear wear of the acetabular component were significantly underestimated (p < 0.05) when radiographs were taken supine. There are two reasons for this. First, a change in pelvic orientation when bearing weight ensures that the thinnest polyethylene is brought into relief, and secondly, the head of the femoral component assumes the position of maximal displacement along its wear path. Interpretation of previous studies on both linear and volumetric polyethylene wear in total hip arthroplasty should be reassessed in the light of these findings. (+info)
(4/715) Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. Einzel-Bild-Rontgen-Analyse-femoral component analysis.
Several methods of measuring the migration of the femoral component after total hip replacement have been described, but they use different reference lines, and have differing accuracies, some unproven. Statistical comparison of different studies is rarely possible. We report a study of the EBRA-FCA method (femoral component analysis using Einzel-Bild-Rontgen-Analyse) to determine its accuracy using three independent assessments, including a direct comparison with the results of roentgen stereophotogrammetric analysis (RSA). The accuracy of EBRA-FCA was better than +/- 1.5 mm (95% percentile) with a Cronbach's coefficient alpha for interobserver reliability of 0.84; a very good result. The method had a specificity of 100% and a sensitivity of 78% compared with RSA for the detection of migration of over 1 mm. This is accurate enough to assess the stability of a prosthesis within a relatively limited period. The best reference line for downward migration is between the greater trochanter and the shoulder of the stem, as confirmed by two experimental analyses and a computer-assisted design. (+info)
(5/715) The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis.
We report the ten-year results for three designs of stem in 240 total hip replacements, for which subsidence had been measured on plain radiographs at regular intervals. Accurate migration patterns could be determined by the method of Einzel-Bild-Roentgen-Analyse-femoral component analysis (EBRA-FCA) for 158 hips (66%). Of these, 108 stems (68%) remained stable throughout, and five (3%) started to migrate after a median of 54 months. Initial migration of at least 1 mm was seen in 45 stems (29%) during the first two years, but these then became stable. We revised 17 stems for aseptic loosening, and 12 for other reasons. Revision for aseptic loosening could be predicted by EBRA-FCA with a sensitivity of 69%, a specificity of 80%, and an accuracy of 79% by the use of a threshold of subsidence of 1.5 mm during the first two years. Similar observations over a five-year period allowed the long-term outcome to be predicted with an accuracy of 91%. We discuss the importance of four different patterns of subsidence and confirm that the early measurement of migration by a reasonably accurate method can help to predict long-term outcome. Such methods should be used to evaluate new and modified designs of prosthesis. (+info)
(6/715) The pathology of bone allograft.
We analysed the histological findings in 1146 osteoarthritic femoral heads which would have been considered suitable for bone-bank donation to determine whether pathological lesions, other than osteoarthritis, were present. We found that 91 femoral heads (8%) showed evidence of disease. The most common conditions noted were chondrocalcinosis (63 cases), avascular necrosis (13), osteomas (6) and malignant tumours (one case of low-grade chondrosarcoma and two of well-differentiated lymphocytic lymphoma). There were two with metabolic bone disease (Paget's disease and hyperparathyroid bone disease) and four with inflammatory (rheumatoid-like) arthritis. Our findings indicate that occult pathological conditions are common and it is recommended that histological examination of this regularly used source of bone allograft should be included as part of the screening protocol for bone-bank collection. (+info)
(7/715) Histopathology of retrieved allografts of the femoral head.
From November 1994 to March 1997, we harvested 137 grafts of the femoral head from 125 patients for donation during total hip arthroplasty according to the guidelines of the American Associations of Tissue Banks (AATB) and the European Association of Musculo-Skeletal transplantation (EAMST). In addition to the standards recommended by these authorities, we performed histopathological examination of a core biopsy of the retrieved bone allograft and of the synovium. Of the 137 allografts, 48 (35.0%) fulfilled all criteria and were free for donation; 31 (22.6%) were not regarded as suitable for transplantation because the serological retests at six months were not yet complete and 58 (42.3%) were discarded because of incomplete data. Of those discarded, five showed abnormal histopathological findings; three were highly suspicious of low-grade B-cell lymphoma, one of monoclonal plasmacytosis and the other of non-specific inflammation of bone marrow. However, according to the standards of the AATB or EAMST they all met the criteria and were eligible for transplantation. Our findings indicate that the incidence of abnormal histopathology in these retrieved allografts was 3.6%. Since it is essential to confirm the quality of donor bones in bone banking, we advise that histopathological screening of donor bone should be performed to exclude abnormal allografts. (+info)
(8/715) Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis.
We have evaluated bone-marrow activity in the proximal femur of patients with corticosteroid-induced osteonecrosis and compared it with that of patients with osteonecrosis related to sickle-cell disease and with a control group without osteonecrosis. Bone marrow was obtained by puncture of the femoral head outside the area of necrosis and in the intertrochanteric region. The activity of stromal cells was assessed by culturing fibroblast colony-forming units (FCFUs). We found a decrease in the number of FCFUs outside the area of osteonecrosis in the upper end of the femur of patients with corticosteroid-induced osteonecrosis compared with the other groups. We suggest that glucocorticosteroids may also have an adverse effect on bone by decreasing the number of progenitors. The possible relevance of this finding to osteonecrosis is discussed. (+info)