Thursday, January 19, 2012

Anyone have a bone graft during revision surgery?


I really paid no attention to my bone graft other than to be concerned that they had to fill a hole the size of a golf ball in my ilium due to the chromium and cobalt eating through the bone.  What's the deal with the bone graft?  I was curious as to the origin of the material used in a bone graft.  Turns out there is shortage of bone so likely, if you had a bone graft to fill the hole made by the Chromium and cobalt, you had a bone substitute.

Injury. 2011 Sep;42 Suppl 2:S40-6. Epub 2011 Jul 12.

Bone graft substitutes in hip revision surgery: a comprehensive overview.

Source

Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, United Kingdom. andy.beswick@bristol.ac.uk

Abstract

INTRODUCTION:

Total hip replacement is increasingly used to treat diseased and damaged joints. With time, some joint replacements may require revision, mainly because of instability and mechanical loosening, and this is of particularly significance to younger patients. A major problem in revision surgery is the loss of bone stock and the consequent difficulty in reconstructing a stable joint. Loss of bone stock has been widely treated using bone autografts and allografts but supplies are limited. Use of bone graft substitutes in combination with, or as a substitute for, human bone is a possible alternative.

AIM:

To identify empirical studies of bone graft substitutes in hip revision surgery.

METHODS:

Systematic review based on Cochrane and MOOSE methods. We searched MEDLINE and EMBASE to December 2010 with terms relating to hip replacement and bone graft substitutes, and checked key citations in ISI Web of Science and reference lists. We considered all human studies irrespective of study design.

RESULTS:

Searches identified 397 articles. Screening of abstracts and full text articles identified 7 studies reporting outcomes of bone-graft substitute combined with autograft or allograft, and 6 studies reporting outcomes of bone graft substitute exclusively. One economic evaluation compared costs of femoral head banking with costs of bone graft substitutes. No randomised controlled trials evaluating bone graft substitute effectiveness were identified. Studies generally included small numbers of patients with a follow up too short to assess outcomes relating to implant survival. However, excepting those based on glass ceramic, ceramic bone graft substitutes show promise as an alternative to use of exclusive autograft or allograft. In the case of calcium phosphate ceramic bone graft substitute, potential cost savings were evident.

CONCLUSION:

With increased allograft shortage, bone graft substitutes will be required in hip revision surgery. However, appropriately designed randomised controlled trials are required to compare use of existing and new bone graft substitutes with established practice. As well as prosthesis related outcomes, studies should explore the patient experience of revision hip replacement with bone graft substitute material.

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Definitions:

Autograft: Tissue transplanted from one part of the body to another in the same individual. Also called an autotransplant.

A patient’s own tissue - an autograft – can often be used for a surgical reconstruction procedure. Autograft tissue is the safest and fastest-healing tissue that can be used. However, harvesting autograft tissue creates a second surgical site from which the patient must recover. The additional recovery time can extend a patient’s hospital stay. In addition, the secondary site could be uncomfortable for years after the surgery.

Allograft tissue, taken from another person, takes longer to incorporate into the recpient’s body, but there is no second surgical site to heal. Also, the surgical time and hospital stay may be shorter when allograft tissue is used. Allograft tissue transplants are not rejected by the body as with organ transplants, so that it is not necessary to use drugs to suppress the body’s immune response.

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I suppose they used a bone substitute on me given I had no other surgery.  ?

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