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Impaction bone grafting for segmental acetabular defects: a biomechanical study.

Wagener Nele1, Fritsch Martina2, Reinicke Stefan2

  • 1Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-University, Robert Koch Straße 40, 37075, Göttingen, Germany. nele.wagener@med.uni-goettingen.de.

Archives of Orthopaedic and Trauma Surgery
|December 14, 2021
PubMed
Summary

Impaction bone grafting (IBG) provides stable fixation for acetabular defects up to 80 degrees in hip revision surgery. This biological method shows comparable biomechanical properties to non-defective bone, supporting its use in complex cases.

Keywords:
Biomechanical studyBone defectImpaction bone graftingMigrationRevision total hip arthroplastyTorsional stiffness

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Bone Regeneration

Background:

  • Implant loosening is the primary cause of revision hip arthroplasty, often involving progressive bone destruction.
  • While contained defects are manageable with impaction bone grafting (IBG), segmental defects typically require metal augmentation.
  • Biological reconstruction of bone stock for future revisions is crucial, especially in younger patients undergoing hip arthroplasty.

Purpose of the Study:

  • To evaluate the biomechanical stability of impaction bone grafting (IBG) in treating Paprosky type IIB segmental acetabular defects.
  • To assess the efficacy of IBG without additional stabilization in restoring bone stock for hip revision arthroplasty.

Main Methods:

  • Paprosky type IIB segmental defects (40°, 80°, 120°) were created in porcine hemipelves.
  • Impaction bone grafting (IBG) was performed, followed by implantation of a cemented polyethylene cup.
  • Cup migration, rotational stiffness, and maximum rupture torque were measured under physiological loading.

Main Results:

  • IBG cups demonstrated asymptotic migration (0.26 mm ± 0.11 mm) irrespective of defect size.
  • Maximum rupture moment was not significantly affected by defect size after IBG.
  • Torsional stiffness was significantly reduced only in 120° defects; smaller defects (≤80°) showed no difference compared to controls.

Conclusions:

  • Impaction bone grafting (IBG) is biomechanically sound for Paprosky type IIB segmental defects up to 80°.
  • IBG offers comparable stability to non-defective bone in these defect sizes, supporting its use in hip revision surgery.