header advert
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

PERFORATIONS IMPROVE REHABILITATION OF MASSIVE CORTICAL GRAFTS: AN EXPERIMENTAL SHEEP MODEL



Abstract

Purpose: Only very partial integration of massive allografts is generally achieved, affecting bone-graft junctions and the peripheral cortical. In clinical practice, this is not a major problem for massive reconstructions with a sleeve prosthesis but can be a handicap for junctional grafts or osteoarticular grafts where weak recolonisation can be a source of complications.

Material and methods: Extraperiosteal resection measuring 5 cm in length was made in the mid shaft region and bridged by a cyropreserved non-irradiated allograft before stabilisation with a static locked nail. Three groups of ten sheep were studied. The first group received a simple allograft without perforation; the allograft was perforated in the second group (1.1 mm drill bit); and the perforations in the allograft in the third group were lined with decalcified bone powder with assumed potential for inducing bone growth. The implantation was studied after a delay of six months. There were three infections so the analysis was made on 27 grafts. Plain x-rays (consolidation of the graft-bone junctions), histomorphometrics (porosity, new peripheral and endomedullary bone deposit, cortical thickness), and bone density were studied.

Results: Rate of bone-graft consolidation was not significantly different in the three groups. The callus was more endosteal in groups 2 and 3 (p< 0.02) and endomedullary bone deposit was greater (p=0.0001) than in group 1 without perforation. There was approximately three times more bone deposit in the perforated allografts than in the non-perforated allografts; Adjunction of demineralised bone around the perforated grafts did not lead to any significant difference compared with the perforated allografts (group 2).

Discussion: Significantly more bone deposit observed with perforated allografts should lead to better biomechanical behaviour. This is being tested in further work.

Conclusion: Perforations induce a significant increase in new bone deposit in massive cortical allografts, remodelling is much more active and extensive than with non-perforated allografts. It would be logical to propose perforated allografts for junctional or osteochondral massive cortical grafts.

The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France