Bone impaction grafting (since 1979)

Morselized bone grafts, which are produced mainly from femoral heads, are pieces of trabecular bone of about 1 cm3 (like the croutons in your soup!). They are nibbled by hand using a rongeur or a specially designed bone mill. Bone impaction grafting (figure 1) was developed by Dr. Tom Slooff in the late 1970-ties. Clinically, bone impaction grafting is used in Nijmegen since 1979, mainly in complex primary and in revision arthroplasties of the hip and knee.

The only way to prove the value of a reconstruction method is a long-term follow-up study. Therefore, several patient groups are followed since 1979: acetabular reconstruction, reconstruction of patients under 50 years, rheumatoid arthritis patients, and patients with congenital hip dysplasia. We have published a number of articles on in vitro mechanical test data in various model systems, we developed different in vivo model systems, performed various in vivo studies, described the histology of patient biopsies and studied the use of bone graft extenders and materials that can replace the allograft bone.

Research nowadays mainly focuses on the clinical long-term follow-up studies and on bone substitutes. For more, see our publications.

Allograft Bone

Total hip replacement is a very successful operation in patients with osteoarthritis of the hip. After 10 years 90% of the implants will still be in situ. Despite this good long-term survival rate, due to the increasing number of primary hip replacements, the number of failed replacements will increase strongly in the next decade. One of the main problems in complex primary arthroplasty and in revision surgery after failure of the primary prostheses is to restore the lack of bone stock which is associated with congenital problems or which is induced by the loosening process. These bone defects makes the implantation of a new prosthesis technically demanding.

In our orthopedic department we developed very successful procedures to restore bone defects during a revision procedure of a failed implant. The use of morselized impacted bone grafts to restore bone loss defects during hip implant revision surgery has a 10 year survival rate of some 94%, this is even better than the 90% survival rate of primary hip replacements. Although an autograft of the patients own bone is still the gold standard, the prolonged operation time, the donor site morbidity and the limited volume that can be harvested, made us investigate the use of allograft bone. Allografts are derived from the human bone banks. Before release, grafts are extensively tested to prevent transmission of diseases and to provide good bone quality. Processing of allograft bone may diminish the risk for the transfer of viruses but it is not known if this processed bone functions as effective as non-processed allograft bone. In the light of the expected world wide shortage of donor bone, substitutes based on biomaterials or metals may in due time totally replace the allograft bone.

Publications

Articles:

See PubMed

Dissertations:

2014 February 5th

Walschot, Luc;
Porous Titanium Particles as a full Bone Substitute for Defect Reconstruction in Hip Joint Replacement Surgery

2010 March 26th

Rijnen, Wim;
Treatment Modalities for Osteonecrosis of Hip and Knee

2008 June 5th

Hannink, Gerjon;
Bone Impaction Grafting under Reconstruction

2006 April 6th

Arts, Chris;
New Developments in Bone Impaction Grafting

2004 March 25th

Bolder, Stefan
Defect Reconstruction with Impacted Morsellized Bone Grafts in Total Hip Arthroplasty


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