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A bone grafting technique in reconstructive joint arthroplasty
A Bone Grafting Technique in Reconstructive Joint Arthroplasty
G e o r g e J. Fipp, M D
Abstract: A technique of creating a cement model of large osseous defects to use in carving bone grafts in total joint arthroplasties is presented. The benefits of making bulk grafts in this way include: (1) less settling; (2) stability of the grafts for prosthetic fitting; (3) increased contact between the graft and host, enhancing incorporation of the graft. Key words: bone grafting, cement model, reconstructive joint arthroplasty.
" d o u g h y " stage, it is lightly packed into defect (Fig. 2). The defect is "overpacked." Just before final setting of the cement, it is removed. This cement is used as a mold to carve the bone graft to fit the defect (Fig. 3). The carved bone graft is then inserted into the defect and frequently is lightly tapped into place. Often it has a great deal of inherent stability at this stage. Screws are used to fix this graft to the host. The screws must be placed so as not to interfere with the placement of the prosthesis. After graft placement, a hole is reamed for a socket (Fig. 4). Placement of the socket is then done in the routine fashion. This technique can be used for reconstructive surgery for total knees as well (Figs. 5-8). The benefits of making the grafts in this way include the following.
Bone grafting has been advocated to augment the skeleton in both primary and revision arthroplasties where significant bone defects are found. Small defects, in situations where the graft can be contained by the surrounding host bone, are inherently stable. Here too, the prosthesis holds the graft into the "hole." Where there are larger defects, especially those made of rim defects, the process of creating the graft, filling the defect, and stabilizing the graft during instrumentation frequently presents a problem. In these situations, the following technique is helpful.
Technique
1. The creation of larger grafts {vs. bone chips, peanut-sized grafts, etc.), reducing the tendency for early settling of a prosthesis. 2. Increased stability of the graft, allowing cutting and reaming the graft for prosthetic fit. 3. Increased contact between the graft and the host, enhancing incorporation of the graft.
The bed of the defect is cleansed of all soft tissue (Fig. 1 ). The bed is not dried, but left moist and bleeding, to prevent the cement mold from sticking. Half a pack of cement is mixed; w h e n it is in the late
From the University of Florida, Gainesville, Florida.
We have used this technique over the past several years and have found it to be very helpful.
Reprint requests: George J. Fipp, MD, 4203 Belfort Drive, Jacksonville, FL 32216.
285
286
The Journal of Arthroplasty Vol. 4 No. 3 September 1989
\,
Fig. 1. A defect in the superior dome and rim of the acetabulum. The defect is cleansed of soft tissue and left moist and bleeding.
Fig. 2. Cement in the late "doughy" stage, lightly packed into the defect. It is removed just before final setting and used to create a model.
_J
Fig. 3. Bone graft is carved to fill the defect, using the removed cement as a model.
Fig. 4. The bone graft is secured in place and cut and reamed as necessary to receive the prosthesis.
Bone Grafting
•
Fipp
/
287
/
Fig. 5. A defect in the medial femoral condyle after removal of a failed total knee arthroplasty is cleansed of soft tissue. Fig. 7. The bone graft is carved using the removed cement as a model.
Fig. 6. Cement in the late "doughy" stage is lightly packed into the defect.
Fig. 8. The bone graft is secured into place and cut to receive the new prosthesis.
G e o r g e J. Fipp, M D
Abstract: A technique of creating a cement model of large osseous defects to use in carving bone grafts in total joint arthroplasties is presented. The benefits of making bulk grafts in this way include: (1) less settling; (2) stability of the grafts for prosthetic fitting; (3) increased contact between the graft and host, enhancing incorporation of the graft. Key words: bone grafting, cement model, reconstructive joint arthroplasty.
" d o u g h y " stage, it is lightly packed into defect (Fig. 2). The defect is "overpacked." Just before final setting of the cement, it is removed. This cement is used as a mold to carve the bone graft to fit the defect (Fig. 3). The carved bone graft is then inserted into the defect and frequently is lightly tapped into place. Often it has a great deal of inherent stability at this stage. Screws are used to fix this graft to the host. The screws must be placed so as not to interfere with the placement of the prosthesis. After graft placement, a hole is reamed for a socket (Fig. 4). Placement of the socket is then done in the routine fashion. This technique can be used for reconstructive surgery for total knees as well (Figs. 5-8). The benefits of making the grafts in this way include the following.
Bone grafting has been advocated to augment the skeleton in both primary and revision arthroplasties where significant bone defects are found. Small defects, in situations where the graft can be contained by the surrounding host bone, are inherently stable. Here too, the prosthesis holds the graft into the "hole." Where there are larger defects, especially those made of rim defects, the process of creating the graft, filling the defect, and stabilizing the graft during instrumentation frequently presents a problem. In these situations, the following technique is helpful.
Technique
1. The creation of larger grafts {vs. bone chips, peanut-sized grafts, etc.), reducing the tendency for early settling of a prosthesis. 2. Increased stability of the graft, allowing cutting and reaming the graft for prosthetic fit. 3. Increased contact between the graft and the host, enhancing incorporation of the graft.
The bed of the defect is cleansed of all soft tissue (Fig. 1 ). The bed is not dried, but left moist and bleeding, to prevent the cement mold from sticking. Half a pack of cement is mixed; w h e n it is in the late
From the University of Florida, Gainesville, Florida.
We have used this technique over the past several years and have found it to be very helpful.
Reprint requests: George J. Fipp, MD, 4203 Belfort Drive, Jacksonville, FL 32216.
285
286
The Journal of Arthroplasty Vol. 4 No. 3 September 1989
\,
Fig. 1. A defect in the superior dome and rim of the acetabulum. The defect is cleansed of soft tissue and left moist and bleeding.
Fig. 2. Cement in the late "doughy" stage, lightly packed into the defect. It is removed just before final setting and used to create a model.
_J
Fig. 3. Bone graft is carved to fill the defect, using the removed cement as a model.
Fig. 4. The bone graft is secured in place and cut and reamed as necessary to receive the prosthesis.
Bone Grafting
•
Fipp
/
287
/
Fig. 5. A defect in the medial femoral condyle after removal of a failed total knee arthroplasty is cleansed of soft tissue. Fig. 7. The bone graft is carved using the removed cement as a model.
Fig. 6. Cement in the late "doughy" stage is lightly packed into the defect.
Fig. 8. The bone graft is secured into place and cut to receive the new prosthesis.