Bone grafts, bone graft extenders, substitutes and enhancers for acetabular reconstruction in revision total hip arthroplasty

• Published in: EFORT Open Reviews Vol. 1; no. 12; pp. 431 - 439
• Main Authors: Pierannunzii, Luca, Zagra, Luigi
• Format: Journal Article
• Language: English
• Published: England BioScientifica Ltd 01.12.2016; British Editorial Society of Bone and Joint Surgery
• Subjects: Acetabulum; Allografts; Bioceramics; Bone Graft; Bone Graft Enhancers; Bone Graft Extenders; Bone Graft Substitute; Bone loss; Bone marrow; Bone matrix; Bone morphogenetic proteins; Calcium phosphates; Hip; Hydroxyapatite; Impaction Grafting; Joint surgery; Mesenchymal Stem Cells; Mesenchyme; Revision; Skin & tissue grafts; Total Hip Arthroplasty; Xenografts; bone graft enhancers; bioceramics; impaction grafting; total hip arthroplasty; bone graft; bone graft substitute; bone graft extenders; mesenchymal stem cells; acetabulum; revision
• ISSN: 2058-5241; 2396-7544; 2058-5241
• DOI: 10.1302/2058-5241.160025

Acetabular bone loss is a relevant concern for surgeons dealing with a failed total hip arthroplasty.Since the femoral head is no longer available, allografts represent the first choice for most reconstructive solutions, either as a structural buttress or impacted bone chips.Even though fresh-frozen bone is firmly recommended for structural grafts, freeze-dried and/or irradiated bone may be used alternatively for impaction grafting. Indeed, there are some papers on freeze-dried or irradiated bone impaction grafting, but their number is limited, as is the number of cases.Xenografts do not represent a viable option based on the poor available evidence but bioactive bioceramics such as hydroxyapatite and biphasic calcium phosphates are suitable bone graft extenders or even substitutes for acetabular impaction grafting.Bone-marrow-derived mesenchymal stem cells and demineralised bone matrix seem to act as reliable bone graft enhancers, i.e. adjuvant therapies able to improve the biological performance of standard bone grafts or substitutes. Among these therapies, platelet-rich plasma and bone morphogenetic proteins need to be investigated further before any recommendations can be made. Cite this article: 2016;1:431-439. DOI:10.1302/2058-5241.160025.