Revision THA Impaction Grafts:Effects of Bone Fusion

描述（摘自申请）：初次全髋关节置换术 （临屋区）正在经历后期失败的大量。相比于 初选，科学依据中肯的特殊需要修订 外科手术的发展还很落后。颗粒嵌塞植骨术 松质骨（MCB）是一种非常有前途的和越来越受临床欢迎的骨 THA修订的方法，但其关键技术属性已收到 很少有系统的实验室研究。在该过程中， 松质骨被磨碎成小块，并在外科手术中受到冲击。 建立骨量的场所。理想情况下，正常的骨重建是从 邻近的活宿主骨，进入骨移植物，使得最终MCB 移植物融合成与宿主相邻的新的松质骨网格 骨头尽管MCB的嵌塞移植广泛（且不断增长）用于 THA翻修，有效使用这种移植物在很大程度上依赖于直观 手术判断更好的生物力学探索， 台架/尸体模型应有助于优化程序。这一领域的进展 由于不能研究终末期（即，完全熔化） 条件，而不是术后立即无粘性的情况 MCB。使用最近开发的MCB融合模型，本研究将 骨水泥翻修中打压植骨生物力学研究 THA，从术后即刻开始 在一些实施方案中，将未融合的MCB颗粒（未凝聚的MCB颗粒）转化为最终临床目标阶段（融合的MCB）。 具体目标是：1）扩大实验室MCB融合的发展 模型，2）测量嵌塞移植翻修THA的稳定性变化 假体，MCB融合前后，和3）测量稳定性的变化 当MCB仅融合在 某些地区。研究设计将包括以下内容：1）创建 尸体股骨和髋臼的空腔缺损，2）嵌塞移植， 植入骨水泥型THA假体，3）使用新的实验室MCB融合 该模型允许MCB颗粒融合，并且融合的MCB也融合到 4）用复制的假体加载假体， 在水平行走期间的完整生理负荷循环，以及5）测量 假体下沉和微动。圆满结束拟议的 研究将提供有助于优化的生物力学数据 从而提高了临床成功率， 这个不断发展的过程。

DESCRIPTION (Taken from the application): Primary total hip arthroplasties (THAs) are undergoing late failure in large numbers. Compared to that of primaries, the scientific basis pertinent to the special needs of revision surgeries is much less well developed. Impaction grafting with morselized cancellous bone (MCB) is one very promising and increasingly clinically popular approach to THA revision, but one whose key technical attributes have received little in the way of systematic laboratory investigation. In that procedure, cancellous bone is ground up into small morsels, and impacted at the surgical site to build up bone stock. Ideally, normal bone remodeling proceeds from the adjacent live host bone, into the bone graft, such that eventually the MCB graft is fused into a new cancellous lattice that is contiguous with the host bone. Despite widespread (and growing) use of impaction grafting with MCB in THA revision, effective use of such grafts has largely relied upon intuitive surgical judgement. Better bio-mechanical exploration with realistic bench/cadaver models should help optimize the procedure. Progress in this area has been hindered by inability to study the end-stage (i.e., totally fused) condition, rather than the immediate postoperative situation of non-cohesive MCB. Using a recently developed model of MCB fusion, this study will investigate bio-mechanical aspects of impaction grafting in cemented revision THA, spanning the time period from the immediate postoperative situation (non-cohesed MCB particles) to the final clinical target stage (fused MCB). The specific aims are to 1) extend development of the laboratory MCB fusion model, 2) measure the change in stability of impaction grafted revision THA prostheses, before and after MCB fusion, and 3) measure the change in stability of impaction grafted revision THA prostheses, when the MCB is fused only in certain regions. The research design will include the following: 1) creating cavitary defects in cadaveric femurs and acetabulae, 2) impaction grafting and implanting of cemented THA prostheses, 3) using a new laboratory MCB fusion model which allows the MCB particles to fuse, and the fused MCB to also fuse to the bone in which it is impacted, 4) loading the prostheses with a replication of the full physiologic load cycle during level walking, and 5) measuring prosthesis subsidence and micromotion. Successful conclusion of the proposed research will provide biomechanical data that will assist in the optimization of the impaction grafting process, thus improving the clinical success rate of this evolving procedure.