Revision THA Impaction Grafts:Effects of Bone Fusion

翻修 THA 打塞移植物：骨融合的影响

• 批准号: 6324221
• 负责人: ANNELIESE D HEINER
• 金额: $ 7.35万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-05-01 至 2004-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6324221
• 关键词: biomaterial compatibility; biomechanics; bone transplantation; hip prosthesis; human tissue; medical implant science; orthopedics; physical model

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.

描述（摘自申请）：初次全髋关节置换术 （THA）正在经历大量后期故障。相比于 初选、科学依据有针对性的特殊需要修改 外科手术还不太发达。颗粒打压嫁接 松质骨（MCB）是一种非常有前途且在临床上越来越受欢迎的骨 THA 修订的方法，但其关键技术属性已获得认可 很少有系统的实验室研究。在该程序中， 松质骨被磨成小块，并在手术时撞击 建立骨量的场所。理想情况下，正常的骨重塑是从 相邻的活宿主骨，进入骨移植物，这样最终 MCB 移植物融合成与宿主相邻的新松质网格 骨。尽管 MCB 打压嫁接技术在 THA 翻修、此类移植物的有效使用很大程度上依赖于直觉 手术判断。更好的生物力学探索与现实 工作台/尸体模型应该有助于优化程序。该领域的进展 由于无法研究末期（即完全融合）而受到阻碍 情况，而不是非粘连的术后立即情况 微型断路器。使用最近开发的 MCB 融合模型，本研究将 研究骨水泥修复中打压移植的生物力学方面 THA，跨越术后即刻的时间段 （非凝聚的 MCB 颗粒）到最终的临床目标阶段（融合的 MCB）。 具体目标是 1) 扩大实验室 MCB 融合的发展 模型，2）测量打压移植翻修术THA稳定性的变化 MCB 融合前后的假体，以及 3) 测量稳定性的变化 当 MCB 仅在 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洞缺损，2) 打压移植和 植入骨水泥 THA 假体，3) 使用新的实验室 MCB 融合术 模型允许 MCB 粒子融合，并且融合的 MCB 也融合到 受影响的骨骼，4) 用复制体装载假体 水平行走期间的完整生理负荷周期，以及 5) 测量 假体下沉和微动。拟议的圆满结束 研究将提供有助于优化的生物力学数据 打压移植过程，从而提高临床成功率 这个不断演变的过程。