Revision THA Impaction Grafts:Effects of Bone Fusion

描述(摘自申请)：初次全髋关节置换术 (Tha)正在经历大量的后期失败。与……相比 初选，与修改的特殊需要相关的科学基础 外科手术的发展要差得多。颗粒嵌压植骨术 松质骨(Mcb)是一种非常有前途的临床应用材料。 该修订的方法，但其关键技术属性已收到 很少进行系统的实验室调查。在这个过程中， 松质骨被磨碎成小块，并在手术中受到冲击。 用于建立骨骼储备的站点。理想情况下，正常的骨重塑发生在 相邻的活体宿主骨，进入骨移植，使最终的母牛 移植物融合成与宿主相邻的新的松质晶格 骨头。尽管广泛(和日益增长)使用埋伏植骨与MCB 修改后，这种移植物的有效使用在很大程度上依赖于直觉 外科医生的判断。更好的生物机械探索与现实 长凳/身体模型应该有助于优化这一过程。这方面的进展 由于无法研究末期(即完全融合)而受到阻碍 状态，而不是术后即刻的非粘连状态 MCB。使用最近开发的MCB融合模型，这项研究将 骨水泥修复术中植入植骨的生物力学研究 THA，从术后即刻开始的时间段 (非粘性MCB颗粒)至最终临床靶期(融合型MCB)。 具体目标是1)扩大实验室MCB融合的发展 模型，2)测量埋伏植骨翻修后稳定性的变化 假体在MCB融合前后，以及3)测量稳定性的变化 植入植入物的翻修术比仅融合人工晶状体的假体 某些地区。研究设计将包括以下内容：1)创建 身体股骨和髋臼的空洞性缺损，2)嵌入性移植和 骨水泥全髋关节假体的植入，3)使用新的实验室MCB融合器 允许MCB粒子融合的模型，以及融合后的MCB也可以融合到 它被嵌入的骨骼，4)用复制品加载假体 水平行走时的全生理负荷周期，以及5)测量 假体下沉和微动。圆满结束拟议中的 研究将提供有助于优化的生物力学数据 减少植入过程，从而提高临床成功率 这个不断演变的过程。

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.