Use of morselized allografts for acetabular ...
Document type :
Article dans une revue scientifique
PMID :
Permalink :
Title :
Use of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years' average follow-up
Author(s) :
Erivan, Roger [Auteur]
Matthieu, Pierre-Alain [Auteur]
Boyer, Bertrand [Auteur]
Reina, Nicolas [Auteur]
Rhame, Michel [Auteur]
Rouchy, René-Christopher [Auteur]
Moreau, Sébastien [Auteur]
Sanchez, Thomas [Auteur]
Roche, Olivier [Auteur]
Caton, Jacques [Auteur]
Rouvillain, Jean-Louis [Auteur]
Missenard, Gilles [Auteur]
Ramdane, Nassima [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Mulliez, Aurélien [Auteur]
Descamps, Stéphane [Auteur]
Boisgard, Stephane [Auteur]
Matthieu, Pierre-Alain [Auteur]
Boyer, Bertrand [Auteur]
Reina, Nicolas [Auteur]
Rhame, Michel [Auteur]
Rouchy, René-Christopher [Auteur]
Moreau, Sébastien [Auteur]
Sanchez, Thomas [Auteur]
Roche, Olivier [Auteur]
Caton, Jacques [Auteur]
Rouvillain, Jean-Louis [Auteur]
Missenard, Gilles [Auteur]
Ramdane, Nassima [Auteur]

Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Mulliez, Aurélien [Auteur]
Descamps, Stéphane [Auteur]
Boisgard, Stephane [Auteur]
Journal title :
Orthopaedics and Traumatology - Surgery and Research
Volume number :
105
Pages :
957-966
Publisher :
Elsevier
Publication date :
2019-09
ISSN :
1877-0568
Keyword(s) :
Bone defect
Acetabular revision
Allograft
THA revision
Bone reconstruction
Bone loss
Acetabular revision
Allograft
THA revision
Bone reconstruction
Bone loss
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Background In the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing ...
Show more >Background In the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors. Hypothesis Acetabular reconstruction can be performed equally well with frozen or processed morselized allografts. Materials and methods This retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years ± 1.89 [5\u201312.32]) than that of the processed grafts (8.22 years ± 1.77 [5.05\u201315.48]) (p = 0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years ± 14.2 [17\u201380]) than in the processed group (57.5 years ± 13.0 [12\u201394]) (p < 0.001) and were also younger at the time of THA revision (67.8 years ± 12.2 [36.9\u201389.3] versus 70 years ± 11.7 [25\u201394.5]) (p = 0.041). Results There were more complications overall in the frozen allograft group (46\/242 = 19.0%) than the processed allograft group (35\/256 = 13.2%) (p = 0.044) with more instances of loosening in the frozen group (20\/242 [8.2%]) than in the processed group (6\/266 [3.3%])(p = 0.001). Conversely, the dislocation rate (16\/242 = 6.6% vs. 17\/266 = 6.4%) (p = 0.844) and infection rate (18\/242 = 7.4% vs. 15\/266 = 5.7%) (p = 0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p = 0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p = 0.006) and a relative risk of 1.95 (95% CI: 1.26\u20132.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23\u20134.70) (p = 0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52\u20136.51) (p = 0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26\u20138.26) (p = 0.022). Discussion Our hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabul ar bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior. Level of evidence III, comparative retrospective study.Show less >
Show more >Background In the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors. Hypothesis Acetabular reconstruction can be performed equally well with frozen or processed morselized allografts. Materials and methods This retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years ± 1.89 [5\u201312.32]) than that of the processed grafts (8.22 years ± 1.77 [5.05\u201315.48]) (p = 0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years ± 14.2 [17\u201380]) than in the processed group (57.5 years ± 13.0 [12\u201394]) (p < 0.001) and were also younger at the time of THA revision (67.8 years ± 12.2 [36.9\u201389.3] versus 70 years ± 11.7 [25\u201394.5]) (p = 0.041). Results There were more complications overall in the frozen allograft group (46\/242 = 19.0%) than the processed allograft group (35\/256 = 13.2%) (p = 0.044) with more instances of loosening in the frozen group (20\/242 [8.2%]) than in the processed group (6\/266 [3.3%])(p = 0.001). Conversely, the dislocation rate (16\/242 = 6.6% vs. 17\/266 = 6.4%) (p = 0.844) and infection rate (18\/242 = 7.4% vs. 15\/266 = 5.7%) (p = 0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p = 0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p = 0.006) and a relative risk of 1.95 (95% CI: 1.26\u20132.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23\u20134.70) (p = 0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52\u20136.51) (p = 0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26\u20138.26) (p = 0.022). Discussion Our hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabul ar bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior. Level of evidence III, comparative retrospective study.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
CHU Lille
Université de Lille
Université de Lille
Submission date :
2020-06-08T14:11:31Z