Allograft Reconstruction for Failed Total Hip Arthroplasties. Evaluation of Bone Incorporation Between Allograft and Host.
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概要
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From 1983 we began to use femoral head allografts in reconstructive surgery for failed total hip arthroplasties. All allograf is were taken from a patient who had undergone primary total hip arthroplasty. They were stored at -80° following Mankin's procedure.<BR>Allograft reconstruction was done on 68 joints of 65 cases (6 males and 59 females) with a severely deficient acetabulum for a minimum period of 12 months. The average age at revision was 62.3, ranging from 34 to 84, and the average follow-up period in this series was 39.8 months. All procedures were performed with bone cement and reinforced by a metal device. The bone incorporation between allograf is and hosts were evaluated not only with an X-ray A-P view but with Tc -MDP bone scintigraphy.<BR>Radiological assessment showed that bone union of the allograf t improved gradually within 2 years after operation. Results were excellent in 36 joints, good in 13 joints, fair in 2 joints and poor in 1 joint at the time of the 2-year follow-up. Two of the three fair or poor cases had an asymptomatic radiolucent line between allograf t and bone cement. The other case (fair) was suspected of having a mild deep infection. No collapse of allografts was seen in this series.<BR>The conventional scintigraphic findings were that the uptake of radionuclide at the grafted lesion was sharply high initially with a ringlet and the grafted lesion became homogenous by 6 months after operation. The uptake of radionuclide decreased gradually and finally became at a normal level within 2 years. In addition, radionuclide angiography showed that the perfusion of blood supply to the grafted bone was maintained continuously.<BR>Clinical results were also excellent or good in all cases. Allograf t reconstruction is considered to be an acceptable procedure to restore the severely deficient acetabulum in revision total hip arthroplasty.
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