Short Term Analysis of various uses of Cancellous Femoral Head and Cortical Allografts and their functional outcome in Orthopaedic Surgery

Yoganandan, S P (2007) Short Term Analysis of various uses of Cancellous Femoral Head and Cortical Allografts and their functional outcome in Orthopaedic Surgery. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Autografting has many disadvantages such as additional blood loss, increased operative time and cutaneous nerve damage, persistent pain at the donor site, vascular injury, and iliac bone fracture, herniation into the defect and in additional morbidity. Also the amount of morbidity is in direct proportion to the quality of graft retried. When the graft requirement is larger as in children where risk of damage to growth plate is high, revision hip surgeries, traumatic bone defects, spiral fusion and decompression surgeries, allograft comes into play. Although technique for allograft bone storage was described in the late 1940s and whole segmental grafts were used for tumor surgery in 1960s, the use of femoral head allografts as structural bone grafts was started in 1976 for revision hip surgeries. Initially, bone grafting was performed most commonly during complex primary hip arthroplasties such as for dysplasia, Protrusio acetebuli etc; currently for revision hip arthroplasty, foot and ankle surgeries, tumors and fracture non unions. The technique and practice of bone allografting in India is yet to take a firm footing. The facility for proper processing of the harvested bone allografts, its storage and strict donor screening is available only at few tertiary heath centers in India. The bone bank in government General Hospital started in the year 2005 is one such place aimed at maximal utilization of the allografts. AIM: 1. To analyze various the uses cancellous and cortical allografts in orthopaedic surgery. 2. The functional outcome of the allografts in these conditions. MATERIALS AND METHODS: Between February 2003-October 2006, 38 cases of cortical and cancellous allografting has been carried out at the department of orthopaedics, Govt. General Hospital, Chennai. This was a prospective study conducted in 38 patients, 22 of which were males and 16 were females. The Age groups of these patients were ranging from 6-55 years. Benign bone tumors were 21 cases of which the histopathological diagnosis was Fibrous dysplasia in 7 cases, Giant cell tumor in 4 cases, ABC in 2 cases, Chondroblastoma in 2 cases, Chondromyxoid fibroma in 1 case, Simple bone cyst in 2 cases, Osteochondroma with fracture in 2 cases and Chondroma 1 case. RESULTS: None of the patients developed systemic infection this highlights the fact that a through donor screening, proper allograft processing and storage was as essential as operative planning and technique for successful outcome of the procedure. Although the short term results were encouraging, it is required to study these cases for longer periods to reach a conclusion about the state of incorporation of structural bone allografts and need for re – surgery at a longer follow up. CONCLUSION: 1. Bone allograft is a safe and reliable adjuvant in the management of bone defect in the setting of tumors and traumatic bone loss, and revision hip surgeries and spine surgeries. 2. Better results are observed with use of both morsellized and structural bone allografts clinically as well as radiologically. 3. Allograft procured and processed in sterile condition and stringent donor screening are very important safe guards for prevention of disease transmission. 4. Autoclaving though weakens the graft, reduces the immunological as well as reduces further, the risk of disease transmission without much comparative on bony union. 5. Cancellous femoral heads are an excellent method in the management of bone tumor defects. 6. Femoral head allografts are available options in traumatic bone defects and in children. 7. Cortical allografts and autografts add additional sterility to the defect. 8. The clinical results are good and support recommendations for continued use the grafts and development of the technique.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Short Term Analysis ; Cancellous Femoral Head ; Cortical Allografts ; functional outcome.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 02:01
Last Modified: 14 Sep 2017 02:01

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