Allograft bone in hip revision: the effect of locally applied pharmacological treatment.
Author
Summary, in English
In papers I and II, the effect of the bisphosphonate zoledronate and BMP-7 on allografts was investigated in a bone conduction chamber in rats. We found a strong synergism of the combined treatment compared to the saline control. Local treatment with the bisphosphonate was efficient but it also tended to inhibit bone formation. In paper III, the same drugs were evaluated in a more clinically relevant prosthetic model in rabbits. A knee prosthesis was inserted into the tibia, which had been filled with impacted, morsellised allograft soaked in BMP-7 and/or zoledronate. Micro-CT showed increased bone density after zoledronate treatment relative to the saline control, but by histology the bone surrounding the prosthesis had a more unstable structure when BMP-7 was used combined with zoledronate. In paper IV, 30 patients had their femoral hip implant revised with the impaction bone grafting technique, and were randomised to have the bone graft soaked in either clodronate—a bisphosphonate— or saline. DXA scans were performed postoperatively and at 3 and 12 months to evaluate the effect of the study drug. Radiostereometry (RSA) was performed postoperatively, after 6 weeks, and after 3 and 12 months, to measure implant micromotion. Bone density and implant motion were similar in both groups and no significant differences were found.
In conclusion, we found that local administration of bisphosphonate is effective in inhibiting bone graft resorption in animal models and that the mode of application may matter. The addition of BMP-7 may lead to reduced stability and cannot be recommended. Finally, we were unable to show any effect of the bisphosphonate clodronate on bone density or implant motion in our clinical study on hip revision with impaction bone grafting.
Department/s
Publishing year
2014
Language
English
Publication/Series
Lund University Faculty of Medicine Doctoral Dissertation Series
Volume
2014:45
Full text
Document type
Dissertation
Publisher
Department of Orthopaedics, Lund University
Topic
- Orthopedics
Keywords
- allograft bone
- bone transplantation
- bisphosphonate
- bone morphogenetic proteins
- hip revision
- radiostereometric analysis
Status
Published
Supervisor
ISBN/ISSN/Other
- ISSN: 1652-8220
- ISBN: 978-91-87651-70-0
Defence date
26 April 2014
Defence time
10:00
Defence place
Belfragesalen, BMC D15, Lund
Opponent
- Mathias P. Boström (Professor)