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Autogenous Onlay Grafting for Enhancement of Extracortical Tissue Formation Over Porous-Coated Segmental Replacement Prostheses*
PETRI VIROLAINEN, M.D., PH.D.†; NOZOMU INOUE, M.D., PH.D.†; MASATO NAGAO, M.D., PH.D.†; ISAO OHNISHI, M.D., PH.D.†; FRANK FRASSICA, M.D.†; EDMUND Y. S. CHAO, PH.D.†, BALTIMORE, MARYLAND
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Investigation performed at the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore
J Bone Joint Surg Am, 1999 Apr 01;81(4):493-9
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Abstract

Background: Prosthetic reconstruction with extracortical bone-bridging is an effective method of limb salvage after resection of a malignant or locally invasive benign bone tumor. Use of cancellous bone graft alone is less effective in achieving extracortical bone-bridging. The present study was performed to investigate the effects of a corticocancellous onlay graft on bone and soft-tissue formation over a porous-coated replacement prosthesis in the mid-diaphyseal region of canine femora.Methods: Bilateral resection of a six-centimeter segment of the femoral diaphysis and reconstruction with a porous-coated segmental prosthesis was performed in six mongrel dogs. In one limb (the experimental side), eight strips of corticocancellous bone were evenly placed around the junctions between the femur and the prosthetic surface. Cancellous bone was placed under and between the strips of cortical bone. No graft was used in the other limb (the control side). The animals were followed for twelve weeks, with sequential assessments of load-bearing and radiographic evaluation. Biomechanical, histological, and microradiographic analyses of the specimens were performed after death.Results: On the control side, load-bearing at four weeks postoperatively was significantly decreased compared with the preoperative value (p < 0.05); no difference in these values could be detected on the experimental side. Both the area of the callus and the contact area between the bone and the prosthetic shoulder were greater on the experimental side (p < 0.05). The mechanical stiffness and the maximum torque at failure of the extracortical bridging tissue across the junction between the bone and the prosthetic shoulder were eighteen (p < 0.007) and five times greater (p < 0.05), respectively, on the experimental side.Conclusions: Extracortical bone-bridging was accomplished with corticocancellous onlay bone-grafting. Without bone-grafting, bone formed only occasionally. Bone-grafting also enhanced the formation of a soft-tissue capsule around the prosthesis.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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