To The Editor:
I was very interested to read the article "Femoral Component Revision
with Use of Impaction Bone-Grafting and a Cemented Polished Stem"
(2005;87:2499-507), by Schreurs
et al. They found a 100% survival rate after a mean of 10.4 years of
follow-up, which is impressive despite there being only thirty-three hips in
the study.
My enquiry is regarding the preparation of the bone graft. The authors
commented that a Novio Magus bone mill (Spierings Medische Techniek, Nijmegen,
The Netherlands) was used to produce particles with a diameter of 2 to 5 mm,
but they did not report any other treatment of the graft. In particular, was
the morsellized bone washed or defatted?
There is evidence that washing of morsellized bone improves the resistance
to subsidence after femoral impaction grafting1 and after
acetabular impaction grafting2. Graft incorporation may also be
facilitated by rinsing of the graft. Bone chamber models in animals have shown
increased bone ingrowth in both impacted and unimpacted bone when rinsed
grafts were compared with unrinsed grafts3-5. Indeed, some of that
work came from the authors' institution.
If, as one might suspect, the earlier cases reported by the authors
involved use of graft that was not rinsed, do their exemplary results suggest
that there is no need to rinse the graft? Is it now the authors' practice to
rinse the graft?