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Strut Onlay Allograft in Revision Arthroplasty: Osseous union and clinical outcome
Author(s):
Mayr R. (Azerbaijan)
,
Mayr R. (Azerbaijan)
Affiliations:
Dammerer D.
,
Dammerer D.
Affiliations:
Frischhut C.
,
Frischhut C.
Affiliations:
Thaler M.
,
Thaler M.
Affiliations:
Nogler M.
,
Nogler M.
Affiliations:
Liebensteiner M.
Liebensteiner M.
Affiliations:
ESSKA Academy. Mayr R. 05/09/18; 209618; P10-1467
Dr. Raul Mayr
Dr. Raul Mayr
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Abstract
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Objectives: To investigate the outcome of the surgical technique 'Strut Onlay Allograft (SOA)' during revision knee or hip arthroplasty. We assumed 1) high union rates between SOA and host bone, 2) little or no loss of correction / alignment and 3) good clinical outcome as determined by patient reported outcome measurements.

Methods: Patients who previously underwent revision knee or hip arthroplasty at our department with concomitant SOA implantation were considered. Those who agreed were invited to the hospital to determine radiographic and patient-reported outcome.
Osseous union' between the strut allograft and the host bone was veryfied by radiography in two planes according to the classification system of Emerson et al.: rounding off (1), scalloping (2), partial bridging (3), complete bridging (4), cancellization (5), resorption (6).
The patient reported clinical outcome was assessed with the 'Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)' with its subscores pain (5 items), stiffness (2 items) and physical function (17 items), which are totaled and expressed as percentage of the maximum score of the sub scale (best: 0; worst: 100). Additionally, the 3 subscales are summed and also expressed as percentage (WOMAC total). Besides the limb-specific outcome the ambulatory status was assessed with the Parker-Mobility-Score (0:Worst, 9:Best).
Medians and Interquartile-Ranges were calculated as descriptive statistics.

Results: 43 cases were identified in our records. Of those, 13 were deceased, 7 could not be contacted, 6 refused to participate. Consequently, 17 cases were available data collection (age 66, BMI 23.2).
Regarding Osseous Union we found complete bridging of the SOA to the recipient bone in 76.5% of the cases. In 17.6% The SOA showed partial bridging to the recipient bone. In all but one cases there was no loss of correction / alignment.
The WOMAC total was 22±21. WOMAC pain was 16±23. WOMAC stiffness was 15±28 and WOMAC function was 25±32. The Parker Mobility Score was found 8±4.

Conclusions: On the basis of our findings it is concluded that the use of strut onlay bone allografts in advanced knee or hip revision arthroplasty is a promising technique. The majority of SOAs is integrated into the recipient bone stock (bone augmentation) and provides additional mechanical stability. These radiographic findings are supported by good results in WOMAC scores and the Parker mobility score.

Keywords:
allograft, total knee arthroplasty, strut onlay allograft, knee revision surgery
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