Autologous morsellised bone grafting restores uncontained femoral bone defects in knee arthroplasty. An in vivo study in horses.
Abstract: The properties of impacted morsellised bone graft (MBG) in revision total knee arthroplasty (TKA) were studied in 12 horses. The left hind metatarsophalangeal joint was replaced by a human TKA. The horses were then randomly divided into graft and control groups. In the graft group, a unicondylar, lateral uncontained defect was created in the third metatarsal bone and reconstructed using autologous MBG before cementing the TKA. In the control group, a cemented TKA was implanted without the bone resection and grafting procedure. After four to eight months, the animals were killed and a biomechanical loading test was performed with a cyclic load equivalent to the horse's body-weight to study mechanical stability. After removal of the prosthesis, the distal third metatarsal bone was studied radiologically, histologically and by quantitative and micro CT. Biomechanical testing showed that the differences in deformation between the graft and the control condyles were not significant for either elastic or time-dependent deformations. The differences in bone mineral density (BMD) between the graft and the control condyles were not significant. The BMD of the MBG was significantly lower than that in the other regions in the same limb. Micro CT showed a significant difference in the degree of anisotropy between the graft and host bone, even although the structure of the area of the MBG had trabecular orientation in the direction of the axial load. Histological analysis revealed that all the grafts were revascularised and completely incorporated into a new trabecular structure with few or no remnants of graft. Our study provides a basis for the clinical application of this technique with MBG in revision TKA.
Publication Date: 2000-05-17 PubMed ID: 10813186DOI: 10.1302/0301-620x.82b3.9491Google Scholar: Lookup
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- Journal Article
Summary
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This study investigates the viability of using autologous morsellised bone graft (MBG) to repair bone defects in knee arthroplasty surgeries in a group of horses. The findings suggest that MBG provides a suitable solution for such defects, offering equivalent performance to a standard knee arthroplasty without grafting.
Research Methods
- The experiment involved 12 horses with the metatarsophalangeal joint in their left hind leg replaced with a human-designed total knee arthroplasty (TKA).
- The horses were randomly divided into two groups—graft and control groups.
- In the graft group, a one-sided, lateral uncontained defect was created in the horses’ third metatarsal bone and then reconstructed using autologous MBG before the TKA was cemented in place.
- In the control group, the TKA was implanted without any bone resection or grafting procedure.
- Over a span of four to eight months, the horses were euthanized for further biomechanical testing.
Biomechanical Testing
- Following euthanization, a biomechanical loading test was administered using a load equivalent to the horse’s body weight to ascertain the mechanical stability of the graft.
- The researchers then removed the prostheses to further examine the distal third of the metatarsal bone through radiological, histological, quantitative and micro CT studies.
Results and Findings
- The study showed no significant differences between the graft and control group in regards to deformation and bone density.
- However, the Bone Mineral Density (BMD) of the MBG was significantly lower than that in other regions of the same limb.
- Micro CT images revealed significant differences in the grafts’ degree of anisotropy compared to the host bone, implying that the grafts were externally different, even though their internal structures presented similar trabecular orientation.
- Through histological analysis, the grafted bones showed full revascularization and incorporation into the new bone structure, with little to no remnants of graft tissue.
Conclusion
- The findings provide a solid foundation for the clinical application of MBG in revision TKA surgeries.
- The study demonstrated that the autologous bone graft effectively fuses with the host bone and restores defects, offering comparable mechanical stability to traditional surgical procedures.
Cite This Article
APA
van Loon CJ, de Waal Malefijt MC, Buma P, Stolk T, Verdonschot N, Tromp AM, Huiskes R, Barneveld A.
(2000).
Autologous morsellised bone grafting restores uncontained femoral bone defects in knee arthroplasty. An in vivo study in horses.
J Bone Joint Surg Br, 82(3), 436-444.
https://doi.org/10.1302/0301-620x.82b3.9491 Publication
Researcher Affiliations
- Department of Orthopaedic Surgery, University Hospital, Nijmegen, The Netherlands.
MeSH Terms
- Animals
- Arthroplasty, Replacement, Knee / instrumentation
- Biomechanical Phenomena
- Bone Density / physiology
- Bone Transplantation / instrumentation
- Female
- Horses
- Humans
- Male
- Metatarsal Bones / pathology
- Metatarsal Bones / surgery
- Osseointegration / physiology
- Weight-Bearing / physiology
Citations
This article has been cited 9 times.- Lei PF, Hu RY, Hu YH. Bone Defects in Revision Total Knee Arthroplasty and Management. Orthop Surg 2019 Feb;11(1):15-24.
- Morales De Cano JJ, Guillamet L, Perez Pons A. ACETABULAR RECONSTRUCTION IN PAPROSKY TYPE III DEFECTS. Acta Ortop Bras 2019 Jan-Feb;27(1):59-63.
- Oláh T, Reinhard J, Gao L, Goebel LKH, Madry H. Reliable landmarks for precise topographical analyses of pathological structural changes of the ovine tibial plateau in 2-D and 3-D subspaces. Sci Rep 2018 Jan 8;8(1):75.
- Carulli C, Matassi F, Civinini R, Innocenti M. Tissue engineering applications in the management of bone loss. Clin Cases Miner Bone Metab 2013 Jan;10(1):22-5.
- Kim H, Lee CK, Yeom JS, Lee JH, Lee KH, Chang BS. The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion. Eur Spine J 2012 Jul;21(7):1324-30.
- Meijerink HJ, van Loon CJ, de Waal Malefijt MC, van Kampen A, Verdonschot N. A sliding stem in revision total knee arthroplasty provides stability and reduces stress shielding. Acta Orthop 2010 Jun;81(3):337-43.
- Bullens PH, Bart Schreuder HW, de Waal Malefijt MC, Verdonschot N, Buma P. Is an impacted morselized graft in a cage an alternative for reconstructing segmental diaphyseal defects?. Clin Orthop Relat Res 2009 Mar;467(3):783-91.
- Fürst A, Meier D, Michel S, Schmidlin A, Held L, Laib A. Effect of age on bone mineral density and micro architecture in the radius and tibia of horses: an Xtreme computed tomographic study. BMC Vet Res 2008 Jan 25;4:3.
- Ma N, Cheng Y, Ding H, Han D, Zhong S, Xie J, Xia Q, Zhang J, Xin P, Xiao L. Comparison of clinical application of locking plate versus cancellous screw in structural autologous bone grafting during TKA for medial tibial bone defects. Front Bioeng Biotechnol 2026;14:1685551.
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