Procedures

Revision Total Hip Arthroplasty
Using Grafton® DBM Putty and Flex

Kenneth B. Mathis, M.D.
Assistant Professor
Baylor College of Medicine, Houston, TX
The patient is a 47-year-old male who had an uncemented left total hip arthroplasty placed 10 years ago for presumed osteonecrosis. Three years ago, he presented to an outside hospital with a perirectal abscess which did not clear up. A sinogram found the sinus tracked all the way to his inferior ischium, which indicated that he had osteomyelitis and a septic hip prosthesis.
A mixture of Grafton® DBM Putty, cancellous chips and autologous reamings is prepared prior to placement.
The Grafton® mixture is further impacted into the acetabulum using a reamer set on reverse, resulting in a nicely compacted graft site.
The revision cup is pressed and fixed into the acetabulum in line with the posterior aspect of the patient.
The flutes of the prosthesis and existing femoral defects prior to being covered with Grafton® DBM Putty.
 The flutes of the prosthesis and existing defects in the femur are coated and filled with Grafton® DBM Putty. A 5cm x 5cm Grafton® DBM Flex strip is placed over the putty-filled defect and secured with Kirschner wires.

"The Grafton® material will actually cause a tremendous amount of new bone to form. I've been using Grafton for several years and have had excellent results both clinically and radiographically"

Dr. Kenneth B. Mathis
General Remarks
This procedure will fix a standard revision cup, fill and repair existing defects with allograft bone chips and Grafton® DBM, as well as replace the existing long-stem cemented prosthesis with a new long-stem, fluted titanium prosthesis to bypass the defect and maintain a stable purchase above and below. Following are Dr. Mathis' guidelines for use.

Detailed Description
  • In an earlier surgery, the infection was treated by removing the prosthesis along with the infected portion of the ischium. An interim prosthesis was then placed using heavily impregnated antibiotic cement.

  • The previously infected bone and acetabulum graft site are debrided to remove all fibrous tissue in the defects caused by the infection.

  • A mixture of Grafton® DBM Putty and cancellous bone chips is prepared according to product insert guidelines.

  • The Grafton® and allograft mixture is placed initially and hand-packed into the acetabulum and surrounding bone defects.

  • The mixture is further impacted into the acetabulum using an appropriately sized reamer set on reverse, resulting in a thoroughly compacted and homogenous graft site that is ready to receive the revision cup.
  • The revision cup is placed and fixed into the acetabulum, using screws for optimal stability.

  • The fluted, long-stem titanium prosthesis is then inserted.

  • The flutes of the prosthesis and existing defects in the femur are coated and filled with Grafton® DBM Putty.
  • A non-rehydrated 5cm x 5cm Grafton® DBM Flex strip is placed over the Grafton® Putty-filled defect in the lateral femoral cortex and secured by Kirschner wires.
  • Grafton® DBM Putty is used to fill an anterior metaphyseal defect along the proximal femur prosthesis.

BACK TO TOP

© Copyright Osteotech, Inc. 2007. All rights reserved.