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The hybrid method for fixation of total hip arthroplasty (THA) has shown excellent results during the first decade in primary operations. To investigate its role in revision surgery, data on 48 revision THAs in 45 patients that met the inclusion criteria were gathered prospectively, using HGP cementless acetabular components and precoated cemented femoral components inserted with so-called second generation femoral cementing technique in each case. For the 48 hips during an average follow-up period of 7.4 years, no acetabular components was loose or had pelvic lysis. One acetabular component was revised for recurrent dislocation; 1 of 48 femoral components was revised for aseptic loosening and 1 for periprosthetic fracture. Three additional femoral stems (6%) were loose. In this small series, the hybrid concept for revision of failed nonseptic THAs has shown excellent results.

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STUDY DESIGN: A prospective follow-up study of patients undergoing anterior spinal decompression and bone graft with cortical iliac crest bone. OBJECTIVE: To describe a modified technique for harvesting cortical bone graft from the anterior iliac crest. SUMMARY OF BACKGROUND DATA: Cortical bone graft from the iliac crest frequently is used in various orthopedic and spinal procedures. The resulting defect in the iliac crest has been associated with many complications. METHODS: Twenty patients were included in this study. All had burst vertebral fracture requiring anterior spinal decompression and cortical bone grafting. The modified technique was used for harvesting the iliac crest bone graft in all patients. RESULTS: All patients were satisfied with the appearance of the iliac crest. None reported chronic pain at the graft site. None had fracture of the iliac wing, and none had symptoms related to the lateral femoral cutaneous nerve or herniation of pelvic contents through the bony defect in the iliac wing. CONCLUSION: This modified technique is technically straightforward and cost-effective. It preserves the contour and shape of the iliac crest and avoids cosmetic deformities and chronic pain at the graft site. It creates a window in the iliac wing rather than disrupting the continuity of the iliac crest, which leaves the iliac wing structurally stronger than with currently used techniques.

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BACKGROUND: In an attempt to contain the high cost of commercially available pedicle screw systems, several authors have used unconventional alternatives such as locally made plates or dynamic compression plates (DCP) along with cancellous screws for transpedicular fixation of the thoracolumbar spine. These plates, however, allow for a wide range of motion at the plate-screw interphase and the construct does not provide stability in the sagittal plane. Round hole bone plates, on the other hand, allow much less mobility at the plate-screw interphase and the final construct offers better stability in the sagittal plane. Our objective was to determine the clinical, radiologic, and functional status of patients who underwent posterior fracture fixation using round hole bone plates and cancellous screws, and evaluate the construct's ability to maintain reduction of the fracture. PATIENTS AND METHODS: This was a prospective follow-up of patients with fractures around the thoracolumbar junction fixed using round hole bone plates and cancellous transpedicular screws. Round hole bone plates along with 6.5 mm transpedicular cancellous screws were used for posterior spinal instrumentation in neurologically intact patients with isolated unstable fractures of the last thoracic or first lumbar vertebra. RESULTS: Seventeen patients were included in this study. Their mean follow-up was 10 months (range 5 to 12). All had evidence of fusion at a mean of 5 months (range 4 to 7). No patient had breakage or loosening of the screws and none had breakage of the plate. The mean kyphosis angle at the fracture site was 34 degrees preoperatively, --4 degrees in the immediate postoperative period, and 3 degrees on final follow-up radiographs. The percentage loss of anterior vertebral body height was 51% preoperatively, 15% in the immediate postoperative period, and 16% on final follow-up radiographs. CONCLUSION: The use of round hole bone plates along with 6.5 mm cancellous screws inserted into the pedicles provides an angle-stable construct that allows for better stability in the sagittal plane. It is effective in the surgical treatment of unstable fractures around the thoracolumbar junction. Because of their low cost and ease of insertion, round hole bone plates are an excellent choice for short arthrodesis and instrumentation of such fractures.

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BACKGROUND: A substantial contribution to the overall surgical correction of Cobb angle has been observed to occur prior to securing the instrumentation. Knowledge specific to the amount of correction prior to instrumentation is scarce in the medical literature. If significant correction is due to the positioning and muscle stripping during exposure of the spine, questions arise about the usefulness and need for extensive rod-rotation maneuvers to further straighten the spine. This study quantifies the extent of correction achieved from standing to prone, with the spine exposed before and after instrumentation. MATERIALS AND METHODS: Eleven patients with the diagnosis of adolescent idiopathic scoliosis (AIS) and a right thoracic major curve were included in the study. Intraoperative changes in Cobb angle were measured before and after instrumentation, as well as postoperatively. The patients underwent posterior spinal instrumentation by the same surgical team using the rod-rotation techniques. Radiographs were taken prior to surgery, intraoperatively before and after instrumentation and postoperatively within one week from surgery. Cobb angle measurements were performed by the same examiner. RESULTS: The median preoperative Cobb angle of 60 degrees +/-14 degrees (48-90 degrees ) corrected to a median of 26 degrees +/-22 degrees (10-80 degrees ) on the right bend film, to a median of 55 degrees +/-12 degrees (30-70 degrees ) intraoperatively after exposure, and to a median 30 degrees +/-10 degrees (20-46 degrees ) after rod-rotation/instrumentation and fixation. The follow-up standing radiograph median Cobb angle was 40 degrees +/-14 degrees (9-56 degrees ). A median intraoperative correction of 28 degrees was obtained, 10 degrees of which was prior to the rod rotation and instrumentation. High variability was observed in the percentage contribution of pre-instrumentation release with a median of 42%+/-25% (0-67%). CONCLUSION: Approximately one-third of the total correction occurred prior to instrumentation being applied, and even though it was variable and substantial, the actual surgical rod rotation and instrumentation maneuver provided the majority of correction.

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Bone grafts and bone substitutes are an essential part of the armamentarium of orthopedic surgeons. This article presents the current knowledge about bone replacements and reviews the available sources, techniques, and indications of the various types of autograft, allograft, and synthetic agents that are used in contemporary hip and knee replacement surgery.

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