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Free vascularized bone transfers are indicated to reconstruct large bone loss, either after traumatism or bone tumor resection.
In the last few years, several attempts have been made to treat large bone loss, including the use of tissue engineering with osteoinductive scaffolds and cells.
We present our early experience with a new type of knee spacer for patients with very large bone loss.
The usual spacer technique in very large bone loss is insertion of 1 antibiotic-covered rod (Grimer et al. 2002, Antoci et al. 2009, Rao et al. 2009) or a prosthesis (Sherman et al. 2008).
The size of the bone loss in our patients did not permit the implantation of unconstrained or semi-constrained spacers, which have been described by others as being suited for large bone loss (Incavo et al. 2009, MacAvoy and Ries 2005), and perhaps the soft tissues even profited from the immobilization.
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A greater BMD decrease was found in Scientific Hip Prosthesis (Biomet, Bridgend, UK) and SPII CoCr stems (Link, Hamburg, Germany) than in Exeter (Howmedica, London, UK), Spectron (Smith & Nephew, Memphis, Tenn), and SPII Titanium stems (P <.05), and the stiffer SPII CoCr stems (Link) had a larger bone loss than the SPII Titanium stems (Link).
One explanation to our finding could be a higher degree of inactivity in the patients with more severe pain, leading to a larger bone loss or a reduced increase in BMD after the operation.
Patients who had dialysis for more than one year had a larger bone loss than those with shorter durations of treatment but this was statistically significant only for the LS BMD.
Major determinants of the deformities such as large relative bone loss of the affected bone, either shortening or a bone defect, malunion, or (infected) nonunion would be expected to affect the treatment outcome negatively.
Current clinical treatments for skeletal conditions resulting in large-scale bone loss include autograft or allograft, both of which have limited effectiveness.
A large amount of bone loss and articular cartilage damage caused by the injury, inability to achieve articular reduction at operation and postoperative loss of anatomical reduction are associated with painful secondary osteoarthritis [ 16, 17, 24].
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