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USE OF BOVINE BONE GRAFT IN REVISION TOTAL HIP REPLACEMENT

Dept of Orthopaedics, Epsom General Hospital, Dorking Road, Epsom, Surrey KT18 7EG

Surgibone (Unilab R) is a dry bone graft substitute prepared from Canadian bovine bone. It contains hydroxyapatite and 20–29% protein. The manufacturer claims that it is biocompatible; does not lead to foreign body reaction and does not produce pyrogenic effects.

We have used Surgibone routinely in revision joint replacement surgery over a 6-year period, to augment autograft in filling osseous defects in the acetabulum and proximal femur. 27 patients who received Surgibone have been reviewed to assess the degree of graft incorporation, any evidence of graft rejection or immunogenic reaction. One patient died and 2 were excluded from the study for early fixation failure. The remaining 24 were studied 6 months to 5 years post surgery.

In 17 patients (71%) there was radiological appearance of complete incorporation of the bone graft within 6 months. In 3 of these patients the graft incorporated as early as 3 months. There were 7 failures (29%). 3 patients have no radiological evidence of graft incorporation up to 3 years post surgery, although 2 have a satisfactory clinical result. Another 3 patients appeared to have graft rejection, and at revision were found to have sterile pus around the graft. These patients had negative responses to skin patch test for allergy to Surgibone. The seventh patient suffered an MRSA deep infection of the prosthesis that resulted in removal of the implants 4 weeks post operatively.

We conclude that the use of xenograft Surgibone in revision hip surgery leads to unacceptable incidence of failure. Although in the majority of cases good incorporation of the graft was observed, there has been a substantial incidence of graft rejection.

The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom