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Biologic treatment options for the hip: A narrative review

Temple, H. Thomas MD

doi: 10.1097/BCO.0000000000000814
Special Focus: 2018 Arthroplasty Disasters International Conference Paper
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The goal of surgery around the hip is to preserve both acetabular and femoral bone stock and to optimize function, specifically abductor function. Biologic options include allografts, allograft metal composites, and structural grafts that over time incorporate, are durable, and provide bone stock for future reconstruction(s). Reconstructive principles are guided by the defect(s) after tumor surgery, patient factors (age, chemotherapy, comorbid conditions), and graft availability. The challenges of reconstruction around the hip are stability of the joint and optimizing abductor function. For routine reconstructions around the hip for osteoarthritis and low-energy trauma, metal implants, either arthroplasty or internal fixation, are employed with high rates of success. Biologic implants are generally reserved for revision and oncologic surgery when large structural bone and soft-tissue defects are present. Structural allografts are used for both acetabular and femoral defects to replace bone and or conserve bone stock in anticipation of future reconstructions. Maintaining soft-tissue attachments and optimizing tension in the hip abductors also is an important consideration in optimizing function, especially in younger patients. Biologic options are also important in patients with prior arthroplasty who sustain periprosthetic fractures or develop tumors above or below existing constructs that require excision and reconstruction. Complications are common both early and late postoperatively. For this reason, patients must be apprised of the risks, and surgeons should be poised to take appropriate steps to mitigate and/or treat potential complications and to anticipate future reconstructions to preserve and enhance function.

Professor Emeritus, University of Miami Miller School of Medicine, Miami, FL

Paper presented at the Biennial Arthroplasty Disaster International Conference in Miami Beach, Florida, September 2018.

Financial Disclosure: The author discloses a financial relationship outside this work with Vivex and Stryker. The author reports no conflicts of interest.

Correspondence to H. Thomas Temple, MD, Professor Emeritus, University of Miami Miller School of Medicine, Senior Vice President, Translational Research and Economic Development, Nova Southeastern University, 3659 S. Miami Ave, Suite 4008, Miami, FL 33133 Tel: +305-285-5025; fax: +305-285-5026; e-mail: htemple@nova.edu.

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