Bone Regeneration Without Hip Harvesting: Modern Alternatives

“Doctor, they told me I need bone harvested from my hip.”

Fortunately, it is a sentence heard less and less. The patient more often heard it from a relative, read it online, or lived through it years ago. It carries a memory — or an anticipation — of pain, hospital, crutches.

The good news: in the vast majority of cases, that harvest is no longer needed.

What changed

Three things, in thirty years.

Biomaterials. Deproteinised bovine xenograft has proven to work as a scaffold (a framework) for bone regeneration with long-term results comparable to autologous bone. It carries no living cells, but provides a structure on which the patient’s cells can build new bone.

Romito and colleagues compared, in 64 randomised patients with ridges 4 mm wide or less, a block of equine bone and a block harvested from the patient (J Clin Periodontol, 2022). The width gained at 30 weeks was almost identical: 2.9 mm against 3.0. Pain and analgesic use were lower with the equine bone. In the same study, however, early implant losses were 20% against 10%. The biomaterial spares the harvest, but has yet to show it osseointegrates implants as well as the patient’s native bone.

Membranes. Guided bone regeneration (GBR) uses collagen or PTFE membranes to create a protected space in which bone regenerates undisturbed. When to choose a membrane and when the patient’s own bone, I laid out in the comparison of GBR and autologous grafting. The technique is mature: at 12-14 years implants placed together with GBR survive in 91.9% of cases, against 94.6% for those placed in bone that needed nothing. The difference is not significant (Jung et al. 2013, Clin Oral Implants Res). Cortical bone laminae and titanium meshes are now also used, and they hold the space better in larger defects.

Ridge expansion. Instead of adding bone from outside, it widens what is already there. The bone ridge is expanded from within using dedicated instruments — the Bruschi-Scipioni technique — creating space for the implant without harvesting of any kind. Lin’s meta-analysis of over 1,400 implants reports 98.1% survival and 3.3 mm of ridge width gained (BMC Oral Health, 2023). Al Haydar and colleagues, across 35 studies and 4,446 implants, reach 98.17% and 3.06 mm, with no difference between ridges expanded with or without biomaterial (Int J Oral Maxillofac Implants, 2023).

The techniques that replaced hip harvesting

Ridge expansion (narrow ridge)

When the ridge is tall but narrow — the most frequent scenario — ridge expansion is the first choice. The patient’s native bone is widened with osteotomes and progressive inserts. The implant is placed in the same session. No biomaterial in many cases, rapid healing, minimal pain.

It is the technique on which we built the customised regeneration approach.

GBR with biomaterials (contained defects)

For dehiscences, fenestrations and defects up to 5-6 mm, GBR with xenograft and collagen membrane is the standard. A single surgical field, no harvesting, predictable results.

Maxillary sinus lift (insufficient posterior bone)

When bone is lacking in the posterior maxilla, a maxillary sinus lift with biomaterial fills the space between the residual ridge and the sinus membrane. Hip harvesting is never indicated for this procedure. The most common fear, perforating the membrane, I addressed in the piece on the sinus in three dimensions.

Intraoral donor site grafts (selected cases)

When autologous bone is needed — for its osteogenic properties — it is harvested from the chin or mandibular ramus. Same anaesthesia, same surgical field, contained morbidity. The iliac crest stays out of the equation. The harvesting and grafting options are compared in advanced bone grafting techniques.

When hip harvesting is still needed

It remains indicated in few scenarios: reconstructions after facial trauma with loss of bone continuity, extensive post-oncological defects, maxillary atrophies so severe that no intraoral technique can provide the required volume.

These are situations that can be counted on one hand, out of hundreds of implant cases per year.

When it is needed, a hip harvest makes itself felt. Boehm and colleagues gathered 44 studies and 2,801 patients operated on for craniofacial reconstruction (Ann Plast Surg, 2019): in the acute phase 45.7% had gait disturbance and 17.8% sensory changes. Chronic problems are rare, 1.5% for gait and 3.1% for pain. The authors conclude that the technique remains valid, and for major reconstructions they are right.

The point

Iliac crest harvesting remains a valid technique for major reconstructions. For the narrow ridge, the contained defect and the maxillary sinus, there are now roads that ask far less of the patient.

The right question is not “where do we harvest bone from?” but “do we actually need to harvest bone from anywhere?”

Often the answer is no.

References

1. Jung RE, Fenner N, Hämmerle CH, et al. Long-term outcome of implants placed with guided bone regeneration (GBR) using resorbable and non-resorbable membranes after 12-14 years. Clin Oral Implants Res. 2013;24(10):1065-1073. doi:10.1111/j.1600-0501.2012.02522.x · PMID: 22697628
2. Lin Y, Li G, Xu T, et al. The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis. BMC Oral Health. 2023;23(1):894. doi:10.1186/s12903-023-03643-2 · PMID: 37986181
3. Moraschini V, Poubel LA, Ferreira VF, et al. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. Int J Oral Maxillofac Surg. 2015;44(3):377-388. doi:10.1016/j.ijom.2014.10.023 · PMID: 25467739
4. Al Haydar B, Kang P, Momen-Heravi F. Efficacy of horizontal alveolar ridge expansion through the alveolar ridge split procedure: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2023;38(6):1083-1096. doi:10.11607/jomi.9972 · PMID: 38085739
5. Boehm KS, Al-Taha M, Morzycki A, Samargandi OA, Al-Youha S, LeBlanc MR. Donor site morbidities of iliac crest bone graft in craniofacial surgery: a systematic review. Ann Plast Surg. 2019;83(3):352-358. doi:10.1097/SAP.0000000000001682 · PMID: 30562201
6. Romito GA, Villar CC, Sapata VM, Soares HH, Fonseca MA, Conde M, et al. Autogenous bone block versus collagenated xenogeneic bone block in the reconstruction of the atrophic alveolar ridge: a non-inferiority randomized clinical trial. J Clin Periodontol. 2022;49(11):1158-1168. doi:10.1111/jcpe.13701 · PMID: 35833539

Were you told you need hip bone harvesting? Ask for a second opinion — it may not be necessary.