Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip.

Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 11/1995; DOI: 10.1097/00003086-199510000-00015
Source: PubMed

ABSTRACT Proximal femoral allografts have been used to restore uncontained circumferential defects of the multiply revised total hip arthroplasty. These grafts are used with long stem components that are cemented to the graft but not the host. The junction of host and graft is stabilized by the stem and a step cut with cerclage wires. Autograft bone is placed at the junctions to induce union. Full weightbearing is delayed until union occurs between the graft and the host femur, usually by 3 months. One hundred sixty-eight structural femoral allografts were done; average followup was 4.8 years as of January 1, 1995. Success was defined as an increase in the clinical score of at least 20 points, a stable implant, and no need for further surgery related to the allograft. The success rate in 130 patients with at least 2 years followup is 85%. There have been 17 revisions in 16 patients: 3 revisions for infection, 8 for dislocation, 5 for nonunion, and 1 for pain. The revision rate is 10.1%. Radiographic analysis showed 7 nonunions, minor resorption in 6 patients, and significant resorption in 1 patient. All implants are stable with no lucent lines. The results support using this technique for full circumferential segmental proximal femoral defects in revision hip arthroplasty.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Allograft-prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft-prosthetic composites, but have rarely focused on the uncemented allograft-prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft-prosthetic composite and to present the radiographic and clinical results. Materials and Methods: Twelve patients who underwent uncemented allograft-prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated. Results: In our series, union occurred in all the patients (100%; range 5-9 months). Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were 26.2 points (range 24-29 points) and 80.6 points (range 66.2-92.7 points), respectively. Conclusions: These results showed that uncemented allograft-prosthetic composite could promote bone union through compression at the host-allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.
    Indian Journal of Orthopaedics 05/2014; 48(3):289-95. DOI:10.4103/0019-5413.132521 · 0.62 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Musculoskeletal allografts have a defi-nite role in reconstructive surgery of the lower extremity. Although this role has been controversial in the past, the use of allografts is now clearly indicated. In addition, the improved safety and avail-ability of banked tissue has made its use more universal. The purposes of the cur-rent paper are to describe the role of al-lografts in revision hip arthroplasty and to outline the indications, surgical tech-niques, and results at our institution. Revision Arthroplasty of the Hip Restoration of bone stock is an impor-tant goal in revision arthroplasty of the hip, particularly for patients who may need additional surgery in the future 1 . In some patients, the bone loss may be so severe that without restoring bone stock it is not possible to stabilize a new implant even when it is one designed to be used after tumor excision. A tumor prosthesis can be used in some revision situations; however, these megaprosthe-ses generally are more appropriate after en bloc excision of bone tumors be-cause the uncertain prognosis necessi-tates faster rehabilitation. Furthermore, chemotherapy and radiation have dele-terious effects on bone grafts 2,3 . These megaprostheses do not restore bone stock, and additional surgery in the future is more difficult because the ce-ment or the implants themselves make revision very difficult. In addition, these implants do not allow biological reat-tachment of tendons to bone 4,5 .
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim In an analysis of 18 complex hip replacements, 25 special circumstances that affected the final results were detected. Materials and methods The treatment and outcome of special circumstances found in a retrospective multicenter series of hip replacements were assessed. These situations, defined by the authors, were sepsis (4 patients), rheumatoid arthritis (1 patient), major osteoporosis (7 patients), periprosthetic fracture (1 patients), coxal dysplasia (2 patients), pelvic discontinuity (1 patients), mega-acetabulum (1 patients), long stems (8 patients), and recurrent dislocation (1 patient).The Merle D’Aubigne and Postel score was determined and the Trendelenberg sign and final dysmetry were evaluated. The DeLee and Charnley methods were used for cups, in addition to measurement of cephalad and medial migration. Stems were evaluated used the Engh criteria. The mean follow-up of these patients was 56 months. Results The results were favorable in terms of pain and mobility, with persistence of Trendelenberg gait in 10 patients. The mean final dysmetry was 2 cm. No cement-bone radiolucence was appreciated in 3 cemented cups. Among the patients with coxal dysplasia, one suffered material failure one year after the intervention. The 18 stems were considered stable at the conclusion of follow-up. Of the allografts used, 9 exhibited a correct appearance and 1 showed partial resorption. Conclusions Revision surgery in complex cases of loosening of a total hip arthroplasty has special features that determine the difficulty of surgery in each patient. These difficulties are compounded by the presence of special circumstances.
    Revista de Ortopedia y Traumatología 10/2005; 49. DOI:10.1016/S0482-5985(05)74473-4