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: 2.77). 11/1995; &NA;(319):151-8. DOI: 10.1097/00003086-199510000-00015
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.
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- "The criteria of Gross et al. were used to define a successful result in our series.8 These criteria include a postoperative increase in the Harris hip score of more than 20 points, a radiologically stable implant, and no need for further femoral reconstructive surgery. "
ABSTRACT: Management of bone loss is a challenge in revision total hip arthroplasty (THA). A retrospective review was performed to study the use of uncemented distal locked prosthesis in cases with proximal femoral bone loss. Uncemented stems with distal interlocking were used in 65 hips during revision THAs with 38 hips having Paprosky IIIB/IV defects between January 1998 and February 2004. There were 48 males and 17 females in the study with an average age of 53 years (range 30-80 years). Radiographic and clinical outcome evaluation using the Harris hip score (HHS) were performed. AN IMPROVEMENT IN HHS (MEAN: 33 points) was observed at final followup (mean: 9 years). Regeneration of proximal bone stock was observed without signs of loosening or subsidence and none of the stems were revised. Three patients developed recurrent dislocation while one had a stem subsidence of 1cm following removal of interlocking bolts. Uncemented distal locked prosthesis provide adequate stability in revision THA, aiding the reconstruction of bony deficiencies while avoiding the disadvantages of fully porous or cemented implants.
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- "Reports of revision operations with histological evidence of osteonecrosis of the graft and only partial or no graft incorporation may reflect rather technical problems of graft fixation than the general biological fate of both homologous and autologous grafts. The higher failure rate of massive homologous grafts in other series [7,9,34,41,42] can not only be attributed to the nature of homologous grafts alone but at least in part also to the poorer bone quality and regenerative capacity of the host bone in revision cases. Exact fitting of the graft, screw placement and tight fixation in arthroplasties can be quite difficult in highly deficient acetabula, especially in older patients whereas bone quality in primary THA for severe acetabular dysplasia is usually good and the patient's are younger. "
ABSTRACT: Severe acetabular deficiencies in cases of developmental dysplasia of the hip (DDH) often require complex reconstructive procedures in total hip arthroplasty (THA). The use of autologous femoral head grafts for acetabular reconstruction has been described, but few data is available about clinical results, the rates of non-union or aseptic loosening of acetabular components. In a retrospective approach, 101 patients with 118 THA requiring autologous femoral head grafts to the acetabulum because of DDH were included. Six patients had died, another 6 were lost to follow-up, and 104 hips were available for clinical and radiological evaluation at a mean of 68 ± 15 (13 to 159) months. The average Merle d'Aubigné hip score improved from 9 to 16 points. Seven implants had to be revised due to aseptic loosening (6.7%). The revisions were performed 90 ± 34 (56 to 159) months after implantation. The other hips showed a stable position of the sockets without any signs of bony non-union, severe radiolucencies at the implant-graft interface or significant resorption of the graft. The use of autologous femoral head grafts with cementless cups in primary THA can achieve promising short- to midterm results in patients with dysplastic hips.
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