Proximal Femoral Allografts for Reconstruction of Bone Stock in Revision Arthroplasty of the Hip

ArticleinClinical Orthopaedics and Related Research &NA;(319):151-8 · November 1995with5 Reads
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.
    • "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. "
    [Show abstract] [Hide abstract] 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.
    Article · Mar 2013
    • "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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jun 2011
    • "Encouraging short-and mediumterm results have been reported by Graham et al. [8] and Blackley et al. [2] with the same technique as that applied in our study, as well as by Haddad et al. [11] with a variant involving resection of the residual host femur (Table 1). Gross et al. [9] reported a 10.1% revision rate after at least two years of follow-up, but they did not cement the distal stem into the host femur; of the 130 patients, only one experienced graft resorption. There was evidence of notable graft resorption in five cases in our study. "
    [Show abstract] [Hide abstract] ABSTRACT: Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a trochanteric claw plate. Between 1988 and 2001, 44 revisions were performed in 42 patients. After a transtrochanteric approach, the femur was cut longitudinally. A long, cemented Charnley-type prosthesis was used, and flaps of the residual femur were folded around the allograft. The greater trochanter was reinserted with wires in all revisions, and with both wires and a claw plate in 20 revisions. Mean follow-up was 7.15 years (range: 3–16); seven patients, died and four were lost to follow-up. The follow-up exceeded five years in 34 patients. The major complication was nonunion of the greater trochanter, which occurred in 25 cases. Six dislocations, one recurrence of infection, two mechanical loosening, and two fractures below the stem were also recorded. The use of a trochanteric claw plate significantly improved final hip stability, even in patients with nonunion. Femoral reconstruction with a massive structural allograft is reliable and long-lived, and serious complications and long-term resorption are uncommon. The use of a trochanteric claw plate significantly improves final hip stability. Level of evidence: Therapeutic study, level III (retrospective comparative study).
    Full-text · Article · Jan 2008
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