Medium term results of revision total hip replacement using radial impaction grafting and a collared textured stem
Department of Orthopaedics, Queen Elizabeth Hospital, Gateshead, UK.Hip international: the journal of clinical and experimental research on hip pathology and therapy (Impact Factor: 0.76). 07/2009; 19(3):227-33.
Massive bone loss is a problem frequently encountered during revision hip surgery. Several ways of addressing the bone loss in proximal femur have been described with varying results. We present our results with the use of a radial impaction grafting technique and a collared textured component. 107 consecutive cases of Revision Total Hip Arthroplasty, who underwent radial impaction grafting and had a textured collared implant inserted for femoral deficiencies were assessed. The average follow up was seven years and four months (3 to 11 years). All the patients experienced a significant improvement in the clinical scores. Oxford Hip scores improved from an average of 41.2 (30 - 56) to 19.3 (12 - 32). Harris Hip scores improved from an average of 40.8 (28 - 65) to 83.4 (60 - 99). There were no cases of subsidence at follow up. Using revision for any cause as the end point the survivorship at an average of 88.8 months was 93.8%. Three revisions were performed for deep infection within the first year. There were three cases of peri-prosthetic fractures distal to the tip of standard length stems at an average of 8.4 months after surgery. We recommend the use of morsellised allografts with radial impaction grafting and textured, collared stems for selected cases with Paprosky type II and type III femoral defects. We also recommend use of long stems bypassing the tip of the previous implant with impaction grafting to avoid peri-prosthetic fractures.
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ABSTRACT: Previously, radiostereometric analysis following hip revision performed using impacted morsellised allograft bone and a cemented Exeter stem has shown continuous subsidence of the stem for up to five years. It is not known whether the subsidence continues thereafter. In our study, 17 of 25 consecutive osteo-arthritic patients with aseptically loose stems who underwent first-time revision using impacted morsellised allograft bone and a cemented Exeter stem were followed by yearly radiostereometric examinations for nine years. The mean subsidence at six weeks was 1.1 mm (0.1 to 2.3), from six weeks to one year 1.3 mm (0 to 2.6), from one to five years 0.7 mm (0 to 2.0), and from five to nine years 0.7 mm (0.1 to 3.1). That from six weeks to nine years was 2.7 mm (0 to 6.4) (95% confidence interval 2.0 to 3.5). The Charnley pain score significantly improved after revision, and was maintained at nine years, but walking ability deteriorated slightly as follow-up extended. Of the eight patients who were not followed for nine years, two had early subsidence exceeding 11 mm. Our findings show that in osteo-arthritic patients who undergo revision for aseptic loosening of the stem using impacted morsellised allograft bone and a cemented Exeter stem, migration of the stem continues over nine years at a slower rate after the first year, but without clinical deterioration or radiological loosening.
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ABSTRACT: Radial impaction grafting (RIG) potentially improves the durability and reliability of cementing the femoral components in revision total hip arthroplasty (THA). In this multicenter, prospective study, 88 revision THAs (87 patients) with RIG technique were performed. The average follow-up time was 7.0years (range, 5.0-10.2). There were 14 femur fractures: 2 intraoperative, 5 within 3months after surgery, and 7 later in the postoperative stage (range, 5-84months). Sixteen patients were lost to follow-up and 20 died without stem re-revision. None of the patients have been re-revised for any reason during follow-up. Age was observed to be a significant factor for determining fracture risk. In conclusion, RIG can be considered a reliable surgical technique, especially for younger patients.
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