This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by MEDING, J. B.
Right arrow Articles by FARIS, P. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by MEDING, J. B.
Right arrow Articles by FARIS, P. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery 79:1834-41 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Impaction Bone-Grafting before Insertion of a Femoral Stem with Cement in Revision Total Hip Arthroplasty. A Minimum Two-Year Follow-up Study*

JOHN B. MEDING, M.D.{dagger}, MERRILL A. RITTER, M.D.{dagger}, E. MICHAEL KEATING, M.D.{dagger} and PHILIP M. FARIS, M.D.{dagger}, MOORESVILLE, INDIANA

Investigation performed at the Center for Hip and Knee Surgery, Mooresville

Impaction bone-grafting was performed before insertion of a collarless, polished, tapered femoral stem with cement in thirty-four revision total hip arthroplasties (thirty-four patients) that were done because of aseptic loosening. The average duration of follow-up was thirty months (range, twenty-four to forty-two months). The operation was the initial revision in twenty-eight patients (82 per cent). Twenty-two patients (65 per cent) also had revision of the acetabular component. Complications included four intraoperative and two postoperative fractures of the femur as well as one dislocation (at one month). Two patients (6 per cent) needed a repeat revision of the femoral stem because of aseptic loosening at twenty-six and thirty-six months postoperatively. Both of these patients had an associated fracture of the femur (one was intraoperative, and the other was postoperative). Subsidence was common (thirteen patients; 38 per cent) and averaged 10.1 millimeters (range, four to thirty-one millimeters). Although the study group was relatively small, with the numbers available subsidence was not found to be associated with the preoperative or postoperative hip score, segmental or cavitary femoral defects, femoral ectasia, intraoperative fracture of the femur, strut-grafting, trochanteric osteotomy, or varus position of the femoral component. Incorporation of the allograft into the trabecular bone and secondary remodeling were noted radiographically in thirty-two (94 per cent) and fourteen (41 per cent) of the patients, respectively, often within one year. Although the duration of follow-up was relatively short, no localized resorption of the allograft occurred and cortical repair was noted in one patient at three years. At the most recent follow-up evaluation, the Harris hip scores had improved from a preoperative average of 51 points (range, 32 to 90 points) to an average of 87 points (range, 65 to 100 points) and twenty-eight patients (82 per cent) had no or only slight pain. Despite the satisfactory early clinical results, we remain concerned about the high rate of fracture of the femur and the rate and extent of subsidence of the femoral component. On the basis of the worrisome findings after this two-year period, we recommend that impaction bone-grafting be used only when proximal femoral osteopenia is so severe that stability cannot be obtained with insertion of a long-stemmed femoral component without cement. In that setting, impaction bone-grafting may be considered instead of implantation of a massive proximal femoral allograft in combination with insertion of a femoral component with cement.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
R. J. Sierra, J. Charity, E. Tsiridis, J. A. Timperley, and G. A. Gie
The Use of Long Cemented Stems for Femoral Impaction Grafting in Revision Total Hip Arthroplasty
J. Bone Joint Surg. Am., June 1, 2008; 90(6): 1330 - 1336.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
D. A. Oakes and M. E. Cabanela
Impaction bone grafting for revision hip arthroplasty: biology and clinical applications.
J. Am. Acad. Ortho. Surg., October 1, 2006; 14(10): 620 - 628.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
B. W. Schreurs, J.J. C. Arts, N. Verdonschot, P. Buma, T. J.J.H. Slooff, and J. W.M. Gardeniers
Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem
J. Bone Joint Surg. Am., November 1, 2005; 87(11): 2499 - 2507.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
A. D. Toms, R. L. Barker, R. S. Jones, and J. H. Kuiper
Impaction Bone-Grafting in Revision Joint Replacement Surgery
J. Bone Joint Surg. Am., September 1, 2004; 86(9): 2050 - 2060.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
C. J. D. Valle and W. G. Paprosky
Classification and an Algorithmic Approach to the Reconstruction of Femoral Deficiency in Revision Total Hip Arthroplasty
J. Bone Joint Surg. Am., November 1, 2003; 85(90004): 1 - 6.
[Full Text] [PDF]

Home page
 JBJSHome page
E. Ornstein, I. Atroshi, H. Franzén, R. Johnsson, P. Sandquist, and M. Sundberg
Early Complications After One Hundred and Forty-four Consecutive Hip Revisions with Impacted Morselized Allograft Bone and Cement
J. Bone Joint Surg. Am., August 12, 2002; 84(8): 1323 - 1328.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. Bohm and O. Bischel
Femoral Revision with the Wagner SL Revision Stem : Evaluation of One Hundred and Twenty-nine Revisions Followed for a Mean of 4.8 Years
J. Bone Joint Surg. Am., July 1, 2001; 83(7): 1023 - 1031.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
H. R.L. Blackley, A. M. Davis, C. R. Hutchison, and A. E. Gross
Proximal Femoral Allografts for Reconstruction of Bone Stock in Revision Arthroplasty of the Hip : A Nine to Fifteen-Year Follow-up
J. Bone Joint Surg. Am., March 1, 2001; 83(3): 346 - 346.
[Abstract] [Full Text]

Home page
 J Am Acad Orthop SurgHome page
S. G. Maurer, A. C. Baitner, and P. E. Di Cesare
Reconstruction of the Failed Femoral Component and Proximal Femoral Bone Loss in Revision Hip Surgery
J. Am. Acad. Ortho. Surg., November 1, 2000; 8(6): 354 - 363.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
S. S. LEOPOLD and A. G. ROSENBERG
Current Status of Impaction Allografting for Revision of a Femoral Component*{{dagger}}{{ddagger}}
J. Bone Joint Surg. Am., September 1, 1999; 81(9): 1337 - 45.
[Full Text]

Home page
 JBJSHome page
S. S. LEOPOLD, R. A. BERGER, A. G. ROSENBERG, J. J. JACOBS, L. R. QUIGLEY, and J. O. GALANTE
Impaction Allografting with Cement for Revision of the Femoral Component. A Minimum Four-Year Follow-up Study with Use of a Precoated Femoral Stem
J. Bone Joint Surg. Am., August 1, 1999; 81(8): 1080 - 92.
[Abstract] [Full Text]

Home page
 JBJSHome page
L. M. JAZRAWI, C. J. DELLA VALLE, F. J. KUMMER, E. M. ADLER, and P. E. DI CESARE
Catastrophic Failure of a Cemented, Collarless, Polished, Tapered Cobalt-Chromium Femoral Stem Used with Impaction Bone-Grafting. A Report of Two Cases
J. Bone Joint Surg. Am., June 1, 1999; 81(6): 844 - 7.
[Full Text]