The Journal of Bone and Joint Surgery (American) 83:346 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Proximal Femoral Allografts for Reconstruction of Bone Stock in Revision Arthroplasty of the Hip
A Nine to Fifteen-Year Follow-up
Hugh R.L. Blackley, BSc, MBChB, FRACS,
Aileen M. Davis, BSc, PT, MSc, PhD,
Carol R. Hutchison, BSc, MD, MED, FRCSC and
Allan E. Gross, MD, FRCSC
Investigation performed at the Department of Orthopaedic
Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
Hugh R.L. Blackley, BSc, MBChB, FRACS
Department of Orthopaedic Surgery, Auckland Hospital, Park Road,
Private Bag 92024, Auckland 1, New Zealand
Aileen M. Davis, BSc, PT, MSc, PhD
Carol R. Hutchison, BSc, MD, MED, FRCSC
Allan E. Gross, MD, FRCSC
Department of Orthopaedic Surgery, Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, ON M5G 1X5, Canada
No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background: Revision of a femoral component
in a patient who has severe bone loss is a complex problem that
is likely to increase with the increasing numbers of patients who
have multiple revision hip arthroplasties. A valuable option in
such a situation is use of a long-stem prosthesis that is cemented
to a proximal femoral allograft but not to the host bone.
Methods: Between April 1984 and December 1989, sixty-three
total hip arthroplasties in sixty consecutive patients were revised
with a proximal femoral allograft-prosthesis construct. The average
length of the allograft was 15 cm. The average age of the patients
at the time of the revision was 62.5 years. All patients had undergone
at least one previous total hip arthroplasty, and an average of
3.8 previous total hip arthroplasties had been performed in the
series. Each patient was assigned a modified Harris hip score. Radiographs
were examined for trochanteric union, allograft-host union, endosteal and
periosteal resorption, component loosening, and fracture.
Results: At an average of eleven years (range, nine
years and four months to fifteen years) after the revision, forty-five
patients were alive, fourteen patients had died, and one patient
had been lost to follow-up. The patients who had died or had been
lost to follow-up had had a total of fifteen allografts (24%) and
had been followed for an average of five years and seven months
(range, two years and four months to eight years). The average preoperative Harris
hip score for the sixty-three hips was 30 points (range, 6 to 65
points). At the latest follow-up evaluation, the average score for
the hips with the original graft in situ was 71 points (range, 47
to 95 points). Five hips failed because of infection, and four of
them were successfully revised. Three hips failed because of aseptic
loosening, at an average of ten years and three months; two were
successfully revised, and the third was awaiting revision at the
time of writing. An additional operation was performed in three
hips with allograft-host nonunion and in two with dislocation. Success
was defined as a postoperative increase in the Harris hip score
of greater than 20 points, a stable implant, and no need for additional
surgery related to the allograft at the time of the review. The
success rate for all hips was 78% (forty-nine of sixty-three)
after an average of nine years of follow-up. The success rate for
the patients who were alive at the time of follow-up was 77% (thirty-seven
of forty-eight hips) after an average of eleven years of follow-up.
Conclusions: The clinical and radiographic results
at an average of eleven years after revision hip arthroplasty with
a proximal femoral allograft are encouraging. This report represents
our early experience; improvements in the technique have been made.
We believe that this technique provides a viable option for treatment
of the difficult problem of severe femoral bone loss.
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