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The Journal of Bone and Joint Surgery (American) 84:1323-1328 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Early Complications After One Hundred and Forty-four Consecutive Hip Revisions with Impacted Morselized Allograft Bone and Cement

Ewald Ornstein, MD, Isam Atroshi, MD, PhD, Herbert Franzén, MD, PhD, Ragnar Johnsson, MD, PhD, Per Sandquist, MD and Martin Sundberg, MD, PhD

Investigation performed at the Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden

Ewald Ornstein, MD
Isam Atroshi, MD, PhD
Per Sandquist, MD
Martin Sundberg, MD, PhD
Department of Orthopedics, Hässleholm-Kristianstad Hospitals, SE-281 25 Hässleholm, Sweden. E-mail address for E. Ornstein: ewald.ornstein{at}skane.se

Herbert Franzén, MD, PhD
Department of Orthopedics, Ängelholm Hospital, SE-262 81 Ängelholm, Sweden

Ragnar Johnsson, MD, PhD
Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce.

Methods: All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation.

Results: Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eight involved the greater trochanter. Of the postoperative femoral fractures, one was proximal and nine were diaphyseal. Other intraoperative complications were the creation of a femoral cortical window in seven hips and incidental perforation of the femoral cortex in fourteen. Multivariate analysis showed the risk factors for femoral fracture during or after revision to be concomitant disease, greater deficiency of the femoral bone stock, and an intraoperative femoral window or perforation. Other complications included dislocation of the femoral head in nine hips, deep infection in one hip, persistence of preoperative deep infection in one hip, and superficial wound infection requiring wound débridement in two hips.

Conclusions: We found the complication rate to be high after hip revision arthroplasty performed with impacted morselized allograft bone and cement. The most serious complication was postoperative diaphyseal femoral fracture.


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