The Journal of Bone and Joint Surgery (American). 2005;87:2499-2507.
doi:10.2106/JBJS.D.02547
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Adult Hip Reconstruction Test 17: Winter 2006
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Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem

B. Willem Schreurs, MD, PhD1, J.J. Chris Arts, MSc1, Nico Verdonschot, PhD1, Pieter Buma, PhD1, Tom J.J.H. Slooff, MD, PhD1 and Jean W.M. Gardeniers, MD, PhD1

1 Department of Orthopaedics 800, Radboud University Nijmegen Medical Centre, Postbox 9101, 6500 HB Nijmegen, The Netherlands. E-mail address for B.W. Schreurs: b.schreurs{at}orthop.umcn.nl

Investigation performed at the Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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. A commercial entity, Stryker Howmedica Osteonics, paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to evaluate the clinical and radiographic outcomes of revision of the femoral component of a hip arthroplasty with use of an impaction bone-grafting technique and a cemented polished stem.

Methods: Thirty-three consecutive femoral reconstructions that were performed between March 1991 and February 1996 with use of the X-change femoral revision system, fresh-frozen morselized allograft, and a cemented polished Exeter stem were followed prospectively. Femoral bone stock defects were classified according to the Endoklinik classification. The average age of the patients at the time of the femoral component revision was sixty-three years. No patient was lost to follow-up, which was performed at a minimum of eight years, but eight patients had died. None of the deaths was related to the surgery.

Results: No femoral reconstruction had been rerevised at a mean of 10.4 years postoperatively. There was one unrecognized intraoperative fracture, which healed following nonoperative treatment. There were three postoperative femoral fractures, all through cortical defects at the level of the tip of the prostheses. All fractures healed after plate fixation, and all femoral implants were left in situ. The average subsidence of the stem within the cement mantle was 3 mm; seven stems migrated ≥5 mm. The average Harris hip score improved from 49 points prior to surgery to 85 points (range, 68 to 100 points) at the time of this review. Subsidence did not affect the Harris hip score. Kaplan-Meier analysis, with an end point of femoral revision for any reason, showed a survival rate of 100% (one-sided 95% confidence interval, 100% to 91.3%).

Conclusions: Femoral revision with use of an impaction bone-grafting technique and a cemented polished stem resulted in an excellent prosthetic survival rate at eight to thirteen years postoperatively. The major problem that occurred was a femoral fracture in four patients.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Femoral Component Revision with Use of Impaction Bone-Grafting and a Cemented Polished Stem
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Letters to the Editor:

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Is it Important to Wash Morsellized Allograft?
Timothy N. Board
JBJS Online, 14 Dec 2005 [Full text]
Dr. Schreurs et al respond to Mr. Board
B. Willem Schreurs, M.D., Ph.D., et al.
JBJS Online, 14 Dec 2005 [Full text]