Femoral Impaction Allografting for Significant Bone Loss in Revision Hip Arthroplasty

2017 ◽  
Vol 27 (3) ◽  
pp. 281-285 ◽  
Author(s):  
Thomas A.J. Goff ◽  
Peter Bobak
Keyword(s):  
Bone Loss ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Bone Allograft ◽  
Revision Hip Arthroplasty ◽  
Stem Subsidence ◽  
Impaction Allografting ◽  
Component Revision

Introduction Femoral impaction bone allografting in revision hip arthroplasty facilitates physiological reconstruction with restoration of bone stock, allowing implantation of a standard cemented femoral component. The purpose of this study was to report our experience in femoral component revision arthroplasty with impaction morsellised cancellous bone allograft using custom impactors and a cemented triple-taper polished stem. Methods Retrospective analysis of all cases of femoral component revision hip arthroplasty with impaction bone grafting undertaken by a single surgeon from 2005 to 2011. Outcome measures included radiographic analysis of stem subsidence over time, graft remodelling and incorporation, and clinical progress. Results We reviewed 47 consecutive hips in 44 patients, mean age 62 years (37-88). Femoral impaction with allograft was performed as either single stage (41 cases) or 2-stage (6 cases) procedures. All patients received a cemented C-stem prosthesis. The mean follow-up period was 5.1 (1.3-9.4) years. The median pre-operative bone defect score was 3 (interquartile range [IQR] 2-3) using the Endo-Klinik classification. Radiological evidence of graft incorporation was observed in 89% (281 of 315 zones) with additional remodelling observed in 33% (103 of 315 zones). The median stem subsidence at 1-year follow-up was 1.1 mm (standard deviation [SD] 1.24 mm, range 0-6 mm). The median Oxford Hip Score at the most recent follow-up was 36.5. To date no femoral component has undergone further revision. Conclusions Encouraging results have been obtained with this technique for the treatment of significant bone loss in revision hip arthroplasty, allowing implantation of a standard prosthesis.

scholarly journals Experience in the use of Distal Fixation Femoral Component Use in Revision Hip Arthroplasty

2017 ◽  
pp. 27-31
Author(s):  
N. V. Zagorodniy ◽  
A. V. Ivanov ◽  
S. V. Kagramanov ◽  
G. A. Chragyan ◽  
I. A. Nikolaev
Keyword(s):  
Femoral Component ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Revision Arthroplasty ◽  
Pain Syndrome ◽  
Revision Hip Arthroplasty ◽  
Treatment Results ◽  
Distal Fixation ◽  
Component Revision

Purpose. To evaluate the efficacy of revision hip arthroplasty with use of distal fixation revision femoral component.Patients and methods. From June 2004 through October 2015 one hundred thirteen revision arthroplasties were performed in patients with type 3A, 3B and 4 femoral defects by Paprovsky classification. Solution, Wagner SL and Cerafit revision femoral components for distal fixation were used. In the majority of cases (87) the cause of revision intervention was aseptic instability of the femoral component. In 60 cases revision was performed for cementless femoral components, in 53 - for cement components.Results.Follow up period made up from 1 to 12 years. In 83.2% of cases excellent, good and satisfactory treatment results, i.e. pain syndrome remission, restoration of joint movements and extremity weight bearing ability were achieved.Conclusion.Wagner SL, Solution and Cerafit modular revision stems ensure acceptable clinical treatment results and can be the implants of choice for hip femoral component revision arthroplasty in types 3A, 3B and 4 femoral defects by Paprovsky.

scholarly journals Experience in the use of Distal Fixation Femoral Component Use in Revision Hip Arthroplasty

2017 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
N. V Zagorodniy ◽  
A. V Ivanov ◽  
S. V Kagramanov ◽  
G. A Chragyan ◽  
I. A Nikolaev
Keyword(s):  
Femoral Component ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Revision Arthroplasty ◽  
Pain Syndrome ◽  
Revision Hip Arthroplasty ◽  
Treatment Results ◽  
Distal Fixation ◽  
Component Revision

Purpose . To evaluate the efficacy of revision hip arthroplasty with use of distal fixation revision femoral component. Patients and methods. From June 2004 through October 2015 one hundred thirteen revision arthroplasties were performed in patients with type 3A, 3B and 4 femoral defects by Paprovsky classification. Solution, Wagner SL and Cerafit revision femoral components for distal fixation were used. In the majority of cases (87) the cause of revision intervention was aseptic instability of the femoral component. In 60 cases revision was performed for cementless femoral components, in 53 - for cement components. Results. Follow up period made up from 1 to 12 years. In 83.2% of cases excellent, good and satisfactory treatment results, i.e. pain syndrome remission, restoration of joint movements and extremity weight bearing ability were achieved. Conclusion. Wagner SL, Solution and Cerafit modular revision stems ensure acceptable clinical treatment results and can be the implants of choice for hip femoral component revision arthroplasty in types 3A, 3B and 4 femoral defects by Paprovsky.

scholarly journals Allogenic bone graft for femoral defect augmentation in hip revision arthroplasty: A case series

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Nils Wirries ◽  
Michael Skutek ◽  
Marcus Örgel ◽  
Stefan Budde ◽  
Alexander Derksen ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Graft ◽  
Cortical Bone ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Femoral Bone ◽  
Allogenic Bone

Cortical bone loss in revision hip arthroplasty requires an adequate stabilization to achieve a durable implant fixation. This case series shall illustrate possible indications for the use of allogenic grafts in revision hip arthroplasty. Twelve patients with femoral bone loss were treated with allografts. In addition to established clinical scores, the radiological follow-ups were analyzed for hints of implants loosening and the osteointegration of the allografts. After a mean follow-up of 3.0 years the mHHS was 61.3 points and the UCLA 3.8. One patient showed a non-progressive radiolucency around the hip implant. The osteointegration of all allogenic grafts happened on time. Up to the last follow-up no revision surgery of the hip implants and the associated femoral bone graft was observed. Allogenic bone grafts present a method for biological stabilization in situations of large femoral cortical bone defects in revision hip arthroplasty.

Proximal Femoral Reconstruction for Revision Hip Arthroplasty with Severe Bone Loss: A New Technique Using Autologous Bone Graft and a Proximally Loading Femoral Component

1997 ◽  
Vol 7 (1) ◽  
pp. 3-10 ◽  
Author(s):  
J. Alfaro Adrian ◽  
M. Emerton ◽  
D.W. Murray ◽  
P. Mclardy-Smith
Keyword(s):  
Bone Loss ◽  
Bone Graft ◽  
Hip Arthroplasty ◽  
Autologous Bone Graft ◽  
Revision Hip Arthroplasty ◽  
Severe Bone Loss ◽  
Successful Technique ◽  
A New Technique ◽  
Proximal Femoral Reconstruction

We report the results of a new method of reconstructing the femur in 22 patients with severe bone loss having revision hip arthroplasty. The calcar and metaphysis were reconstructed with cortico-cancellous autograft around a new modular hip replacement. The metaphyseal portion of the implant is free to slide on the stem and therefore loads the graft and, we believe, encourages bone graft incorporation. The stem gains cementless fixation distal to the area of bone loss, thus preventing fractures and allowing the areas of bone loss to heal. At the time of review at a mean of 3 years follow-up there had been no revisions (since then there has been one re-revision due to recurrence of infection). The modified D'Aubigné and Postel hip score improved from 7.3 to 15. In 17 patients the graft has incorporated, in 5 it has partially resorbed but the prosthesis remains secure. We conclude that this is a relatively simple and successful technique for overcoming the problem of major femoral bone loss.

scholarly journals Proximal Femoral Allograft for Major Segmental Femoral Bone Loss: A Systematic Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
B. A. Rogers ◽  
A. Sternheim ◽  
D. Backstein ◽  
O. Safir ◽  
A. E. Gross
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
Surgical Techniques ◽  
Stress Shielding ◽  
Review Article ◽  
Revision Hip Arthroplasty ◽  
Femoral Bone ◽  
Endoprosthetic Reconstruction ◽  
Press Fit ◽  
Impaction Allografting

As the indications for total hip arthroplasty increase, the prevalence of extensive proximal femoral bone loss will increase as a consequence of massive osteolysis, stress shielding and multiple revisions. Proximal femoral bone stock deficiency provides a major challenge for revision hip arthroplasty and is likely to account for a significant future caseload. Various surgical techniques have been advocated included impaction allografting, distal press-fit fixation and massive endoprosthetic reconstruction. This review article provides a systematic review of the current literature to assess the outcome of revision hip arthroplasty using allograft to reconstruction massive proximal femoral bone loss.

Proximal Cementing for Revision Hip Arthroplasty

1998 ◽  
Vol 8 (2) ◽  
pp. 62-69 ◽  
Author(s):  
J. Alfaro-Adrian ◽  
R.W. Crawford ◽  
A. Wulke ◽  
D.W. Murray ◽  
P. Mclardy-Smith
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
High Rate ◽  
Revision Hip Arthroplasty ◽  
Hip Revision ◽  
Risk Of Fracture ◽  
Slight Pain ◽  
Continued Use ◽  
A New Technique

We report the results of a new technique of proximal cement fixation in 41 patients having revision hip arthroplasty using the Oxford modular femoral component. This consists of two parts, a metaphised wedge and a stem. The metaphyseal wedge is cemented and applies the load proximally to encourage bone healing. The wedge is free to slide on an uncemented stem that gains fixation distal to areas of bone loss, with the intention of reducing the risk of fracture. The clinical and radiographic follow-up ranged from a minimum of 3 years to 7 years. There have been no re-revisions. Ninety percent of the patients had pain or slight pain. Despite a relatively high rate of early subsidence, we feel that our results are encouraging, and justify the continued use of this component in hip revision surgery.

scholarly journals Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Szu-Yuan Chen ◽  
Chi-Chien Hu ◽  
Chun-Chieh Chen ◽  
Yu-Han Chang ◽  
Pang-Hsin Hsieh
Keyword(s):  
Hip Arthroplasty ◽  
Cox Regression ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
Two Stage ◽  
Eradication Of Infection ◽  
The Mean

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

scholarly journals Results of Bone Plasty with Allografts in Revision Hip Arthroplasty

2014 ◽  
Vol 21 (2) ◽  
pp. 33-39
Author(s):  
N. V Zagorodniy ◽  
V. I Nuzhdin ◽  
K. M Bukhtin ◽  
S. V Kagramanov
Keyword(s):  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Bone Defects ◽  
Revision Hip Arthroplasty ◽  
Treatment Results ◽  
Group I ◽  
Group Ii ◽  
Distal Fixation ◽  
Hip Arthroplasties

Results of 79 revision hip arthroplasties using bone defects plasty with allografts were analyzed. Plasty of defects in the zone of acetabulum was performed in 62 operations (group I), alloplasty of femoral defects - in 17 interventions (group II). Mean follow up period made up 5 (3-14) years. In group I excellent treatment results were recorded in 18 (29.03%) cases, good - in 23 (37.1%), satisfactory - in 15 (24.19%), poor - in 6 (9.68%) cases and in II group in 4 (23.53%), 6 (35.29%), 5 (29.41%) and 2 (11.76%) cases, respectively. It was shown that in revision arthroplasty application of allografts increased the risk of suppurative complication development while insertion of distal fixation revision stems enabled to avoid allograft application in femoral defects.

Femoral Revision with Impaction Allografting and an Uncemented Femoral Component

2008 ◽  
Vol 18 (4) ◽  
pp. 278-285 ◽  
Author(s):  
T.N. Nickelsen ◽  
M. Erenbjerg ◽  
J.B. Retpen ◽  
S. Solgaard
Keyword(s):  
Aseptic Loosening ◽  
Femoral Component ◽  
Clinical Performance ◽  
Successful Outcome ◽  
Femoral Revision ◽  
Slight Pain ◽  
Impaction Allografting ◽  
Component Revision ◽  
Regeneration Of Bone

A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric®, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone and implant survival.

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