W e report 11 patients having revision of total hip arthroplasty using massive structural allografts for failure due to sepsis and associated bone loss. All patients had a two-stage reconstruction and the mean follow-up was 47.8 months (24 to 72). Positive cultures were obtained at the first stage in nine of the 11 patients, with Staphylococcus epidermidis being the most common organism. The other two patients had draining sinuses with negative cultures. There was no recurrence of infection in any patient. The mean increase in the modified Harris hip score was 45 and all the grafts appeared to have united to host bone. Two patients required additional procedures, but only one was related to the allograft. Complications included an incomplete sciatic nerve palsy and one case of graft resorption. Our results support the use of massive allografts in failed septic hip arthroplasty in which there is associated bone loss.
Proximal femoral allografts have been used to restore uncontained circumferential defects of the multiply revised total hip arthroplasty.These grafts are used with long stem components that are cemented to the graft but not the host. The junction of host and graft is stabilized by the stem and a step cut with cerclage wires. Autograft bone is placed at the junctions to induce union. Full weightbearing is delayed until union occurs between the graft and the host femur, usually by 3 months. One hundred sixtyeight structural femoral allografts were done; average followup was 4.8 years as of January 1, 1995. Success was defined as an increase in the clinical score of at least 20 points, a stable implant, and no need for further surgery related to the allograft. The success rate in 130 patients with at least 2 years followup is 85%. There have been 17 revisions in 16 patients: 3 revisions for infection, 8 for dislocation, 5 for nonunion,
Ligamentum patella rupture following local steroid injection in an Australian Rules footballer is described. The relationship between local steroid injection and rupture of large ligaments and tendons is reviewed. Careful consideration prior to steroid injection is strongly suggested because of the risk of rupture of these structures.
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