Femoral Revision with Impaction Grafting and a Collarless, Polished, Tapered Stem

Background Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem. Questions/purposes We used a sensitive technique to measure subsidence of a cemented polished collarless double-taper stem at each interface after femoral impaction grafting and compared subsidence, radiographic loosening, complications, and reoperations over three series of hips defined by technique developments. Patients and Methods Three series were defined: Series 1 (n = 23, irradiated allograft), Series 2 (n = 12, doublewashed, size-profiled graft, nonirradiated bone, long stems as required), and Series 3 (n = 21, modular tamps). Stem subsidence was analyzed with Ein Bild Röntgen Analyse software. Radiographic loosening, complications, and reoperations were also determined. Results The median subsidence at 12 months for Series 1, 2, and 3 were 2.1, 0.5, and 0.7 mm at the prosthesis-cement interface and 1.3, 0

Section: Introductionmentioning

confidence: 99%

Reduced Femoral Component Subsidence with Improved Impaction Grafting at Revision Hip Arthroplasty

Howie

Callary

McGee

et al. 2010

“…We previously described the surgical technique [11] and it has not changed. One surgeon (KLG) performed all of the procedures.…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported our results of 41 patients (44 hips) with impaction bone grafting followed a minimum of 2 years (average, 4.7 years; range, 2-8 years) [11]. Survivorship using femoral reoperation for symptomatic aseptic loosening as the end point was 95% (confidence interval [CI], 72%-99%) at 8 years.…”

Section: Introductionmentioning

confidence: 99%

What is the Long-term Survival of Impaction Allografting of the Femur?

Garvin¹,

Konigsberg²,

Ommen³

et al. 2013

Background Revision hip surgery of the femur for patients with substantial bone loss is challenging. We previously reported 41 patients (44 hips) treated with femoral impaction grafting followed for a minimum of 2 years. The survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97% at 8 years. However, data on longer term survival are crucial to adequately compare this surgical technique with other types of revision hip arthroplasty procedures. Questions/purposes We therefore asked what the survivorship of impaction bone grafting was at longer followup, if the severity of bone loss was associated with failure, and finally, if longer length stems had improved survival compared with shorter stems.Methods Between 1993 and 2002, 78 femoral revisions were performed in 71 patients using impaction grafting. The average age of the patients was 67 years (range, 33-84 years). Sixty-nine of the 71 patients were available for followup evaluation. We obtained Harris hip scores preoperatively and postoperatively. Radiographs were measured for radiolucent lines. Patients were followed a minimum of 2 years (average, 10.6 years; range, 2-19 years).

“…The use of a double-tapered polished stem therefore appears suitable because such a stem can achieve secondary stability after subsidence. Recently, another type of tapered polished stem, such as the CPT 1 stem or the Spectron TM stem (Smith & Nephew Richards, Memphis, TN), and an unpolished stem have also provided good clinical results [14,16]; however, there are no clear data on a choice for a particular stem. From our results, a stem should have good rotational stability owing to a rectangular cross section and a wide anteroposterior surface in the proximal part.…”

Section: Discussionmentioning

confidence: 99%

“…Halliday et al [12] reported a survivorship rate of 99.1% at 10 to 11 years and Schreurs et al [19] reported a survivorship rate of 100% at 8 to 13 years using the Exeter TM stem (Stryker Howmedica, Newbury, UK). Mahoney et al [16] reported a survivorship rate of 97% at 4.7 years.…”

Section: Introductionmentioning

confidence: 98%

Factors Influencing the Stability of Stems Fixed with Impaction Graft in Vitro

Ohashi

Matsuura

Ebara

et al. 2009

Mechanical stability of the stem is believed to be an important factor in successful impaction grafting in revision THA. We asked whether particle size, femoral bone deficiencies, stem design, graft composition, and impaction technique influenced the initial stability of the stem in vitro using model femora and human bone particles. Bone particles made with a reciprocating blade-type bone mill contained larger particles with a broader size distribution than those made by a rotating drum-type bone mill and had higher stiffness on compression testing. The stiffness on torsional testing decreased as the degree of proximal-medial segmental deficiencies increased. The stiffness and maximum torque in a stem with a rectangular cross section and wide anteroposterior surface were higher in torsional tests. Adding hydroxyapatite granules to the bone particles increased the torsional stability. To facilitate compact bone particles, we developed a spacer between the guidewire and modified femoral packers. This spacer facilitated compacting bone particles from the middle up to the proximal and the technique increased the amount of impacted bone particles at the middle of the stem and also improved the initial stability of the stem. Stem design and degree of deficiencies influenced stiffness in the torsional test and the addition of hydroxyapatite granules enhanced torsional stiffness.