Impaction allograft with cement for the revision of the femoral component. A minimum 39-month follow-up study with the use of the Exeter stem in Asian hips

Abstract

We report the results of impaction bone grafting of the femoral side in revision total hip arthroplasty in Asian hips (South Korean patients) in which the surgery was performed with the Exeter stem. The minimum follow-up was 39 months (mean, 48.4; range, 39-66). There was subsidence of the cement-graft interface (<1 mm) in three hips (5%), of the stem-cement interface (<1 mm) in 12 hips (21%) and of the stem-cement interface (1-2 mm) in 14 hips (25%). Five hips (9%) developed intraoperative femoral fracture and two hips (4%) femoral perforation in revision. The complications of femoral fracture and subsidence did not have an adverse effect on the final clinical outcomes. The impaction of fresh-frozen allograft and use of a cemented, polished, tapered stem (Exeter stem) were also successful with good clinical and radiographic outcomes in our study of Asian hips (South Korean patients). However, we used smaller stems than the usual ones used for Western patients because of the smaller femur sizes.Résumé Nous reportons les résultats de la technique d'Exeter avec greffons impactés dans les reprises totales de hanche, étude réalisée sur des hanches asiatiques et sur des patients sud coréens, avec utilisation de la tige d'Exeter.Le suivi minimum a été de 39 mois (48.4 à 39.66). La migration à l'interface ciment greffe a été inférieure à 1 mm dans 3 cas, 5%. A l'interface tige ciment, (<1 mm) dans 12 hanches (21% des cas) et enfin à l'interface tige ciment, cette migration est comprise entre 1 et 2 mm dans 14 hanches (25% des cas). 5 hanches (11%) ont présenté durant l'intervention des complications avec une fracture fémorale dans 5 cas (9%) et une perforation fémorale dans 2 cas (4%). Ces complications ainsi que la migration de la tige n'ont pas entraîné de problèmes cliniques. La technique utilisant des allogreffes compactées cryoconservées et l'utilisation d'une tige cimentée et polie de type Exeter ont donné, dans cette étude, de bons résultats, tant sur le plan clinique que sur le plan radiographique. Cependant, nous avons dû utiliser des tiges beaucoup plus petites qu'habituellement en Europe compte tenu de la petite taille des fémurs asiatiques sud coréens.

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

“…These include the hips with intraoperative fractures and those radiographically defined as definitely loose. These findings agree with the results of Yim et al [45] who found femoral fracture and early subsidence in their series of 56 hips with femoral IBG did not necessarily lead to failure at an average of 39 months' followup. For the majority of stems in Series 2 and 3, cement-bone subsidence was less than 2 mm at 12 months and at up to a maximum of 8 years.…”

“…Although measures of total stem subsidence are routine, few studies have distinguished stem subsidence at the prosthesis-cement interface from that at the cement-bone interface so as to properly describe the pattern of subsidence after femoral IBG [8,10,14,25,45]. These studies suggest that stem subsidence within the cement mantle occurs in a predictable pattern and support the use of this technique.…”

Initial stability of circumferential meshes with impacted bone allografts for massive femoral defects

“…The use of impacted bone allograft technique in revision surgery on the femoral side has been reported with good to excellent results over the mid-and long-term [3,7,8,20,23,24]. A prerequisite for its use is containment of the grafts.…”

Medium-term Outcomes of Cemented Prostheses and Cementless Modular Prostheses in Revision Total Hip Arthroplasty

“…However, it was observed that a stable fixation can be difficult to achieve with cement especially in those patients who have poor femoral bone stock1. Some studies showed good clinical results during femoral revision when a cemented stem was used in conjugation with an impacted bone graft234. However, this technique was not widely used clinically because of a high intraoperative and postoperative femoral fracture rate, frequent postoperative subsidence, and prolonged operative time requirements45678.…”