Massive early subsidence following femoral impaction grafting

Influence of water and fat content on compressive stiffness properties of impacted morsellized bone: An experimental ex vivo study on bone pellets

“…Cemented prostheses, surrounded by an envelope of impacted morsellized bone, are widely used in revision hip surgery (Gie et al 1993, Welten et al 2000, Schreurs et al 2003. Early axial subsidence and torsion may disturb the geometry of the implant system and hence reduce the durability of the revised prosthesis (Franzén et al 1995, Eldridge et al 1997, Brodt et al 1998, Ornstein et al 2002. Various factors influence the mechanical stability of impacted bone: particle size and grading (Brewster et al 1999, Ullmark 2000, moisture (Voor et al 2000, Dunlop et al 2003, addition of bone substitutes (Verdonschot et al 2001), and impaction energy (Ullmark 2000, Fosse et al 2004.…”

Bone substitution in revision hip replacement

“…This mechanical failure was related to poor graft packing, associated with the trochanteric non-union. These results compare favourably with the rates of aseptic loosening reported with the femoral reconstruction with impacted cancellous allograft, ranging from 0 to 10% [7,11,17,19]. Extensive bone defect remains a high-risk situation for intra-operative fracture [19,27].…”

“…Rates of subsidence vary from almost 0 to 90% in reports of femoral reconstruction with impacted morcellised allograft in the literature [7,9,11,19]. Gie et al [11] recorded subsidence of the stem within the cement mantle from 3 to 10 mm in 22 cases of 56 revisions.…”

“…However, the initial stability of the stem-graft composite is still far from optimal. Subsidence of the stem has been commonly reported [7,9,11,15,25,27]. Among various variables, intrinsic allograft properties (particle morphology and size, composition, quality and preparation) have been shown to influence the initial stability of the composite [1,6].…”

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

“…The treatment has been described using extensively coated femoral stems [3,13,26], modular stems with distal tapers [10,12,14,15,17,19,22], and impaction bone grafting with cemented polished stems [4,7,16,21,23,25,27]. Femoral impaction grafting, first reported by Gie et al in 1993 [5], has the advantage of adding bone to the deficient femur, but it is a time-consuming procedure with reported risks of fracture ranging from 5% to 12% [1,5,7,9].…”