Preliminary Report of Impaction Grafting for Exchange Femoral Arthroplasty

Elting, James J.; Mikhail, W. E. M.; Zicat, B.; Hubbell, J. C.; Lane, L. E.; House, B.

doi:10.1097/00003086-199510000-00016

Cited by 69 publications

(78 citation statements)

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“…Most of the reports on this technique that include a section on complications have been highlighted; the prevalence has ranged from 5 to 24% [4,9,11,15,16,20,24]. In our study, intraoperative proximal fractures occurred in two hips during the removal of cement prior to impaction bone grafting, while intraoperative proximal fracture happened in three hips during impaction.…”

Section: Discussionmentioning

confidence: 59%

“…The advocates of this stem design in revision with impacted allograft have suggested that the design permits gradual subsidence of the implant within the cement mantle because of plastic deformation of the cement and even viscoelastic deformation of the graft [10]. This leads to a self-tightening that allows restabilisation within the cement [4,9] and provides a beneficial compressive load to the allograft [19]. However, other authors question whether subsidence of a polished stem can be beneficial or if relatively high subsidence of a stem can lead to clinical failures [3,15,16].…”

Section: Discussionmentioning

confidence: 99%

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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

Yim

Kim

Suh

2006

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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

Yim

Kim

Suh

2006

International Orthopaedics (SICOT)

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“…Initial use of impaction bone grafting for hip arthroplasty was to restore acetabular integrity in both primary and [2]. An important part of this procedure is the use of a collarless, polished, tapered stem, femoral prosthesis forged with cobalt chrome alloy.…”

Section: Discussionmentioning

confidence: 99%

Impaction bone grafting for total hip revision

Gore¹

2002

International Orthopaedics

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We used impaction bone grafting for total hip revision on 26 hips in 25 patients. Average patient age was 68 (34-89) years, and average duration from last surgery was 9 years. In all cases morselized allograft bone was used for the graft, and the femoral component was a collarless, polished, tapered stem. Average duration of surgery was 2.4 h, intraoperative blood loss 600 cc, blood replacement 2.4 units, and acute-care hospital stay 5 days. Complications were varus placement of the stem in two patients and postoperative development of varus in one, one intraoperative and three postoperative femoral fractures, and one postoperative dislocation. Average subsidence was 0.6 cm. We believe that most, if not all, of these complications could have been prevented.Résumé Nous avons utilisé greffe à frottement dur pour reprise d'arthroplastie de la hanche totale sur 26 hanches dans 25 malades. L'âge moyen était 68 années, et durée de dernière chirurgie 9 années. L'os allologue morselisee a été utilisé pour la greffe et le composant fémoral était une tige polie conique sans collerette. La durée moyenne de la chirurgie était 2.4 heures; perte du sang intraopéra-toire, 600 cc,; remplacement du sang, 2.4 unités et le séjour d'hôpital de soin aigu cinq jours. Les complications étaient placement de la tige en varus dans deux malades et développement postopératoire de varus en un. Il y avait une fracture intraopératoire et trois fractures fémorales postopératoires. Il y avait un déboîtement postopératoire. La subsidence moyenne était 0.6 centimètres. Nous croyons que plus, si pas tout, de ces complications avaient pu être prévenu. IntroductionOur interest in impaction bone grafting was stimulated by the presentation of a 34-year-old woman who received a cementless total hip replacement 7 years previously for avascular necrosis caused by high doses of immunosuppressive drugs that were required for a kidney transplant. She had done well for 6 years when she began having pain. Her roentgenograms showed good distal fixation of the femoral stem but extensive proximal bone loss (Fig. 1). We did not believe this problem could be satisfactorily managed with a standard cemented or noncemented revision prosthesis. Therefore, impaction bone grafting, along with a collarless, polished, tapered stem Presented at the SICOT/SIROT conference,

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“…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.…”

Section: Introductionmentioning

confidence: 93%

“…However, stem subsidence of greater than 5 mm and up to 31 mm [9,15,18,24,25,33,41,42] and postoperative femoral fracture with a prevalence of up to 15% [6,10,12,25,29] have been reported for femoral IBG in rTHA.…”

Section: Introductionmentioning

confidence: 99%

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

Howie

Callary

McGee

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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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

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Preliminary Report of Impaction Grafting for Exchange Femoral Arthroplasty

Cited by 69 publications

References 0 publications

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

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

Impaction bone grafting for total hip revision

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

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