Proximal femoral allograft-prosthesis composites in revision hip replacement

Park

Clinical Orthopaedics &Amp; Related Research

et al. 2015

Background Numerous studies have investigated the clinical and radiographic results of revision THAs with use of cementless stems and cortical strut allografts. However, to our knowledge, no long-term followup studies have evaluated patients undergoing revision THA with use of cortical strut allografts where the allografts provided the primary stability for extensively coated femoral stems in the presence of extensive femoral diaphyseal bone defects. Question/purposes We performed this study to determine (1) validated outcomes scores; (2) radiographic signs of fixation and allograft healing; (3) frequency of complications; and (4) survivorship of the components after use of cortical strut onlay allografts in Types IIIB and IV femoral diaphyseal bone defects.Methods Between 1994 and 2003, we performed 140 revision THAs in 130 patients with Paprosky Types IIIB and IV femoral diaphyseal defects. The patients were treated using extensively coated femoral stems and cortical strut allografts because primary axial or rotational stability could not be achieved without grafting. Ten of the patients (10 hips; 7.7%) were lost to followup or died before 10 years; the remaining 120 patients (130 hips) represent the study group in this retrospective study. There were 66 men and 54 women. Their mean age at the time of index surgery was 59 ± 18 years (range, 36-67 years). The primary diagnosis was predominantly osteonecrosis of the femoral head (53%). The most common reason for revision was aseptic loosening (97%), followed by periprosthetic fracture (3%). The mean time from primary to revision THA was 12 years (range, 8-27 years). The mean duration of followup was 16.1 years (range, 12-20 years). Results The mean Harris hip score was 39 ± 10 points before revision and improved to 86 ± 14 points at 16 years followup (p = 0.02). The mean preoperative WOMAC score was 62 ± 29 (41-91) points and improved to 22 ± 19 (11-51) points at 16 years followup (p = 0.003). Of the 130 stems, 113 (87%) had bone ingrowth, five (4%) had stable fibrous ingrowth, and 12 (9%) were unstable. All allografts were incorporated. Four hips (3%) had a displaced femoral shaft fracture at the stem tip; four (3%) had a postoperative dislocation; and six (5%) had early postoperative infection. Kaplan-Meier survivorship analysis, with revision or radiographic failure as the endpoint, revealed that the 16-year rate of survival of the components was 91% (95% CI, 0.88%-0.96%).

Section: Discussioncontrasting

confidence: 58%

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Park

Clinical Orthopaedics &Amp; Related Research

et al. 2015

“…These values were already expected, as it is a consensus in international literature that the prognosis is closely related to disease progression. 10 compared the use of arthrodesis technique to non-reconstruction of the pelvic ring and found better results in favor of arthrodesis. However, Hillmann et al 11 found 37% of poor results in reconstructions with endoprostheses and amputations against 79% of good results when reconstruction was not performed.…”

Section: Resultsmentioning

confidence: 99%

Hemipelvectomias: tratamento, avaliação funcional e prognóstica dos tumores pélvicos

Penna¹,

Toller²,

Pinheiro

et al. 2011

Acta ortop. bras.

Objective: To describe the experience of one single institution in internal hemipelvectomies without reconstruction and external hemipelvectomies. Methods: Twenty-one patients with primary tumors of the pelvic region underwent total hemipelvectomy, at Barretos Cancer Hospital, São Paulo, Brazil, between 2004 and July 2009. Of these, seven were treated with external hemipelvectomy (classic) and 14 with internal hemipelvectomy. Evaluation was done based on Enneking's surgical classification for internal hemipelvectomy. Results: Overall survival in two years was 63.9%. Median survival of 43 months. Functional outcomes demonstrated that procedures with innominate bone resection reached 12.5%, 62.5% and 25% of bad, good and excellent results, respectively. When innominate bone was preserved the results were 16.7% and 83.3% good and excellent, respectively. No endoprosthesis or bone graft reconstructions were done. Conclusions: Hemipelvectomy is an unusual procedure that is rarely performed because it is infrequently indicated and because of its high morbidity rate. In some reports, the morbidity rate has reached 77% of the cases. We did not perform any type of reconstruction or arthrodesis based on complications and the experience of good results with this method. Our results are similar to the main reports and are still subject of discussion by the oncologic surgeons. Level of evidence IV, Case-control study.

“…These cases may be associated with major bone defects as a consequence of previous surgery and/or extensive age and/or disease-related degeneration [2,3]. Specialised endoprosthetic components can be used to treat many types of defects.…”

Section: Introductionmentioning

confidence: 99%

“…Such a collaboration is also required to deliver the high level of inter-component precision that is a prerequisite for a successful outcome. Matching the allograft to the bone is described as one of the problems associated with the use structural macro-allografts [3]. This can be solved by custom provement of bone stock is necessary for likely revisions [22].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

CT Lesion Model-Based Structural Allografts: Custom Fabrication and Clinical Experience

Brune

Hesselbarth²,

Seifert³

et al. 2012

Transfus Med Hemother

Background: Patients requiring knee and hip revision arthroplasty often present with difficult anatomical situations that limit options for surgery. Customised mega-implants may be one of few remaining treatment options. However, extensive damage to residual bone stock may also be present, and in such cases even customised prosthetics may be difficult to implant. Small quantities of lost bone can be replaced with standard allografts or autologous bone. Larger defects may require structural macro-allografts, sometimes in combination with implants (allograft-prosthesis composites). Methods: Herein, we describe a process for manufacturing lesionspecific large structural allografts according to a 3D, fullscale, lithographically generated defect model. These macroallografts deliver the volume and the mechanical stability necessary for certain complex revisions. They are patient- and implant-matched, negate some requirements for additional implants and biomaterials and save time in the operating theatre by eliminating the requirement for intra-operative sizing and shaping of standard allografts. Conclusion: While a robust data set from long-term follow-up of patients receiving customised macro-allografts is not yet available, initial clinical experience and results suggest that lesion-matched macro-allografts can be an important component of revision joint surgery.