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

Garvin, Kevin L.; Konigsberg, Beau S.; Ommen, N. Dawn; Lyden, Elizabeth

doi:10.1007/s11999-013-2954-2

Cited by 17 publications

(6 citation statements)

References 22 publications

(39 reference statements)

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“…[1][2][3][4][5][6] there are studies that have focused on long-term outcomes of femoral revision ibG. [6][7][8][9][10][11][12][13] however, we have now updated the experience to 2021 with this technique based on 30 years of using the instrumented X-change system. in 2015, we published our data based on 208 consecutive stem revisions that had all been treated with femoral ibG and a cemented exeter stem using the X-change system.…”

Section: Discussionmentioning

confidence: 99%

Thirty years of experience with instrumented femoral impaction bone grafting and a cemented polished Exeter stem

Özdemir

Kuijpers

Visser

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique. Methods We updated the outcomes of our previous study, based on 208 consecutive revisions using IBG and the X-change femoral revision system in combination with a cemented polished stem, performed in our tertiary care institute between 1991 and 2007. Kaplan-Meier survival analyses were used to determine the survival rate of the revisions with endpoint revision for any reason and aseptic loosening. Secondary outcomes were radiological loosening and patient-reported outcome measures. Results Mean age at revision total hip arthroplasty (THA) was 64.9 years (30 to 86). The most prevalent diagnosis for the femoral revision was aseptic loosening. At review in May 2021, 81 patients (85 hips) were still alive and 118 patients (120 hips; 58%) had died. Three patients (3 hips; 1%) were lost to follow-up at 11, 15, and 16 years after surgery, respectively. Data of all deceased and lost patients were included until final follow-up. The mean follow-up was 13.4 years (0 to 28). During the follow-up, 22 re-revisions were performed. The most common reason for re-revision was infection (n = 12; 54%). The survival with endpoint re-revision for any reason was 86% (95% confidence interval (CI) 79 to 91) at 20 years and 74% (95% CI 43 to 89) at 25 years after surgery. The survival for endpoint re-revision for aseptic loosening was 97% (95% CI 91 to 99) after both 20 and 25 years. Conclusion We conclude that femoral IBG is a valuable technique that can reconstitute femoral bone loss in the long term. After 25 years of follow-up, few re-revisions for aseptic loosening were required. Also, the overall revision rate is very acceptable at a long follow-up. This technique is especially attractive for younger patients facing femoral revisions with extensive bone loss. Cite this article: Bone Joint J 2022;104-B(9):1039–1046.

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Section: Discussionmentioning

confidence: 99%

Thirty years of experience with instrumented femoral impaction bone grafting and a cemented polished Exeter stem

Özdemir

Kuijpers

Visser

et al. 2022

The Bone & Joint Journal

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“… 2012 , Garvin et al. 2013 ) (Table 3, see Supplementary data). Excellent survival rates have been reported with re-revision for aseptic loosening as the end point, generally with a survival of greater than 98%.…”

Section: Methodsmentioning

confidence: 99%

Medium-term follow-up of 92 femoral component revisions using a third-generation cementing technique

et al. 2015

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Background and purpose — Very little has been published on the outcome of femoral cemented revisions using a third-generation cementing technique. We report the medium-term outcome of a consecutive series of patients treated in this way.Patients and methods — This study included 92 consecutive cemented femoral revisions performed in our department with a third-generation cementing technique and without instrumented bone impaction grafting between 1996 and 2007. The average age of the patients at revision was 66 (25–92) years. None of the patients were lost to follow-up. At review in December 2013, 55 patients were still alive and had a non-re-revised femoral revision component in situ after a mean follow-up of 11 (5–17) years.Results — The mean preoperative Harris hip score was 50, and improved to 73 at final follow-up. 2 patients died shortly after the revision surgery. 1 stem was re-revised for aseptic loosening; this was also the only case with radiolucent lines in all 7 Gruen zones. A femoral reoperation was performed in 19 hips during follow-up, and in 14 of these 19 reoperations the femoral component was re-revised. Survivorship at 10 years, with femoral re-revision for any reason as the endpoint, was 86% (95% CI: 77–92). However, excluding 8 patients with reinfections after septic index revisions and 1 with hematogenous spread of infection from the survival analysis, the adjusted survival for re-revision for any reason at 10 years was 92% (95% CI: 83–96). With re-revision for aseptic loosening as endpoint, the survival at 10 years was 99% (CI: 90–100).Interpretation — Femoral component revision with a third-generation cemented stem results in acceptable survival after medium-term follow-up. We recommend the use of this technique in femoral revisions with limited loss of bone stock.

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“…It was first described for the acetabulum in 1984 by Slooff et al [ 31 ] and subsequently, for the femur, in 1993, by Gie et al [ 14 ]. Satisfying results have been reported from several centers with up to 25 years of followup on the acetabular side [ 5 , 9 , 15 , 29 ] and up to 20 years on the femoral side [ 13 , 21 , 26 , 32 , 34 ]. In our opinion, the IBG technique may be a valuable treatment option in revision THA in patients younger than 55 years.…”

Section: Introductionmentioning

confidence: 99%

Satisfying Outcomes Scores and Survivorship Achieved With Impaction Grafting for Revision THA in Young Patients

Stroet

Gardeniers

Kampen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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BackgroundThe increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.Questions/purposesThe purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.MethodsDuring the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.ResultsThe mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%–95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%–100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.ConclusionsIBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.Level of EvidenceLevel IV, therapeutic study.

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

Cited by 17 publications

References 22 publications

Thirty years of experience with instrumented femoral impaction bone grafting and a cemented polished Exeter stem

Thirty years of experience with instrumented femoral impaction bone grafting and a cemented polished Exeter stem

Medium-term follow-up of 92 femoral component revisions using a third-generation cementing technique

Satisfying Outcomes Scores and Survivorship Achieved With Impaction Grafting for Revision THA in Young Patients

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