Revision Arthroplasty for the Aseptic Loosening after Semiconstrained Total Elbow Replacement: Midterm Results / 대한정형외과학회잡지

PURPOSE: To analyze the clinical results of revision arthroplasty for aseptic loosening after performing semiconstrained total elbow replacement. MATERIALS AND METHODS: We retrospectively analyzed fifteen patients that had undergone aseptic loosening after semiconstrained total elbow replacement who also had revision arthroplasty. There were 4 men and 11 women, with a mean age of 57 years. The average duration of follow-up was 54 months. The primary causes of arthroplasty were posttraumatic arthrosis (five cases), rheumatoid arthritis (four cases), primary osteoarthritis (four cases), ankylosis (one case) and Charcot joint (one case). For eleven (73%) elbows, the cementing technique was considered marginal or inadequate at the time of primary arthroplasty. An impaction bone graft was used in seven patients at revision, a strut allograft was used in four patients and cement alone was used in four patients. RESULTS: The average preoperative Mayo elbow performance score was 56.6 points; the average postoperative score was 84.5 points. At the latest follow-up, according to the Mayo elbow performance index, six patient elbows showed an excellent result, six patient elbows showed a good result, one patient elbow had a fair result and two patient elbows showed a poor result. Aseptic loosening occurred in three of four elbows that had been revised with cement only. CONCLUSION: Revision arthroplasty for aseptic loosening after semiconstrained total elbow replacement was useful for the relief of pain, maintenance of stability and the activities of daily living. A poor cementing technique and an inadequate selection of implant may be associated with loosening as a main risk factor. Revision using an impaction graft or strut allograft can be a reliable technique for treating a failed total elbow arthroplasty with massive bone loss.

Revision Total Hip Arthroplasty using Allogenic Impaction Bone Grafts and Cemented Cup in Acetabular Bone Deficiency: Minimum Seven Years Clinical and Radiological Analysis

PURPOSE: This study examined the minimum seven years clinical and radiological results of revision total hip arthroplasty using an allogenic impaction bone graft and a cemented cup in an acetabular bone deficiency. MATERIALS AND METHODS: Fifty two revision total hip arthroplasty procedures performed on forty nine patients between March 1992 and June 1998 and followed for more than minimum seven years were examined. The clinical and radiological results were evaluated by Harris hip score and roentgenography including anterior-posterior view of pelvis and lateral view of operated hip. RESULTS: The mean Harris hip score was 47 points preoperatively, 81 points at three years after revision, and 84 points at seven years. The radiological evaluation revealed osseous union that trabeculated between grafted bone and host bone within four months in 47 hips, a complete grafted bone-cement radiolucent line of two millimeters or more in at least one zone in 5 hips at two years and in 7 hips at the seven year follow-up. CONCLUSION: We recommend the technique using an allogenic impaction bone graft and cemented cup to reconstruct an acetabular cavitary defect in revision total hip arthroplasty.

Impaction bone grafting in THA revision with freeze-dried allograft and anatomic cemented femoral stem / 中国矫形外科杂志

[Objective]To explore the efficacy and result of femoral component revision by using impaction bone grafting technique with anatomic cemented stem and freeze-dried allograft.[Method]Anatomic cemented stem combined with freeze-dried allograft were used in IBG for 49 cases of femoral revisions from Jan,2001 to Dec 2005.36 cases(73%)of which had severe bone loss(Paprosky grades ⅢB and Ⅳ).The mean follow-up time was 35.3 months(26~52 months).Harris Hip Score System and radiography were used to evaluate the clinical results.[Result]The mean Harris Hip Score was improved from 44.6 points preoperatively to 88.3 points at final evaluation.Good and excellent scores were about 89.8%.No major femoral stem subsidence was found in our patients.There were one case of dislocation(2%),one case of deep infection(2%)and 3 cases of femoral fractures during operations(6.1%),which were not related to the selection of femoral component and the type of allograft.[Conclusion]The impaction bone grafting technique by using freeze-dried allograft and the anatomic cemented femoral prosthesis for femoral revision was feasible and the short and mid-term result was good.Longer follow-up was needed to evaluate the long term result.