Reconstruction of the deficient femur by impaction - grafting in revision hip arthroplasty Apreliminary report of twenty patients

ABSTRACT

Impaction bone-grafting was performed using compressed morselized cancellous allograft and a cemented collarless polished double tapered Exeter stem in twenty revision total hip arthroplasties that were done because of aseptic loosening. The average follow-up duration was 26 months [range 13 to 30 months]. The average age at the time of the revision was 58.4 years [range 38 to 72 years]. There were 15 men and 5 women. The operation was the initial revision in 19 patients [95%] and re-revision in one patient [5%]. The postoperative Harris hip score was 89 points [range 60-96 points] and 75% of the patients were pain-free. On radiograph, subsidence was common [12 patients, 60%] and averaged 2.5mm [range 1- 6mm], however, although the study group was relatively small, the overall score may not accurately reflect the rate or amount of subsidence. On the other hand, migration of the cement mantle within the allograft reconstruction was evident in two patients only [10%], non-progressive with an average sunk of 1.5mm. Lucent lines were rare, and in 90% of the revisions the radiographs showed evidence of graft incorporation and bone remodeling. Intra-operative complications included two patients [10%] with fracture of the femur during impaction and were managed by insertion of circlage wires. Early complications included one case [5%] of superficial wound infection, DVT, and heterotopic ossification. Late complications included one case [5%] of graft resorption with no evident incorporation after one year. Further study is necessary, but these preliminary findings are encouraging and we believe that this is a reliable method for femoral revision, reconstruction, and reconstitution