Survivorship Analysis of Eighty Revised Hip Arthroplasties With the Impaction Grafting Technique Using Whole Femoral Head Allografts With the Articular Cartilage.

BACKGROUND: Acetabular impaction bone grafting aims to restore anatomy in hip revision surgery. This is an effective but expensive and time-consuming technique. Usually, the articular cartilage is removed from the femoral head allograft. We aimed to reproduce the same results retaining the cartilage of the allograft. METHODS: Eighty acetabular revisions using impacted morselized bone graft retaining the articular cartilage and a cemented cup were studied retrospectively. Six were lost during follow-up. The mean follow-up was 6.5 years (range 1-13). Clinical and radiological assessment was made using the Oxford Hip Score, Hodgkinson's criteria for socket loosening, and the Gie classification for evaluation of allograft incorporation. RESULTS: Sixty-three sockets (85.1%) were considered radiologically stable (type 0, 1, and 2 demarcations), 8 (10.8%) were radiologically loose (type 3), and 3 (4.1%) presented with migration. Fifty-one (68.9%) cases showed good trabecular remodeling (grade 3), 20 (27%) showed trabecular incorporation (grade 2), and 3 (4.1%) showed poor allograft incorporation. Mean preoperative hip score was 43 and postoperative score was 28. Six (8.1%) cases presented heterotopic ossification around the revised implants, 2 patients (2.7%) had periprosthetic fractures, and 4 (5.4%) had dislocations. The Kaplan-Meier survivorship at a mean of 6.5 years with revision of the cup for any reason was 95.9% (95% confidence interval 5.6-7.5). CONCLUSION: The mid-term results of our technique are promising. Particularly when the supply of fresh-frozen allografts and surgical time is limited, using whole femoral head with articular cartilage is both safe and effective.

Comparison of femoral stem alignment in primary total hip replacement by transtrochanteric and posterior approach.

BACKGROUND: In this study we have compared the femoral component alignment in primary cemented THR performed by a single surgeon using the same implant by trochanteric osteotomy and posterior approach in 50 consecutive cases. MATERIAL AND METHODS: The femoral component was compared in sagital and coronal planes on plane X-rays. The femoral stem position was classified as neutral, varus or valgus in the sagital plane. In the coronal plane the femoral stem was graded as neutral, stem pointing anteriorly or stems pointing posteriorly. Chi square test was used for the statistical significance of the findings. RESULTS: The number of stems in neutral position in AP radiograph (coronal plane) was 36 and 42 respectively in osteotomy and posterior approach. 6 stems were in varus/valgus angle of ≥5° in osteotomy group and 1 stem in the posterior approach group had a varus/valgus angle of ≥5° (p value 0.05). In the lateral radiograph (sagital plane) 45 and 43 stems respectively in osteotomy and posterior approach were in neutral position (p value 0.37). CONCLUSIONS: There is no statistically significant difference in the positioning of the femoral stem in the sagital plane by either trochanteric osteotomy or posterior approach to the hip. The positioning of the femoral stem in the coronal plane is better with the posterior approach as compared to trochanteric osteotomy

Early results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacements.

INTRODUCTION: Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Some use cancellous graft alone whilst others morselise the whole femoral head after removal of articular cartilage. This paper asks, if it really necessary to use pure cancellous graft? PATIENTS AND METHODS: Forty-two acetabular revisions using impacted morselized bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow-up was 3 years (range, 2-5.6 years). Clinical and radiographic assessment was made using the Oxford hip score, Hodgkinson's criteria (1988) for socket loosening and the Gie classification (1993) for evaluation of allograft consolidation and remodelling. RESULTS: Forty (95%) sockets were considered radiologically stable (type 0, 1, 2 demarcations) and two (5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. Twenty-seven(64%) cases showed good trabecular remodelling (grade 3). Twelve (29%) cases showed trabecular incorporation (grade 2). Only three (7%) cases showed poor allograft incorporation (grade 1). Average pre-operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 3 years. CONCLUSIONS: Early radiological and clinical survival results with retaining articular cartilage of femoral head allografts are similar and comparable to other major studies for acetabular impaction bone grafting in revisions. Minimal loss of allograft mass is 40% in obtaining pure cancellous graft. When there is a limited supply and demand of allograft, saving up to 40% of the material is a valuable and cost-effective use of scarce resources.

False aneurysm of the superior lateral geniculate artery following Total Knee Replacement.

Arterial complications following Total Knee Replacement are uncommon. We present a case of false aneurysm of the superior lateral geniculate artery presenting in the immediate postoperative period with continued bleeding from the surgical wound. This is the first case of false aneurysm of this vessel described following Total Knee Replacement. A method of treatment is outlined. Early consultation with vascular surgery colleagues is recommended to prevent delayed diagnosis of serious vascular complications.