Preliminary report of impaction grafting for exchange femoral arthroplasty.
Gie and Ling have described a method for femoral component revision using compressed morselized cancellous allograft and a cemented collarless polished taper stem. The authors report their early experience with this technique. Of the first 67 patients who had femoral exchange by impaction grafting, 60 were alive 2 to 5 years after hip revision; 2 hips failed because of late sepsis, and 5 patients were decreased. In 56 individuals available for review, the Harris Hip Score average was 90 points, with > 80% reporting no pain. On radiograph, 48% of the stems showed an average of 2.8 mm of subsidence in the polymethylmethacrylate mantle, but only 7% of the cement graft composites had subsided in the cortical tube. Lucent lines were rare, and in 93% of revised femurs the radiographs showed evidence of graft incorporation and bone remodeling. There were 6 reoperations in the group: 3 for late fracture of the femoral shaft and 3 for cup exchange (2 chronically dislocating, 1 loose). No evidence for femoral component loosening was found in this group. Further study is necessary, but these preliminary findings give rise to cautious optimism that this is a reliable method for femoral revision, reconstruction, and reconstitution.
Elting
J J
JJ
Otsego Orthopaedics, PC, Oneonta, New York 13820, USA.
Mikhail
W E
WE
Zicat
B A
BA
Hubbell
J C
JC
Lane
L E
LE
House
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016723:Bone Remodeling; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D014184:Transplantation, Homologous