title: Revision of the femoral prosthesis with impaction allografting and a Charnley stem. A 2- to 12-year follow-up.
abstract: Impacted morcellised bone allograft and a Charnley stem was used to revise 59 loose femoral components in 57 consecutive patients. Femoral bone loss was rated as Endo-Klinik grade 2 in nine patients, grade 3 in 41, and grade 4 in nine. The immediate postoperative radiographs and those taken at the most recent follow-up were compared for radiolucencies, subsidence and incorporation of the graft. One patient was lost to follow-up and two were not available for radiological analysis. The mean clinical follow-up in 58 procedures was 56.7 months (24 to 144) and the mean radiological review of 56 reconstructions was 54.4 months (24 to 144). An intraoperative femoral fracture occurred in one patient (1.7%) and was successfully treated by strut grafting and cerclage wiring. Extrusion of cement through perforations or incomplete hoop fractures was detected in the postoperative radiographs of ten procedures (17%); none of these patients sustained a complete fracture. Three patients had dislocations (5%) and two (3.5%) developed painful subsidence of the stem which required a further revision. The latest follow-up radiographs in 56 reconstructions showed a well fixed stem and radiological healing of the graft in 52 (93%), and definite loosening in four (7%). Of these four, two were revised again and two were asymptomatic after a follow-up of 120 months each. The mean subsidence in the 52 successful revisions was 0.38 mm (0 to 4). Impaction allografting with a Charnley stem restored bone stock and provided adequate fixation of the stem in 93% of the hips. There was a low rate of rerevision (3.5%) and a low incidence of intraoperative and postoperative complications.
authors.affiliation: Institute of Orthopaedics Carlos E Ottolenghi, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: F
authors.initials: F
authors.lastname: Piccaluga
authors.forename: A
authors.initials: A
authors.lastname: González Della Valle
authors.forename: J C
authors.initials: JC
authors.lastname: Encinas Fernández
authors.forename: R
authors.initials: R
authors.lastname: Pusso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors