title: Early complications after one hundred and forty-four consecutive hip revisions with impacted morselized allograft bone and cement.
abstract: BACKGROUND
  The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce.
  
  
  METHODS
  All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation.
  
  
  RESULTS
  Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eight involved the greater trochanter. Of the postoperative femoral fractures, one was proximal and nine were diaphyseal. Other intraoperative complications were the creation of a femoral cortical window in seven hips and incidental perforation of the femoral cortex in fourteen. Multivariate analysis showed the risk factors for femoral fracture during or after revision to be concomitant disease, greater deficiency of the femoral bone stock, and an intraoperative femoral window or perforation. Other complications included dislocation of the femoral head in nine hips, deep infection in one hip, persistence of preoperative deep infection in one hip, and superficial wound infection requiring wound débridement in two hips.
  
  
  CONCLUSIONS
  We found the complication rate to be high after hip revision arthroplasty performed with impacted morselized allograft bone and cement. The most serious complication was postoperative diaphyseal femoral fracture.
authors.affiliation: Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden. ewald.ornstein@skane.se
authors.forename: Ewald
authors.initials: E
authors.lastname: Ornstein
authors.forename: Isam
authors.initials: I
authors.lastname: Atroshi
authors.forename: Herbert
authors.initials: H
authors.lastname: Franzén
authors.forename: Ragnar
authors.initials: R
authors.lastname: Johnsson
authors.forename: Per
authors.initials: P
authors.lastname: Sandquist
authors.forename: Martin
authors.initials: M
authors.lastname: Sundberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D016025:Bone Transplantation; D005260:Female; D005264:Femoral Fractures / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D014184:Transplantation, Homologous
chemical_list: D001843:Bone Cements