Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function.
Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a trochanteric claw plate. Between 1988 and 2001, 44 revisions were performed in 42 patients. After a transtrochanteric approach, the femur was cut longitudinally. A long, cemented Charnley-type prosthesis was used, and flaps of the residual femur were folded around the allograft. The greater trochanter was reinserted with wires in all revisions, and with both wires and a claw plate in 20 revisions. Mean follow-up was 7.15 years (range: 3-16); seven patients, died and four were lost to follow-up. The follow-up exceeded five years in 34 patients. The major complication was nonunion of the greater trochanter, which occurred in 25 cases. Six dislocations, one recurrence of infection, two mechanical loosening, and two fractures below the stem were also recorded. The use of a trochanteric claw plate significantly improved final hip stability, even in patients with nonunion. Femoral reconstruction with a massive structural allograft is reliable and long-lived, and serious complications and long-term resorption are uncommon. The use of a trochanteric claw plate significantly improves final hip stability.


METHODS
Therapeutic study, level III (retrospective comparative study).
Vastel
Laurent
L
Department of Orthopedic Surgery, Hôpital Cochin, AP-HP, Paris V University, 27 rue du Faubourg St Jacques, 75014, Paris, France. laurent.vastel@cch.ap-hop-paris.fr
Lemoine
Camille Thevenin
CT
Kerboull
Marcel
M
Courpied
Jean Pierre
JP
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D001860:Bone Plates; D001862:Bone Resorption / Q000209:etiology; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000502:physiology* / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007593:Joint Instability; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D001843:Bone Cements