The use of long cemented stems for femoral impaction grafting in revision total hip arthroplasty.
BACKGROUND
Following revision total hip arthroplasty involving femoral impaction grafting, fractures usually have occurred distal to a standard-length stem in an area of weakened bone that was left inadequately supported. The purpose of the present study was to determine whether the use of a long stem decreases the rate of femoral fracture after revision hip surgery. We hypothesized that the use of a long-stem femoral component would decrease the risk of these fractures.


METHODS
From 1991 to 2000, 567 revision total hip arthroplasties were performed with use of femoral impaction grafting. Of these, forty-two procedures in forty patients (average age, 73.8 years) were performed with use of a stem that was > or = 220 mm in length. The average number of previous revisions was 1.85. Thirty-four of the forty hips with preoperative radiographs had preoperative bone loss that was classified as grade III or IV according to the Endo-Klinik system. Major complications were recorded, and survival analysis was performed.


RESULTS
No patient was lost to follow-up. Sixteen patients (sixteen hips) died at an average of fifty-two months postoperatively. The average duration of clinical follow-up for the hips in which the implant survived for more than forty-eight months was 7.5 years. The rate of major postoperative complications was 29%. Two postoperative femoral fractures occurred. Six patients (six hips) required a femoral reoperation. The survival rate with revision hip surgery as the end point was 90% at both five and ten years. The rate of survival with any failure as the end point was 82% at five years and 64% at ten years.


CONCLUSIONS
The use of a long stem for femoral impaction grafting did not completely resolve the problem of postoperative fractures in these patients with substantial loss of bone stock undergoing revision hip surgery. Poor bone stock, technical errors, and other patient-related factors continue to account for the high postoperative fracture rate.
Department of Orthopedic Surgery, Mayo Clinic, Mayo Clinic College of Medicine, 200 First Street S.W., North 14, Rochester, MN 55905, USA. sierra.rafael@mayo.edu
Rafael J
RJ
Sierra
John
J
Charity
Eleftherios
E
Tsiridis
John A
JA
Timperley
Graham A
GA
Gie
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D001843:Bone Cements