title: Femoral impaction bone allografting with an Exeter cemented collarless, polished, tapered stem in revision hip replacement: a mean follow-up of 10.5 years.
abstract: Femoral impaction bone allografting has been developed as a means of restoring bone stock in revision total hip replacement. We report the results of 75 consecutive patients (75 hips) with a mean age of 68 years (35 to 87) who underwent impaction grafting using the Exeter collarless, polished, tapered femoral stem between 1992 and 1998. The mean follow-up period was 10.5 years (6.3 to 14.1). The median pre-operative bone defect score was 3 (interquartile range (IQR) 2 to 3) using the Endo-Klinik classification. The median subsidence at one year post-operatively was 2 mm (IQR 1 to 3). At the final review the median Harris hip score was 80.6 (IQR 67.6 to 88.9) and the median subsidence 2 mm (IQR 1 to 4). Incorporation of the allograft into trabecular bone and secondary remodelling were noted radiologically at the final follow-up in 87% (393 of 452 zones) and 40% (181 of 452 zones), respectively. Subsidence of the Exeter stem correlated with the pre-operative Endo-Klinik bone loss score (p = 0.037). The degree of subsidence at one year had a strong association with long-term subsidence (p < 0.001). There was a significant correlation between previous revision surgery and a poor Harris Hip score (p = 0.028), and those who had undergone previous revision surgery for infection had a higher risk of complications (p = 0.048). Survivorship at 10.5 years with any further femoral operation as the end-point was 92% (95% confidence interval 82 to 97).
authors.affiliation: Department of Orthopaedics, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK. pjwraighte@yahoo.co.uk
authors.forename: P J
authors.initials: PJ
authors.lastname: Wraighte
authors.forename: P W
authors.initials: PW
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements / Q000592:standards*; D016025:Bone Transplantation; D002484:Cementation / Q000379:methods* / Q000592:standards; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation / Q000379:methods; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements