title: Cemented impaction grafting with moulded intramedullary mesh for femoral stem revision--long-term results.
abstract: To address femoral bone loss in revision total hip arthroplasty (THA) we developed a technique involving impaction allografting with intramedullary mesh moulded around the revision stem, to prevent excessive cement penetration of the allograft. The length of the revision stem was determined by the extent of femoral bone loss. Between 1986 and 1998, 32 such procedures were undertaken on 28 patients. The mean pre-operative HHS for function was 22 (range 5 to 42), improving to 41 (range 12 to 47) at final follow-up. Only 1 patient presented with aseptic loosening after revision at 147 months (12.2 years). The 12.5 year survivorship for the stem was 92.8%. The technique has provided stable and durable reconstruction, with good new bone formation visible radiologically. It is technically demanding and time consuming, but it avoids the previously published problem of massive subsidence within the bone graft.
authors.affiliation: Orthopaedic Department C, Roger Salengro Hospital, Lille, France. j_girard_lille@yahoo.fr
authors.forename: Julien
authors.initials: J
authors.lastname: Girard
authors.forename: Philippe
authors.initials: P
authors.lastname: Riera
authors.forename: Olivier
authors.initials: O
authors.lastname: Pearce
authors.forename: Antoine
authors.initials: A
authors.lastname: Duquennoy
authors.forename: Henri
authors.initials: H
authors.lastname: Migaud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D016025:Bone Transplantation; D002484:Cementation; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006304:Health Status; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods*; D012720:Severity of Illness Index; D014184:Transplantation, Homologous