title: Impaction bone grafting with proximal and distal femoral arthroplasty.
abstract: Capacious diaphyses and poor bone stock in revision arthroplasty can lead to fracture and poor component fixation. Impaction bone grafting can be performed in salvage reconstructions in cases with extensive circumferential bone loss. We present a consecutive series of patients who underwent proximal or distal femoral reconstructions in combination with impaction bone grafting. The average age was 62 years, and the mean follow-up was 36 months (range, 24-84). No revisions were performed for mechanical failure, and radiographs revealed no evidence of implant loosening. No patient complained of end-of-stem thigh pain. There were 3 failures: 1 for periprosthetic fracture, 1 for instability, and 1 for infection. Impaction bone grafting can be used in combination with proximal and distal femoral arthroplasty to successfully manage cases with extensive bone loss after failed hip and knee arthroplasty. The procedure reconstitutes necessary bone stock, improves stress shielding, and provides immediate fixation in capacious canals.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: Atul F
authors.initials: AF
authors.lastname: Kamath
authors.forename: Pramod B
authors.initials: PB
authors.lastname: Voleti
authors.forename: Tae Won B
authors.initials: TW
authors.lastname: Kim
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Garino
authors.forename: Gwo-Chin
authors.initials: GC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000295:instrumentation* / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001862:Bone Resorption / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D019736:Prostheses and Implants; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome