title: Femoral revision surgery with impaction bone grafting: 31 hips followed prospectively for ten to 15 years.
abstract: The purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all, 21 hips (68%) had grade III or IV femoral defects according to the Endo-Klinik classification. A total of 11 patients (12 hips) died before the ten-year follow-up period. Of the remaining patients, 18 patients (19 hips) were followed for 10 to 15 years; three further patients died during this time. None of the 31 stems underwent further revision of their stem. However, four stems showed extensive subsidence (> 15 mm). One of these patients had a femoral fracture that required fixation. Three other patients had a femoral fracture, two of which required fixation and the other was treated conservatively. Patients with a femoral fracture and/or severe subsidence had significantly more grade IV defects (six of seven hips; p = 0.004). One patient needed a closed reduction for dislocation. Impaction allografting in revision hip surgery gives good long-term results for femora with grades I, II and III Endo-Klinik-classified defects. Extensive subsidence and femoral fractures were seen mainly in patients with grade IV damaged femora.
authors.affiliation: Martini Hospital Groningen, Orthopaedic Department, Van Swietenplein 1, Groningen 9728, The Netherlands. havetenb@mzh.nl
authors.forename: B L E F
authors.initials: BL
authors.lastname: Ten Have
authors.forename: R W
authors.initials: RW
authors.lastname: Brouwer
authors.forename: R W
authors.initials: RW
authors.lastname: Brouwer Md
authors.forename: F C
authors.initials: FC
authors.lastname: van Biezen
authors.forename: J A N
authors.initials: JA
authors.lastname: Verhaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000517:prevention & control; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods