title: A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery: a 12-year follow-up study.
abstract: We describe the results of 81 consecutive revision total hip replacements with impaction grafting in 79 patients using a collared polished chrome-cobalt stem, customised in length according to the extent of distal bone loss. Our hypothesis was that the features of this stem would reduce the rate of femoral fracture and subsidence of the stem. The mean follow-up was 12 years (8 to 15). No intra-operative fracture or significant subsidence occurred. Only one patient suffered a post-operative diaphyseal fracture, which was associated with a fall. All but one femur showed incorporation of the graft. No revision for aseptic loosening was recorded. The rate of survival of the femoral component at 12 years, using further femoral revision as the endpoint, was 100% (95% confidence interval (CI) 95.9 to 100), and at nine years using re-operation for any reason as the endpoint, was 94.6% (95% CI 92.0 to 97.2). These results suggest that a customised cemented polished stem individually adapted to the extent of bone loss and with a collar may reduce subsidence and the rate of fracture while maintaining the durability of the fixation.
authors.affiliation: Center for Osteoarthritis Surgery, Hôpital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, Marseille 13009, France. xavier.flecher@ap-hm.fr
authors.forename: X
authors.initials: X
authors.lastname: Flecher
authors.forename: G
authors.initials: G
authors.lastname: Blanc
authors.forename: B
authors.initials: B
authors.lastname: Sainsous
authors.forename: S
authors.initials: S
authors.lastname: Parratte
authors.forename: J N
authors.initials: JN
authors.lastname: Argenson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D016025:Bone Transplantation / Q000009:adverse effects* / Q000379:methods; D002484:Cementation; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000517:prevention & control; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation