title: Management of severe femoral bone defect in revision total hip arthroplasty--a 236 hip, 6-14-year follow-up study.
abstract: This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty. A total of 234 patients (involving 236 hips) with Paprosky III and IV femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug. 2006. Impaction bone graft technique was used for 112 hips, with allogeneic freeze-dried bone as bone graft and SPII as prosthesis. With 124 hips, modular distal press-fit fixation and tapered femoral stem (MP stem) were employed. After the operation, the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score (HHS) and 12-item Short Form Health Survey (SF-12). Radiolucence, subsidence and loosening were observed and complications, including infection, fracture, dislocation etc. were recorded. A 6-14-year follow-up showed that prostheses failed, due to infection, in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure, with the survival rates for the two techniques being 96.43% and 95.16%, respectively. One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications (P<0.05) and was not related to the type of the bone defects (P>0.05). The rate of complications bore significant association with the type of bone defects in the two groups (P<0.05). Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects. It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect. Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Guo-Qiang
authors.initials: GQ
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China. yanwang1961@yahoo.com.cn.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Ji-Ying
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Zhou
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Xiu-Tang
authors.initials: XT
authors.lastname: Cao
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chai
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Ni
authors.affiliation: Department of Orthopedics, General Hospital of People's Liberation Army, Beijing, 100853, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006615:Hip / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged
references.citation: J Bone Joint Surg Br. 1993 Jan;75(1):14-21
references.pmid: 8421012
references.citation: J Arthroplasty. 2003 Apr;18(3 Suppl 1):94-7
references.pmid: 12730939
references.citation: J Bone Joint Surg Br. 2004 May;86(4):504-9
references.pmid: 15174543
references.citation: J Bone Joint Surg Am. 2001 Jul;83(7):1023-31
references.pmid: 11451971
references.citation: J Bone Joint Surg Am. 2007 Apr;89(4):780-5
references.pmid: 17403800
references.citation: Sichuan Da Xue Xue Bao Yi Xue Ban. 2010 Nov;41(6):1044-6
references.pmid: 21265112
references.citation: J Arthroplasty. 2007 Oct;22(7):993-9
references.pmid: 17920471
references.citation: J Arthroplasty. 2009 Aug;24(5):751-8
references.pmid: 18977637
references.citation: J Bone Joint Surg Br. 2008 Aug;90(8):1000-4
references.pmid: 18669953
references.citation: Clin Orthop Relat Res. 2005 Mar;(432):181-7
references.pmid: 15738820
references.citation: Zhonghua Wai Ke Za Zhi. 2012 May;50(5):385-8
references.pmid: 22883940
references.citation: J Arthroplasty. 2008 Oct;23(7):964-70
references.pmid: 18534480
references.citation: Zhonghua Wai Ke Za Zhi. 2005 Oct 15;43(20):1309-12
references.pmid: 16271241
references.citation: J Arthroplasty. 2011 Jan;26(1):16-23
references.pmid: 20149579
references.citation: J Bone Joint Surg Am. 2005 Nov;87(11):2499-507
references.pmid: 16264127
references.citation: Clin Orthop Relat Res. 2003 Mar;(408):302-10
references.pmid: 12616075
references.citation: J Bone Joint Surg Br. 2009 Apr;91(4):441-6
references.pmid: 19336801
references.citation: J Arthroplasty. 2010 Apr;25(3):348-54
references.pmid: 19232890
references.citation: J Arthroplasty. 2008 Feb;23(2):220-5
references.pmid: 18280416
references.citation: J Am Acad Orthop Surg. 2006 Oct;14(11):620-8
references.pmid: 17030595
references.citation: Clin Orthop Relat Res. 2002 Mar;(396):131-41
references.pmid: 11859236
references.citation: J Arthroplasty. 2006 Apr;21(3):372-80
references.pmid: 16627145
references.citation: J Bone Joint Surg Br. 2003 Aug;85(6):809-17
references.pmid: 12931796
references.citation: J Bone Joint Surg Br. 1999 Jan;81(1):118-24
references.pmid: 10068018