Femoral revision with impaction bone grafting and a cemented polished tapered stem.
OBJECTIVE
Biological repair of femoral bone loss using bone impaction grafting. Reconstruction of the centre of rotation of the hip using a cemented stem, the size and offset of which are at the discretion of the surgeon.


METHODS
Femoral implant loosening with bone loss.


METHODS
Infection, neurological disorders, noncompliant patient.


METHODS
Extraction of the loose femoral implant, cortical reconstruction using meshes if required, impaction bone grafting with special instruments, cement fixation of a polished tapered stem.


METHODS
Individualized period of bed rest and limited weight bearing.


RESULTS
Impaction bone grafting and a cemented polished stem were used to perform 33 femoral reconstructions. After a mean follow-up of 15 years, no femoral reconstruction had to be revised. One unrecognized intraoperative fracture healed after nonsurgical treatment, three postoperative femoral fractures healed after plate fixation with the stem left in situ. The average Harris Hip Score improved from 49 prior to surgery to 85 points thereafter. Kaplan-Meier analysis with femoral revision for any reason as the end point showed a survival rate of 100 %.
Department of Orthopaedics, Atrium MC Heerlen, SHE, Faculty of Health, Medicine and Life Sciences, University Maastricht, 6401, Heerlen, The Netherlands, i.heyligers@atriummc.nl.
I C
IC
Heyligers
B W
BW
Schreurs
E H
EH
van Haaren
D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D002484:Cementation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery*; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome