title: Satisfying outcomes scores and survivorship achieved with impaction grafting for revision THA in young patients.
abstract: BACKGROUND
  The increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.
  
  
  OBJECTIVE
  The purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.
  
  
  METHODS
  During the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.
  
  
  RESULTS
  The mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%-95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%-100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.
  
  
  CONCLUSIONS
  IBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.
  
  
  METHODS
  Level IV, therapeutic study.
authors.affiliation: Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Martijn A J
authors.initials: MA
authors.lastname: Te Stroet
authors.affiliation: Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Wim H C
authors.initials: WH
authors.lastname: Rijnen
authors.affiliation: Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Jean W M
authors.initials: JW
authors.lastname: Gardeniers
authors.affiliation: Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: van Kampen
authors.affiliation: Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands. Wim.Schreurs@radboudumc.nl.
authors.forename: B Willem
authors.initials: BW
authors.lastname: Schreurs
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000367:Age Factors; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements / Q000627:therapeutic use; D016025:Bone Transplantation; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements