title: Revision hip arthroplasty using impacted cancellous bone and cement: a long-term follow-up study.
abstract: Acetabular bone deficiency is one of the many challenging problems encountered in revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our long-term experience of 68 consecutive cups in 64 patients, using impacted cancellous bone grafting with bone cement. With a mean follow-up of 10.5 year (IQR 7.5-12.9) after revision surgery, three implants had undergone further revision. Three patients had subsequent femoral peri-prosthetic fractures, and none of these three required further acetabular revision. Survival of the acetabular components was 95.5 % for all causes and 100 % for aseptic loosening as the end point, with a further four patients showing radiographic, but asymptomatic loosening. A significant correlation was found between previous revision and re-revision (early failure) (p = 0.01) as well as progression of lytic lesion and re-revision (p = 0.01). The median Harris hip score at final follow-up was 79.5 (IQR 67.9-80.4). The use of impacted morcellised allograft bone with a cemented cup is an effective technique to achieve longevity and restoration of bone stock in acetabular revision arthroplasty. Our series has shown good clinical and radiological outcome with survivorship of the prosthesis exceeding 95 % at 10 years.
authors.affiliation: University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK. drgowtham@gmail.com.
authors.forename: Gowthaman
authors.initials: G
authors.lastname: Arumugam
authors.affiliation: King's Mill Hospital, Sutton-in-Ashfield, UK. shashikumartn@gmail.com.
authors.forename: Shashi Kumar
authors.initials: SK
authors.lastname: Nanjayan
authors.affiliation: Royal Derby Hospital, Derby, UK. conalquah@yahoo.com.
authors.forename: Conal
authors.initials: C
authors.lastname: Quah
authors.affiliation: St Richard's Hospital, Chichester, UK. pjwraighte@yahoo.co.uk.
authors.forename: Philip
authors.initials: P
authors.lastname: Wraighte
authors.affiliation: Royal Derby Hospital, Derby, UK. peter.howard@nhs.net.
authors.forename: Peter
authors.initials: P
authors.lastname: Howard
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000368:Aged; D064591:Allografts / Q000000981:diagnostic imaging; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D020959:Polyethylene / Q000627:therapeutic use; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D014184:Transplantation, Homologous / Q000379:methods
chemical_list: D001843:Bone Cements; D020959:Polyethylene
keywords: Impaction bone grafting; Morcellised allograft; Revision arthroplasty