title: Predictors of unsuccessful outcome in cemented femoral revisions using bone impaction grafting; Cox regression analysis of 208 cases.
abstract: BACKGROUND
  Despite improvements in the technique of femoral impaction bone grafting, reconstruction failures still can occur. Therefore, the aim of our study was to determine risk factors for the endpoint re-revision for any reason.
  
  
  METHODS
  We used prospectively collected demographic, clinical and surgical data of all 202 patients who underwent 208 femoral revisions using the X-change Femoral Revision System (Stryker-Howmedica), fresh-frozen morcellised allograft and a cemented polished Exeter stem in our department from 1991 to 2007. Univariable and multivariable Cox regression analyses were performed to identify potential factors associated with re-revision.
  
  
  RESULTS
  The mean follow-up was 10.6 (5-21) years. The cumulative re-revision rate was 6.3% (13/208). After univariable selection, sex, age, body mass index (BMI), American Association of Anesthesiologists (ASA) classification, type of removed femoral component, and mesh used for reconstruction were included in multivariable regression analysis.In the multivariable analysis, BMI was the only factor that was significantly associated with the risk of re-revision after bone impaction grafting (BMI ≥30 vs. BMI &lt;30, HR = 6.54 [95% CI 1.89-22.65]; p = 0.003).
  
  
  CONCLUSIONS
  BMI was the only factor associated with the risk of re-revision for any reason. Besides BMI also other factors, such as Endoklinik score and the type of removed femoral component, can provide guidance in the process of preclinical decision making. With the knowledge obtained from this study, preoperative patient selection, informed consent, and treatment protocols can be better adjusted to the individual patient who needs to undergo a femoral revision with impaction bone grafting.
authors.affiliation: Department of Orthopaedics, Radboud University Medical Center, Nijmegen - The Netherlands.
authors.forename: Martijn A J
authors.initials: MA
authors.lastname: Te Stroet
authors.affiliation: Department of Orthopaedics, Radboud University Medical Center, Nijmegen - The Netherlands.
authors.forename: Wim H C
authors.initials: WH
authors.lastname: Rijnen
authors.affiliation: Department of Orthopaedics, Radboud University Medical Center, Nijmegen - The Netherlands.
authors.forename: Jean W M
authors.initials: JW
authors.lastname: Gardeniers
authors.affiliation: Department of Orthopaedics, Radboud University Medical Center, Nijmegen - The Netherlands.
authors.forename: B Willem
authors.initials: BW
authors.lastname: Schreurs
authors.affiliation: Department of Orthopaedics, Radboud University Medical Center, Nijmegen - The Netherlands.
authors.forename: Gerjon
authors.initials: G
authors.lastname: Hannink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001843:Bone Cements; D016025:Bone Transplantation; D005260:Female; D005269:Femur; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D012044:Regression Analysis; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements