title: Femoral impaction bone grafting in revision hip arthroplasty: 705 cases from the originating centre.
abstract: OBJECTIVE
  Femoral impaction bone grafting was first developed in 1987 using morselised cancellous bone graft impacted into the femoral canal in combination with a cemented, tapered, polished stem. We describe the evolution of this technique and instrumentation since that time.
  
  
  METHODS
  Between 1987 and 2005, 705 revision total hip arthroplasties (56 bilateral) were performed with femoral impaction grafting using a cemented femoral stem. All surviving patients were prospectively followed for a mean of 14.7 years (9.8 to 28.3) with no loss to follow-up. By the time of the final review, 404 patients had died.
  
  
  RESULTS
  There were 76 further revisions (10.8%) involving the stem; seven for aseptic loosening, 23 for periprosthetic fracture, 24 for infection, one for malposition, one for fracture of the stem and 19 cement-in-cement exchanges of the stem during acetabular revision. The 20-year survival rate for the entire series was 98.8% (95% confidence interval (CI) 97.8 to 99.8) with aseptic loosening as the endpoint, and 87.7% (95% CI 82.8 to 92.6) for revision for any reason. Survival improved with the evolution of the technique, although this was not statistically significant due to the overall low rate of further revision.
  
  
  CONCLUSIONS
  This is the largest series of revision total hip arthroplasties with femoral impaction grafting, and the results support the continued use of this technique. Cite this article: Bone Joint J 2016;98-B:1611-19.
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wilson
authors.affiliation: St Richard's Hospital, Chichester, PO19 6SE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hook
authors.affiliation: Queensland University of Technology , Brisbane, Queensland, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Whitehouse
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Timperley
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Gie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D016025:Bone Transplantation / Q000379:methods*; D002484:Cementation; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D055815:Young Adult
chemical_list: D001843:Bone Cements
keywords: Bone grafting; Exeter stem; Femoral revision; Impaction grafting; Revision hip surgery