The Use of Long Cemented Stems for Femoral Impaction Grafting in Revision Total Hip Arthroplasty

Sierra, Rafael J.; Charity, John; Tsiridis, Eleftherios; Timperley, John A.; Gie, Graham A.
June 2008
Journal of Bone & Joint Surgery, American Volume;Jun2008, Vol. 90-A Issue 6, p1330
Academic Journal
Background: Following revision total hip arthroplasty involving femoral impaction grafting, fractures usually have occurred distal to a standard-length stem in an area of weakened bone that was left inadequately supported. The purpose of the present study was to determine whether the use of a long stem decreases the rate of femoral fracture after revision hip surgery. We hypothesized that the use of a long-stem femoral component would decrease the risk of these fractures. Methods: From 1991 to 2000, 567 revision total hip arthroplasties were performed with use of femoral impaction grafting. Of these, forty-two procedures in forty patients (average age, 73.8 years) were performed with use of a stem that was ≥220 mm in length. The average number of previous revisions was 1.85. Thirty-four of the forty hips with preoperative radiographs had preoperative bone loss that was classified as grade Ill or IV according to the Endo-Klinik system. Major complications were recorded, and survival analysis was performed. Results: No patient was lost to follow-up. Sixteen patients (sixteen hips) died at an average of fifty-two months post-operatively. The average duration of clinical follow-up for the hips in which the implant survived for more than forty-eight months was 7.5 years. The rate of major postoperative complications was 29%. Two postoperative femoral fractures occurred. Six patients (six hips) required a femoral reoperation. The survival rate with revision hip surgery as the end point was 90% at both five and ten years. The rate of survival with any failure as the end point was 82% at five years and 64% at ten years. Conclusions: The use of a long stem for femoral impaction grafting did not completely resolve the problem of post-operative fractures in these patients with substantial loss of bone stock undergoing revision hip surgery. Poor bone stock, technical errors, and other patient-related factors continue to account for the high postoperative fracture rate. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Was tun, wenn die Hüftendoprothese versagt? Gravius, S.; Randau, T.; Wirtz, D.C. // Der Orthopäde;Dec2011, Vol. 40 Issue 12, p1084 

    Revision surgery after total hip arthroplasty is increasing steadily in numbers. These procedures demand high performance from both the treating surgeon as well as the implants used. Novel developments from basic research and industrial partners extend the possibilities for treating affected...

  • REVISION OF THE ACETABULAR COMPONENT WITHOUT CEMENT AFTER TOTAL HIP ARTHROPLASTY. Della Valle, Craig J.; Shuaipaj, Tasin; Berger, Richard A.; Rosenberg, Aaron G.; Shott, Susan; Jacobs, Joshua J.; Galante, Jorge O. // Journal of Bone & Joint Surgery, American Volume;Aug2005, Vol. 87-A Issue 8, p1795 

    Abstract: We previously reported our results at a minimum of three and seven years after use of a porous-coated acetabular metal shell in a consecutive series of 138 revision total hip arthroplasties. The current report presents the longer-term outcomes of these procedures, at fifteen to...

  • PREOPERATIVE PLANNING FOR REVISION TOTAL HIP ARTHROPLASTY. Barrack, Robert L.; Burnet, R. Stephen J. // Journal of Bone & Joint Surgery, American Volume;Dec2005, Vol. 87-A Issue 12, p2800 

    This article informs that perioperative complications and unexpected surgical findings are much more common in revision total hip arthroplasty than they are in primary total hip arthroplasty. There are often problems during surgery that require special instruments, implants, bone grafts, or...

  • Strategies for head and inlay exchange in revision hip arthroplasty. Pospischill, Martin; Knahr, Karl // International Orthopaedics;Feb2011, Vol. 35 Issue 2, p261 

    Due to the increasing number of total hip arthroplasties performed during the last three decades and the limited long-term survival, mainly because of wear, the number of revisions has increased during the last two years. If the implant itself is still considered to be stable, only head and...

  • Cementless Acetabular Revision with the Harris-Galante Porous Prosthesis. Hallstrom, Brian R.; Golladay, Gregory J.; Vittetoe, David A.; Harris, William H. // Journal of Bone & Joint Surgery, American Volume;May2004, Vol. 86-A Issue 5, p1007 

    Revisions of the acetabular component of a total hip arthroplasty have a higher rate of complications, particularly loosening and dislocation, than do primary procedures. The purpose of this study, in which the results of a consecutive series of revisions performed with the Harris-Galante Porous...

  • Medium term results of revision total hip replacement using radial impaction grafting and a collared textured stem. KAKWANI, RAJESH G.; SAQUIB, MOHAMMED; KASHYAP, SHANKAR // Hip International;Jul-Sep2009, Vol. 19 Issue 3, p227 

    Massive bone loss is a problem frequently encountered during revision hip surgery. Several ways of addressing the bone loss in proximal femur have been described with varying results. we present our results with the use of a radial impaction grafting technique and a collared textured component....

  • Radiographic assessment of biomechanical parameters following hip resurfacing and cemented total hip arthroplasty. ROBB, CURTIS; HARRISS, RICHARD; O'DWYER, KEVIN; ASLAM, NADIM // Hip International;Jul-Sep2009, Vol. 19 Issue 3, p251 

    Resurfacing hip arthroplasty and total hip replacement both aim to restore anatomical parameters. Leg length and offset discrepancy can result in altered joint reaction forces, and are associated with increased wear, dislocation, and decreased patient satisfaction. This study assesses the...

  • Late instability of bilateral metal on metal hip resurfacings due to progressive local tissue effects. KILLAMPALLI, VIJAY V.; READING, ALEXANDER D. // Hip International;Jul-Sep2009, Vol. 19 Issue 3, p287 

    Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeplyinclined acetabular...

  • Waiting for hip revision surgery: the impact on patient disability. Davis, Aileen M.; Agnidis, Zoe; Badley, Elizabeth; Davey, J. Roderick; Gafni, Amiram; Gollish, Jeffrey; Mahomed, Nizar N.; Saleh, Khaled J.; Schemitsch, Emil H.; Szalai, John Paul; Waddell, James P.; Gross, Allan E. // Canadian Journal of Surgery;Apr2008, Vol. 51 Issue 2, p92 

    Objective: Increased wait times for total joint arthroplasty (TJA) are a concern nationally and provincially. Additionally, the number of patients requiring revision of their initial TJA is increasing. The purpose of this study was to evaluate the wait times and impact of waiting for revision...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics