TITLE

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

AUTHOR(S)
Sierra, Rafael J.; Charity, John; Tsiridis, Eleftherios; Timperley, John A.; Gie, Graham A.
PUB. DATE
June 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Jun2008, Vol. 90-A Issue 6, p1330
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
32630640

 

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