Cementless revision of total hip arthroplasty using the anatomic porous replacement revision prosthesis

Buoncristiani, Anthony M.; Dorr, Lawrence D.; Johnson, Curtis A.; Wan, Zhinian

doi:10.1016/s0883-5403(97)90196-0

Cited by 32 publications

(18 citation statements)

References 41 publications

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“…Severe acetabular and femoral bone loss (Paprosky Types IIIB and IV) [28] can be seen in patients who have had multiple revision arthroplasties and in patients who have severe osteolysis. Large bulk allografts (such as proximal femoral allografts) or proximal femoral or total femoral replacement prostheses such as those used in tumor cases have been proposed as suitable reconstructive techniques for more severe femoral bone deficiencies [6,9,28,29,32,33]. As an alternative, the use of structural cortical strut onlay allografts, in combination with cementless revision femoral stems, is a technique used for reconstruction of large femoral bone defects [3,18,[23][24][25].…”

Section: Introductionmentioning

confidence: 99%

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Kim

Park

Kim

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Numerous studies have investigated the clinical and radiographic results of revision THAs with use of cementless stems and cortical strut allografts. However, to our knowledge, no long-term followup studies have evaluated patients undergoing revision THA with use of cortical strut allografts where the allografts provided the primary stability for extensively coated femoral stems in the presence of extensive femoral diaphyseal bone defects. Question/purposes We performed this study to determine (1) validated outcomes scores; (2) radiographic signs of fixation and allograft healing; (3) frequency of complications; and (4) survivorship of the components after use of cortical strut onlay allografts in Types IIIB and IV femoral diaphyseal bone defects.Methods Between 1994 and 2003, we performed 140 revision THAs in 130 patients with Paprosky Types IIIB and IV femoral diaphyseal defects. The patients were treated using extensively coated femoral stems and cortical strut allografts because primary axial or rotational stability could not be achieved without grafting. Ten of the patients (10 hips; 7.7%) were lost to followup or died before 10 years; the remaining 120 patients (130 hips) represent the study group in this retrospective study. There were 66 men and 54 women. Their mean age at the time of index surgery was 59 ± 18 years (range, 36-67 years). The primary diagnosis was predominantly osteonecrosis of the femoral head (53%). The most common reason for revision was aseptic loosening (97%), followed by periprosthetic fracture (3%). The mean time from primary to revision THA was 12 years (range, 8-27 years). The mean duration of followup was 16.1 years (range, 12-20 years). Results The mean Harris hip score was 39 ± 10 points before revision and improved to 86 ± 14 points at 16 years followup (p = 0.02). The mean preoperative WOMAC score was 62 ± 29 (41-91) points and improved to 22 ± 19 (11-51) points at 16 years followup (p = 0.003). Of the 130 stems, 113 (87%) had bone ingrowth, five (4%) had stable fibrous ingrowth, and 12 (9%) were unstable. All allografts were incorporated. Four hips (3%) had a displaced femoral shaft fracture at the stem tip; four (3%) had a postoperative dislocation; and six (5%) had early postoperative infection. Kaplan-Meier survivorship analysis, with revision or radiographic failure as the endpoint, revealed that the 16-year rate of survival of the components was 91% (95% CI, 0.88%-0.96%).

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Section: Introductionmentioning

confidence: 99%

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Kim

Park

Kim

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…A transfer of results to clinical situations should be possible, as in our perception the simulated femoral bearing conditions correspond to revision situations orthopaedic surgeons are commonly confronted with [1,23]. As stabilization of transfemoral osteotomies [4,7] and uncontained femoral defects [1,2,10] with strut grafts are recommended in such cases, the management of these revision situations is also consistent with current orthopaedic practice.…”

Section: Discussionmentioning

confidence: 76%

“…In current literature [7,8,10], no distinct differences of graft union to host bone have been observed in relation to primary mechanical support of the implant by the allograft. Nevertheless, physiological stress [4,8,10] appears to enhance allograft remodeling and incorporation, and proximal resorption of the graft has been interpreted as stress shielding [4]. Thus transferring load to strut grafts, which are provided for primary support, might ensure the remodeling and incorporation of these grafts.…”

Section: Discussionmentioning

confidence: 99%

“…In order to manage these defects, strut allografts are frequently used [2][3][4][5][6][7][8][9][10]. They are individually sized beams of non-vital bone attached to the deficient femur via tension or cable wires.…”

Section: Introductionmentioning

confidence: 99%

“…They are individually sized beams of non-vital bone attached to the deficient femur via tension or cable wires. Incorporation and remodeling of these allografts to the host bone has been shown to be successful in 80-100 % of cases in numerous studies [2][3][4][5][6][7][8][9][10][11]. Some authors solely use strut grafts to rebuild the proximal femur [7,8,10], whereas other orthopaedic surgeons also rely on these grafts for a support of the stem to achieve better stability [3,6,9].…”

Section: Introductionmentioning

confidence: 99%

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Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Kinkel

Thomsen

Nadorf

et al. 2014

International Orthopaedics (SICOT)

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Purpose In total hip arthroplasty fixation of revision stems can be demanding due to femoral bone loss. Strut grafts are often used for bone augmentation and stabilization of the newly inserted prosthesis. The aim of this study was to assess the effect of strut grafts on primary stability under various stem fixation conditions. Methods Two different revision stems (cylindrical and conical shape) were implanted into synthetic femora. Following a semicircular transfemoral osteotomy, three deficient femoral bearings were simulated (bony lid reattached with cable wires; weakened lid reattached with cable wires; strut grafts placed to the weakened lid with cable wires). Relative micromovements were measured between prostheses and bones due to an axial moment applied to the stems. Results Relative movements correlated to the stem shape. The cylindrical stem showed higher movements increasing significantly with a weakened bony lid and portrayed a slight decrease of movements with strut graft application. No unequivocal influence of the weakened lid could be detected for the conical implant. Strut graft application did not show an additional stabilizing effect. Conclusions The primary stability of the cylindrical fixation concept decreases with impaired fixation conditions of the femur. A clear restabilizing effect with strut grafts could not be proven. A decrease of primary stability due to the impaired bone could not be observed for the conical stem shape. Additionally, strut grafts do not enhance fixation for this stem shape. We conclude that surgeons should not rely on a stabilizing effect of strut grafts in revision hip surgery.

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Cemented versus cementless surgical approach for total hip arthroplasty revision

Meek

Allan

2005

Cochrane Database of Systematic Reviews

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Cementless revision of total hip arthroplasty using the anatomic porous replacement revision prosthesis

Cited by 32 publications

References 41 publications

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Strut grafts in revision hip arthroplasty faced with femoral bone defects: an experimental analysis

Cemented versus cementless surgical approach for total hip arthroplasty revision

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