Femoral impaction bone grafting in revision hip arthroplasty

Wilson, Matthew; Hook, Samantha; Whitehouse, Sarah L.; Timperley, A. John; Gie, Graham A.

doi:10.1302/0301-620x.98b12.37414

Cited by 48 publications

(24 citation statements)

References 38 publications

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“…It is also suggested that aseptic loosening of cemented stems results from debonding of the cement from the femoral canal (Sundfeldt et al 2006 ), and the risk of its occurrence could increase with increasing magnitude of bone defects, but this phenomenon was not observed in our study. The technique of bone impaction grafting was introduced to restore bone stock and to facilitate cementation in a femoral canal devoid of trabecular bone, and modern bone impaction techniques yield promising results (Ornstein et al 2009 , Howie et al 2010 , Wilson et al 2016 , Stigbrand and Ullmark 2017 ). In our study bone impaction grafting in combination with cementation did not reduce the risk of re-revision compared with cementation alone, even though the use of bone impaction grafting was performed equally often in patients with large bone defects as was cementation alone.…”

Section: Discussionmentioning

confidence: 99%

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

et al. 2020

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Background and purpose — Uncemented stems are gradually replacing cemented stems in hip revision surgery. We compared the risk of re-revision between uncemented and cemented revision stems and assessed whether the different fixation methods are used in similar femoral bone defects. Patients and methods — 867 patients operated on with uncemented or cemented stems in first-time hip revision surgery due to aseptic loosening performed 2006–2016 were identified in the Swedish Hip Arthroplasty Register. Preoperative femoral bone defect size was assessed on radiographs of all patients. Cox regression models were fitted to estimate the adjusted risk of re-revision during different postoperative time periods. Re-revision of any component for any reason, and stem re-revision, as well as risk of cause-specific re-revision was estimated. Results — Most patients in both fixation groups had Paprosky class IIIA femoral bone defects prior to surgery, but there were more severe bone defects in the cemented group. The adjusted risk of re-revision of any component for any reason was higher in patients with uncemented compared with those with cemented revision stems during the first 3 years after index surgery (hazard ratio [HR] 4, 95% confidence interval [CI] 2–9). From the 4th year onward, the risk of re-revision of any component for any reason was similar (HR 0.5, CI 0.2–1.4). Uncemented revision stems conferred a higher risk of dislocation compared with cemented stems (HR 5, CI 1.2–23) during the first 3 years. Interpretation — Although not predominantly used in more complex femoral defects, uncemented revision stem fixation confers a slightly higher risk of re-revision during the first years, but this risk is attenuated after longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

et al. 2020

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“…The Exeter technique has been applied by the hip group of our institution over the last decades. Although not the aim of this study, this technique was well-described by Wilson et al, 14 who evaluated 705 cases with a high success rate (98.8%).…”

Section: Discussionmentioning

confidence: 94%

“…A técnica Exeter vem sendo aplicada no grupo do quadril da nossa instituição nas últimas décadas. Embora não seja o objetivo deste estudo, esta técnica foi bem descrita por Wilson et al, 14 que avaliaram 705 casos com alta taxa de efetividade (98,8%).…”

Section: Discussionunclassified

Estudo comparativo da osteointegração de enxertos ósseos irradiados e não irradiados utilizados em pacientes com revisão de artroplastia do quadril

et al. 2019

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Resumo Objetivo Avaliar e comparar a osteointegração dos enxertos ósseos congelados irradiados e não irradiados utilizados em 21 pacientes submetidos a revisão de prótese do quadril pela técnica Exeter. Métodos Foi realizado estudo retrospectivo de 21 pacientes submetidos a revisão de artroplastia do quadril pela técnica Exeter com utilização de tecidos ósseos tratados ou não com radiação gama no período entre 2013 e 2014. Dividimos os pacientes em dois grupos, de acordo com o uso do enxerto tratado ou não com radiação ionizante (raios gama), que foram, portanto, classificados como: grupo irradiado e não irradiado. Os resultados da osteointegração por análise radiográfica destes enxertos foram comparados no pós-cirúrgico de 6 e 12 meses. Resultados Quando comparamos a osteointegração dos enxertos no pós-cirúrgico de 6 e 12 meses de todos os pacientes, notamos que houve diferença significativa entre as avaliações radiográficas neste período (p = 0,031). Dos pacientes estudados, 7 pertenciam ao grupo irradiado, e 14, ao grupo não irradiado. Não foram observadas diferenças estatisticamente significativas (p = 0,804) quando a osteointegração entre os grupos irradiados e não irradiados foi comparada. Conclusão Não houve diferença significativa no uso de enxerto irradiado e não irradiado nas revisões de artroplastias do quadril pela técnica Exeter.

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“…In the early 1990s, the use of impaction bone graft with a cemented mantle had gained popularity and had proven to be clinically effective and histologically valid [1]. Some clinicians hold the view that conventional cemented impaction bone graft is not ideal for the preservation of bone stock [2], and after 2000, some authors began to report the use of cementless impaction bone grafting using a long stem, with the aim of preserving bone stock [3]. Several authors compared conventional cemented impaction bone grafting using polished Landos Fjord-CrCo stems, and cementless impaction bone grafting using Corail® (DePuy Synthes) stems, and reported that the functional scores were similar [4].…”

Section: Introductionmentioning

confidence: 99%

A Case of Cementless Impaction Bone Graft in a Revision Total Hip Arthroplasty Requiring Calcar Reconstruction

Ishiguro¹,

Asanuma

Tamaki

et al. 2021

Case Reports in Orthopedics

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Introduction. In cases of bone deficiency or osteoporosis, and especially in revision cases, there were only two options for treatment until the impaction bone graft procedure was proposed. These were cemented or cementless femoral prosthesis. In the early 1990s, the use of impaction bone graft with a cemented mantle had gained popularity and had proven to be clinically effective. In Germany, a cementless impaction bone graft procedure using Corail® (DePuy Synthes) stems was devised, and functional scores were similar to conventional cemented Impaction bone grafts. Case presentation. A 48-year-old man presented with femur loosening of a reamed bipolar arthroplasty performed in 1990. The patient was treated with a cementless impaction bone graft using a Corail® (DePuy Synthes) stem in the femur in revision THA surgery, and the calcar was reconstructed by allograft. Results. At five years, the calcar allograft united with the host bone, and the femoral component showed no subsidence. Conclusion. Calcar reconstruction with a strut allograft, aimed at preventing sinking of the stem was key in this operation. Surgical indication for femoral cementless impaction bone graft should be for loosened femoral prosthesis in a type II Paprosky classification, where only the cortical bone of the isthmus is partially affected, cortical thinning does not exist, and it is mechanically strong enough for the allograft tip impaction. The procedure was safely feasible through the direct anterior approach.

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Femoral impaction bone grafting in revision hip arthroplasty

Abstract: 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.

Cited by 48 publications

References 38 publications

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

Uncemented or cemented stems in first-time revision total hip replacement? An observational study of 867 patients including assessment of femoral bone defect size

Estudo comparativo da osteointegração de enxertos ósseos irradiados e não irradiados utilizados em pacientes com revisão de artroplastia do quadril

A Case of Cementless Impaction Bone Graft in a Revision Total Hip Arthroplasty Requiring Calcar Reconstruction

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