Femoral impaction grafting with cement in revision total hip replacement

Abstract

e report the results of cancellous femoral impaction grafting with cement in revision hip arthroplasty in all patients from one centre who had undergone surgery more than five years previously. A total of 32 surgeons undertook femoral impaction grafting in 207 patients (226 hips). There were no deaths attributable to the revision surgery; 33 patients with 35 functioning hips died with less than five years' follow-up. One patient was lost to follow-up. Two hips (1%) developed early postoperative infection. Of the 12 stems which underwent a further surgical procedure for aseptic failure, ten were for femoral fracture and two for loosening.Survivorship with any further femoral operation as the endpoint was 90.5% (confidence intervals, 82 to 98) and using femoral reoperation for symptomatic aseptic loosening as the endpoint, the survivorship was 99.1% (confidence intervals, 96 to 100) at 10 to 11 years. As a consequence of the experience in this series, we have modified our technique with an increased use of longer stems with impacted allograft. Long stems are indicated when the host bone around the tip of a short stem is compromised, in patients with major loss of bone stock, or when a femoral fracture occurs.

What is the Long-term Survival of Impaction Allografting of the Femur?

“…The treatment has been described using extensively coated femoral stems [3,13,26], modular stems with distal tapers [10,12,14,15,17,19,22], and impaction bone grafting with cemented polished stems [4,7,16,21,23,25,27]. Femoral impaction grafting, first reported by Gie et al in 1993 [5], has the advantage of adding bone to the deficient femur, but it is a time-consuming procedure with reported risks of fracture ranging from 5% to 12% [1,5,7,9].…”

“…Several authors have reported high survival (77%-100%) at 5 to 19 years for femoral bone impaction grafting [4,7,16,21,23,25,27]. Halliday et al [7], reporting findings of the developers of the technique, found a survivorship of 90.5% at 11 years for femoral reoperation and 99.1% at 11 years for femoral revision for aseptic loosening as the end point. In a retrospective study of 79 patients (81 hips) followed 5 to 17 years, Garcia-Cimbrelo et al [4] found a survival rate for reoperation for any cause of 98.6%.…”

Proximal Femoral Reconstructions with Bone Impaction Grafting and Metal Mesh

“…We have been using metal meshes to reconstruct femoral deficiencies since 1990. Because of favorable outcomes in the literature [15,20,25,39] as well as in our patients [4] and laboratory tests [18], we extended the indication of these devices to reconstruct complete circumferential proximal cortical bone loss. However, this circumferential bone loss has been considered a contraindication for the impaction bone grafting technique in the femur by one group [39].…”

Factors Influencing the Stability of Stems Fixed with Impaction Graft in Vitro

“…Recently, high survivorship has been reported in three studies. Halliday et al [12] reported a survivorship rate of 99.1% at 10 to 11 years and Schreurs et al [19] reported a survivorship rate of 100% at 8 to 13 years using the Exeter TM stem (Stryker Howmedica, Newbury, UK). Mahoney et al [16] reported a survivorship rate of 97% at 4.7 years.…”