High Incidence of Irradiated Cortical Strut Allograft Resorption Following Revision of Femoral Stems

Abstract

Background: Despite the widespread use of revision total hip arthroplasties using cementless stems and cortical strut allografts, graft resorption has not been explicitly studied. Methods: Between 2010 and 2018, 40 femoral strut grafts were used in the revision of femoral stems of 36 patients (18 males and 18 females; average age, 51.9 ± 12.9 years). The mean follow-up was 78.9 ± 37.3 months. Failure was defined as revision surgery for any reason and subsidence of greater than 5 mm. Results: The survival rate of the stem without the need for revision at 5 years was 95% (mean graft survival time, 10.8 [95% CI, 9.414-12.234] years). Overall survival with graft resorption as the endpoint was 90% at 5 years (mean graft survival time, 8.8 [95% CI, 7.5-10.2] years). Survival with graft nonunion as the endpoint was 90% at 3 years (mean survival time, 11.7 [95% CI, 10.5-12.8] years). Conclusion:The resorption rate increases proportionally to the follow-up duration and can be very severe in a high percentage of cases. Long-term multicenter studies are required to assess the effect of resorption on prosthesis longevity.

Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study

“…The previous research has reported the complete resorption of the allografts, and the resorption rate increases proportionally to the follow-up duration in the revision of femoral stems. However, the toughest bone would probably take longer to resorb and provide maximum stability [ 33 ].…”

Differences in the Microarchitectural and Histomorphologic Characteristics Between Glucocorticoid-induced Osteonecrosis of Femoral Head and Alcohol-induced Osteonecrosis of Femoral Head

“…Using histological analysis, Kim et al found that patients with idiopathic ONFH or AIONFH have normal or nearly normal cancellous bone in the acetabulum and proximal femur, whereas GIONFH might be associated with more extensive osteonecrosis 21 . Patients with ONFH secondary to sickle-cell disease or steroid use have been found to have poor results of total hip arthroplasty when compared with agematched controls [22][23][24][25][26] . This heterogeneity may be related to the different biological effects on the bone tissue induced by different risk factors.…”

Response to Letter to the Editor on “High Incidence of Irradiated Cortical Strut Allograft Resorption Following Revision of Femoral Stems”

“…Thank you for giving us the chance to reply to the letter to the editor regarding our article "High incidence of irradiated cortical strut allograft resorption following revision of femoral stems" published in JoA lately [1]. We would like to thank the readers for their important comments on the article.…”