Subsidence of the stem after impaction bone grafting for revision hip replacement using irradiated bone

Abstract

Loss of bone stock is a major problem in revision surgery of the hip. Impaction bone grafting of the femur is frequently used when dealing with deficient bone stock. In this retrospective study a consecutive series of 68 patients (69 hips) who had revision of a hip replacement with femoral impaction grafting were reviewed. Irradiated bone allograft was used in all hips. Radiological measurement of subsidence of the stem, incorporation of the graft and remodelling was carried out and showed incorporation of the graft in 26 of 69 hips (38%). However, there was no evidence of trabecular remodelling. Moderate subsidence of 5 mm to 10 mm occurred in ten hips (14.5%), and massive subsidence of > 10 mm in five (7.2%). The results of this study are less favourable than those of others describing studies of revision of the femoral stem using impaction bone grafting. The absence of the characteristic changes of graft remodelling noted in other series raises the question as to whether irradiated bone graft may be a significant factor influencing the post-operative outcome.

Reduced Femoral Component Subsidence with Improved Impaction Grafting at Revision Hip Arthroplasty

“…However, stem subsidence of greater than 5 mm and up to 31 mm [9,15,18,24,25,33,41,42] and postoperative femoral fracture with a prevalence of up to 15% [6,10,12,25,29] have been reported for femoral IBG in rTHA.…”

“…This evolution includes the method of graft preparation, such as the removal of fat by washing, size profiling of the bone particles [7,28,40], the use of nonirradiated bone graft [16,18], and the use of modular tamps.…”

Impaction bone grafting in revision hip surgery: past, present and future

“…However, concerns exist as to the effect that irradiation has upon both the mechanical properties and also long term biological incorporation (Anderson et al 1992;Currey et al 1997;Moreau et al 2000;Hassaballa et al 2009). The typical Gamma irradiation dose used to reduce the bacterial load in bone used impaction grafting is 25 kGy; however, this dose may be ineffective in inactivating HIV (Pruss et al 2002).…”

Erkennung von Hüftschaftsinterungen am Röntgenbild

“…Verwendung finden anatomische Landmarken des Femur in Form des Trochanter major oder minor in Bezug zur Prothesenspitze, zur Prothesenschulter oder dem Rotationszentrum [7][8][9][10][11][12]. Wie uneinheitlich die praktische als auch die wissenschaftliche Verwendung ist, zeigt ein Blick in eine aktuell publizierte Arbeit, in welcher verschiedene femorale Referenzpunkte herangezogen und die gemessenen Distanzen unkritisch verglichen werden [13].…”

“…Die Autoren definieren eine mögliche Sinterung als minimal (< 5 mm), moderat (5-10 mm) und massiv (> 10 mm) ohne auf eine referenzspezifische Ungenauigkeit einzugehen [13,14] …”