Abstract
Introduction: The impaction grafting technique appears to be a very useful method for revising failed THA with extensive cavitary proximal femoral bone loss. However, its use with short, polished stems has been associated with femoral fractures, stem subsidence and instability. This study describes a new surgical impaction grafting technique and reports the results using blasted femoral stems of variable lengths, with variable head-neck offsets and lengths.
Methods – Results: Fifteen revision THA using an impaction grafting technique were performed. Minimum follow-up was five years. Preoperative diagnosis was aseptic loosening of cemented femoral stems in 11 cases, and uncemented stems in four cases. Thirteen of the 15 revision cases with impaction grafting were cemented. Three revision cases were performed using stems less than 150 mm in length, the remainder utilised stems from 165 mm – 315 mm in length. Neck lengths of the revision implants ranged from 40 – 80 mm, including four calcar replacements. Intraoperative fractures occurred in two cases and were successfully treated with cerclage wires. There were two postoperative fractures, both in patients with stems less than 150 mm. Both were successfully treated with plates and onlay allografts. At most recent follow-up, all patients were pain-free. All patients were ambulating unlimited distances. Two patients required canes. All stems were well fixed radiographically with no evidence of progressive radiolucencies or subsidence. The graft appeared to be incorporating. The surgical technique consists of: 1.) removal of previously failed implant and cement; 2.) placement of cerclage wires around femur into which graft will be impacted; 3.) introduction of impacted allograft; 4.) radially impacting with tapered, polished, smooth straight impactors to a distance into femur that permits firm engagement with endosteal cortex for a distance of at least 3 cm; 5.) use of polished, smooth broaches to create final shape of cavity; 6.) trial reduction using polished broaches; and 7.) insertion of implant with or without cement.
Discussion – Conclusions: This report describes a new technique for impaction grafting in revision THA. This study suggests that the use of rough surfaced, long femoral stems with variable head-neck lengths and offsets in conjunction with the impaction grafting technique may reduce the incidence of subsidence, femoral fractures, and dislocations that can occur when this revision technique is used with short, polished stems.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
