Abstract
Introduction Early complications of revision total hip replacement (rTHR) with femoral impaction allografting have included stem subsidence and loosening. In this comparative study, the impact of new techniques, including the use of longer stems, non-irradiated washed allograft, larger bone chips and medial mesh, on early clinical and radiographic outcomes was examined.
Methods The initial series of rTHRs with femoral impaction allografting comprised 20 hips (19 patients, median age 68 years) with a median follow-up of eight years. In the current series where the new techniques were used, there are 11 hips (11 patients, median age 69 years) with a median follow-up of 1.5 years. Three surgeons at one hospital undertook all rTHRs using a polished cemented collarless double tapered stem. Patients were mobilised on day one with partial weight bearing for 12 weeks. The femoral deficiencies commonly comprised extensive cavitatory loss combined with segmental deficiencies. Regular clinical and radiographic assessment was undertaken.
Results In the initial series, there were three early rerevisions for subsidence and stem loosening and one rerevision for infection. Periprosthetic fracture occurred early in three hips. EBRA FCA was used to assess stem subsidence. By two to four years, nine femoral stems had subsided more than five millimetres. At mid-term follow-up of eight years there have been no further rerevisions. In comparison, there has been minimal stem subsidence in the current series, with no stems subsiding more than five millimetres. To-date there have been no periprosthetic fractures and no complications requiring re-revision.
Conclusions Prospective monitoring of rTHR is important to identify factors that may be associated with poor outcome. Current techniques of femoral impaction grafting at rTHR, that includes washing of allograft and the use of long length stems and proximal mesh support yield good early-term radiographic and clinical results.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
