Abstract
Background: The use of impacted morselized allograft bone and cement in hip revision arthroplasty has proved to be a useful technique for reconstructing femoral bone stock. Studies that specifically address intraoperative and early postoperative femoral fractures and their relationship with bone deficiency, surgical approach or events, fixation of removed implant as well design of implanted stem have been scarce.
Methods: Two hundred and eighty five consecutive hip revision arthroplasties with impacted morselized allograft bone were studied.
Clinical and radiographic follow-up evaluation was performed and all kind of femoral fractures and incidental perforations during the surgery and within the first year after were analysed.
Results: Sixty four (22,4 %) femurs were affected with an incidental perforation or fracture during the surgery and within the first year after. Intraoperative fracture was present in forty femurs. Twenty three were diaphyseal vertical cracks, eight proximal vertical cracks, four fractures of the greater trochanter and two complete diaphyseal fractures. Incidental femoral perforation was present in twenty five femurs.
Six fractures occurred during the first year. Four patients of the femoral incidental perforation group suffered a complete diaphyseal fracture at the perforation level. No patient with a diaphyseal femoral crack suffered a complete diaphyseal fracture. Two additional complete fractures occurred during the first year without previous intraoperative complication.
Multivariate analysis showed the risk factors for femoral fractures during or after revision to be grater according to preoperative deficiency of the femoral bone stock, or the presence of an intraoperative femoral perforation. Vertical cracks, surgical approach, removal of a cemented or uncemented stem as well as design of the implanted stem showed no difference regarding this complication.
Conclusions: Even though a high rate of femoral complications (22,4 %) was observed we found that vertical cracks regardless their location and trochanteric fractures (12,2%) account for almost all of them but have no clinical relevance. Incidental perforation occurred in 9% of the cases and it was found to be related to complete femoral fractures as well as bone stock deficiency. This serious complication requiring revision occurred in only 2.8% of the cases. Due to this results we encourage the use of this technique.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
