Abstract
Introduction: Impaction allografting is an established method for restoring deficient bone during revision arthroplasty of the hip. Graft augmentation with synthetic materials has been proposed and evaluated experimentally. Our aim was to assess clinically whether migration and wear of implants with a synthetic graft mix would be equivalent to pure allograft.
Materials and Methods: Patient inclusion criteria were: acetabular and or femoral defects from aseptically loosened primary THR undergoing cemented revision with impaction grafting; age 55–80 years; initial diagnosis of osteo arthritis; good health with reasonable daily activity level. Patients were randomized to receive either pure allograft or a 50% mixture with a porous hydroxyapatite material (Apapore60, Apatech, UK). Revision was with the Exeter stem, antibiotic Simplex cement (Stryker Howmedica Ltd), and Ogee cup (Depuy Int. Ltd., Leeds, UK). Tantalum markers were inserted into the pelvis, cup, femur, cement and graft in order to measure migration with radiostereometry (RSA). Patients received a sequence of RSA examinations up to 2 years. A total of 26 patients (18 for the femur) have been analysed.
Results: At 2 years no significant differences were seen in cup wear, or migration of the cup, femoral and pelvic graft markers. Stem migration occurred mainly at the stem cement interface. The rate of distal migration for the femoral head was greater for pure allograft in the first year (p < 0.05), however this rate reduced significantly in year two. Higher medial migration in year one was observed for the proximal medial cement mantle for allograft (p < 0.05).
Conclusions: Improved stability and normal cup wear were observed in a randomized clinical study for a synthetically augmented allograft. This agrees with experimental findings1. Longer follow up with increased patient numbers is recommended to confirm these findings.
Correspondence should be addressed to EORS Secretariat Mag. Gerlinde M. Jahn, c/o Vienna Medical Academy, Alserstrasse 4, 1090 Vienna, Austria. Fax: +43-1-4078274. Email: eors@medacad.org
1 Munro NA, Downing MR, et al., Hydroxyapatite Graft Substitute Reduces Subsidence in a Femoral Impaction Grafting Model. Clinical Orthopaedics & Rel Res. 2007; 455: 246–52. Google Scholar
