Revision of massive femoral defects in revision hip arthroplasty is extremely difficult. This study assesses defects where bone loss extends to the isthmus of the femur. By using a medial allogeneic femoral graft in a wedge fashion, rotational and axial stability of the femoral implant is augmented, allowing bone ingrowth to occur. The technique is described which is simple, inexpensive and readily available in most institutions. A medial allogeneic femoral strut graft is assessed in hip arthroplasty revision to improve implant stability and thereby promote bony ingrowth into the implant. Thirty-three revision arthroplasties were preformed in twenty-nine patients (avg. age 63.7 yrs) using a fully-porous coated implant of eight or ten inch length. All patients had a Paprosky Type III or IV femoral defect. The implants, by definition were press-fit at or past the isthmus. To aid ingrowth and to decrease axial and rotational stresses, a medial femoral strut graft was wedged into the remaining medial host bone and under the collar of the implant. Cabling was utilized to prevent dislodgement of the graft from the implant and host. A radiographic and clinical comparison to a series of similar defects without grafting was performed for a minimum of thirty-five month follow-up. Twenty-eight of the thirty-three implants had radiographic evidence of ingrowth with migration of only two millimeters (average). Medial femoral strut grafting displayed much better potential for ingrowth and decreased potential for migration. Harris hip scores averaged eighty-one from a preoperative score of thirty-two. Cost of the grafts averaged $2100 cheaper compared to a bulk structural graft which would otherwise have been used in this situation. Medial femoral strut grafts augment initial implant stability to allow for implant in- growth. The advantages of the medial strut grafts are decreased cost, improved stability, and improved implant in- growth potential.
Staged revision arthroplasty for the periprosthetic hip infection is the accepted mode of treatment. Unfortunately, the first stage revision compromises the patient’s function secondary to inability to weight-bear. Pros-theses coated with antibiotic-loaded cement have been adapted to improve function but have failed in larger femoral defects. This implant and technique described improves patient mobility and decreases morbidity as compared to conventional techniques. The purpose of this study was to find an implant to accommodate most femoral defects and to be readily available for managing periprosthetic hip infections A prospective study was performed comparing the PROSTALAC(DePuy, IN) implant (Group I) to a Solution(DePuy, IN) implant (Group II) covered in antibiotics for management of the first stage. All patients had a confirmed pyogenic gram positive or gram negative infection. Fifty-two patients were compared with each group being matched by their femoral defect type (Paprosky: Type I and II: 24, Type III:20, Type IV: 8). Follow-up was for a minimum of thirty-six months. All patients were encouraged to weight bear as tolerated. One recurrence of infection occurred after a second stage revision in Group I. Cost of the implant averaged $700 cheaper in Group II. More significant was the fact that the average length of hospital stay was decreased in Group II by seven days and forty-seven days for the Type III and Type IV femurs respectively. All patients in Group I received a second stage revision. Five of the Group II patients refused a second stage revision secondary to their satisfactory function and had better post-op function. An alternative treatment for staged periprosthetic hip infections is proposed which can decrease hospital stay, improve function, and allow routine implant use for its implementation.
