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|Title:||Reduced femoral component subsidence with improved impaction grafting at revision hip arthroplasty|
Mc Gee, M.
|Citation:||Clinical Orthopaedics and Related Research, 2010; 468(12): pp.3314-3321|
|Publisher Place:||233 Spring Street, New York, NY 10013 USA|
|Conference Name:||Closed Meeting of the International Hip Society (2009 : Minneapolis, MN, USA)|
|Abstract:||BACKGROUND: Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem. QUESTIONS/PURPOSES: We used a sensitive technique to measure subsidence of a cemented polished collarless double-taper stem at each interface after femoral impaction grafting and compared subsidence, radiographic loosening, complications, and reoperations over three series of hips defined by technique developments. PATIENTS AND METHODS: Three series were defined: Series 1 (n = 23, irradiated allograft), Series 2 (n = 12, double-washed, size-profiled graft, nonirradiated bone, long stems as required), and Series 3 (n = 21, modular tamps). Stem subsidence was analyzed with Ein Bild Röntgen Analyse software. Radiographic loosening, complications, and reoperations were also determined. RESULTS: The median subsidence at 12 months for Series 1, 2, and 3 were 2.1, 0.5, and 0.7 mm at the prosthesis-cement interface and 1.3, 0.1, and 0.1 mm at the cement-bone interface. There were two postoperative Vancouver B periprosthetic fractures in Series 1, four hips were revised for loosening in Series 1, and there were no fractures or loosening in Series 2 and 3 at minimum 2 years' followup. There were no surviving hips radiographically classified as possibly or probably loose. CONCLUSIONS: Evolution in techniques of femoral impaction grafting in this study were associated with reduced subsidence of the stem at both the prosthesis-cement interface and cement-bone interface when compared to the original series. Concurrent with reduced stem subsidence was the absence of periprosthetic fracture, radiographic loosening, and complications requiring rerevision.|
|Keywords:||Femur; Hip Joint; Humans; Joint Instability; Bone Cements; Treatment Outcome; Arthroplasty, Replacement, Hip; Bone Transplantation; Reoperation; Transplantation, Homologous; Prospective Studies; Prosthesis Design; Hip Prosthesis; Time Factors; Adult; Aged; Aged, 80 and over; Middle Aged; South Australia; Female; Male; Fractures, Bone|
|Rights:||© The Association of Bone and Joint Surgeons® 2010|
|Appears in Collections:||Orthopaedics and Trauma publications|
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