Impaction bone grafting in revision hip surgery : A high incidence of complications

• Published in: Journal of bone and joint surgery. British volume Vol. 82; no. 1; pp. 103 - 107
• Main Authors: PEKKARINEN, J, ALHO, A, LEPISTÖ, J, YLIKOSKI, M, YLINEN, P, PAAVILAINEN, T
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 2000; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Biological and medical sciences; Bone Transplantation - methods; Female; Follow-Up Studies; Humans; Incidence; Male; Medical sciences; Orthopedic surgery; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Radiography; Reoperation; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Human; Reoperation; Prosthesis; Epidemiology; Hip; Incidence; Orthopedic surgery; Treatment; Total; Complication; Graft; Spongious bone; Technique; Public health
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.82B1.9802

We have reviewed retrospectively 68 revisions of the femoral component in arthroplasties of the hip in 65 patients, using impaction bone grafting, at a median of three years (1 month to 6 years). We employed the cemented Exeter X-Change technique in 36 patients and the uncemented Bi-Metric allografting method in 32. The 37 bone defects were grade 3 or grade 4 on the Endo-Klinik classification. The Mayo hip score improved from a mean of 32 (SD +/- 18) to 62 (SD +/- 15). Most (25) of the 34 complications occurred in grade-3 and grade-4 defects; nine were intraoperative diaphyseal fractures and eight fractures of the greater trochanter. All the fractures united. The risk of intraoperative fracture was prevented by supporting the bone with wires in 16 hips, with reinforcement mesh in 18 and by a plate in six. Early migration of the stem of more than 10 mm during the first year indicated rotational instability; it occurred in three cases. In difficult revision cases with large defects of the femoral bone, bone-impaction techniques carry a high risk of complications.