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Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function

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Abstract

Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a trochanteric claw plate. Between 1988 and 2001, 44 revisions were performed in 42 patients. After a transtrochanteric approach, the femur was cut longitudinally. A long, cemented Charnley-type prosthesis was used, and flaps of the residual femur were folded around the allograft. The greater trochanter was reinserted with wires in all revisions, and with both wires and a claw plate in 20 revisions. Mean follow-up was 7.15 years (range: 3–16); seven patients, died and four were lost to follow-up. The follow-up exceeded five years in 34 patients. The major complication was nonunion of the greater trochanter, which occurred in 25 cases. Six dislocations, one recurrence of infection, two mechanical loosening, and two fractures below the stem were also recorded. The use of a trochanteric claw plate significantly improved final hip stability, even in patients with nonunion. Femoral reconstruction with a massive structural allograft is reliable and long-lived, and serious complications and long-term resorption are uncommon. The use of a trochanteric claw plate significantly improves final hip stability.

Level of evidence: Therapeutic study, level III (retrospective comparative study).

Résumé

Les pertes osseuses, extensives sont un problème complexe dans les révisions de prothèses totales de hanche. Le but de cette étude est d’évaluer le résultat de la reconstruction en utilisant une longue tige cimentée et des allogreffes massives implantées dans le fémur proximal avec ou sans ostéosynthèse du grand trochanter. Entre 1988 et 2001, 44 révisions ont été réalisées chez 42 patients. Après un abord transtrochantérien, le fémur a été ostéotomisé longitudinalement. Une longue prothèse de reprise de type Charnley a été utilisée et les fragments de fémur hôte ont été réamarrés autour de l’allogreffe. Le grand trochanter a été inséré avec des fils métalliques et dans 20 cas avec une plaque additionnelle. Le suivi moyen a été de 7.15 ans (de 3 à 16), 7 patients sont morts et 4 ont été perdus de vue. Le suivi a été supérieur à 5 ans chez 34 patients. La complication majeure est la pseudarthrose du grand trochanter qui est survenue dans 25 cas. Nous avons également observé 6 luxations, 1 récidive d’infection, 2 descellements mécaniques et 2 fractures sous la queue. L’utilisation d’une plaque trochantérienne améliore de façon significative le problème de la pseudarthrose du grand trochanter. La reconstruction fémorale par des allogreffes massives est une technique fiable. Les complications à long terme avec résection de la greffe ne sont pas habituelles, l’utilisation d’une plaque trochantérienne améliore de façon significative le résultat final et la stabilité de la hanche.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hôpital Cochin, AP-HP, Paris V University, 27 rue du Faubourg St Jacques, 75014, Paris, France

    Laurent Vastel, Camille Thevenin Lemoine, Marcel Kerboull & Jean Pierre Courpied

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  1. Laurent Vastel
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  2. Camille Thevenin Lemoine
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  3. Marcel Kerboull
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  4. Jean Pierre Courpied
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Correspondence to Laurent Vastel.

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Vastel, L., Lemoine, C.T., Kerboull, M. et al. Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function. International Orthopaedics (SICO 31, 851–857 (2007). https://doi.org/10.1007/s00264-006-0275-8

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